Thirteen dental patients to avoid

When I was starting out in practice I was desperate to be successful. I took on any and every patient who came along.

But, after I’d gained a few years of experience I started to realise that some patients cost me a lot of anguish and stomach lining.

Here’s my personal list of thirteen dental patients who I try to avoid.

1. Patients who say: “Patch it for now and I'll get it fixed properly later.”

With such patients, “later” never comes.

Whenever I take them on I find myself doing endless rounds of patchwork treatment. And, when that treatment fails, they don't remember that I was doing it to help them out. They expect me to fix it for free because it was “only done 12 months ago”.

It's demotivating to wrack my brains figuring out how to glue something together when I know it's just a short term compromise like painting over rust on a car and that my work might break the first time they bite on it.

In my entire career I've never found a “patch it” patient who became a good regular member of the practice. “Patch it” patients use me when they need me and fail appointments when it suits them.

2. Patients who blame previous dentists for the disastrous state of their teeth.

Some patients come in looking like they swallowed a hand grenade — multiple missing teeth, rampant decay, abrasion, attrition, erosion and advanced periodontal disease.

The ones who worry me are those who tell me that it's not their fault and that all the problems were caused by “incompetent” dentists.

The first thing that worries me about such patients is that they only have a tenuous grip on reality. The fact that their mouth is in such a state yet they think it's not their fault shows that they do not have a clue how things work.

The second thing is that I will very likely become the next on their list of “incompetent” dentists even if I’m blameless.

The third thing is that they never accept my advice. Even if I work out a beautiful plan to fix their mouth, they continue with the same poor decisions and behaviours that got their teeth into that state in the first place.

3. Patients who hold the mirror very close to their mouth when pointing out aesthetic problems.

Patients who are aware of tiny aesthetic problems are virtually impossible to satisfy. The closer they hold the mirror, the more they should be avoided.

I once had a lady who was convinced that the lengths of her two front teeth was unequal but I couldn’t see it. I even got a ruler out and held it across the edges of her front teeth — it was perfectly straight as far as I could tell, and the nurse too. The woman didn't agree.

Taking on such a patient is a recipe for disaster. Suddenly I’m on my third remake and totally losing the plot.

I only take on people with big, obvious cosmetic problems that I can easily see from conversational distance. Anything that I cannot see at a glance is way too much trouble.

4. Patients who, the moment you start to put the chair back, say “don’t lie me back too far”.

Nothing gets my back and neck sore quicker than working at a strange angle where I struggle to see. It also compromises the quality of my work.

Some patients don't even get to 60 degrees before they start complaining. Yet, the vast majority of them can lie flat in bed at night to sleep.

I'm sympathetic to the rare few patients who have a peculiar medical condition that prevents them lying flat but for the rest, they need to get over it.

I prefer to avoid a trip to the physiotherapist.

5. Patients who move constantly and won't keep their mouth open.

If you're like me you take pride in your work — you want to do a nice job. But, certain patients make that impossible.

Within a second or two of starting work they act like they're drowning and start flailing around. Or, they want to rinse every 5 seconds even though there’s nothing in their mouth. Or, even though the tooth is totally numb they suddenly and without any warning pull their head away. Or they close their mouth constantly so that you become like a broken record saying: “Open your mouth”, over and over and over. Or they move their head side to side and up and down constantly for no apparent reason. Or their tongue puffs up like a tennis ball the moment they open their mouth.

A simple filling becomes an epic event at the end of which I’m like a rung-out dish mop and running 20 minutes late. Life is too short.

6. Patients who fail multiple appointments.

Practice overheads are usually more than 50% of gross revenue. That means that if a patient turns up for every second appointment and fails the other one I’m doing their work for free or even losing money.

I was once in a practice where a patient had failed 14 appointment over the course of 2 years. 14 appointments equates to over $5,000 of lost revenue. The practice would have been better off to give the patient $1,000 as a reward for going elsewhere!

The only way to convert an unreliable patient into a reliable one is to demand a deposit on all appointments. But, most unreliable patients refuse to pay a deposit.

I once had a lady who pleaded with me not to charge her a deposit when she’d failed her two previous appointments. She said those appointments were aberrations and she would definitely turn up next time. Foolishly I relented.

Guess what. She failed once again.

7. Patients who arrive with a Google diagnosis.

Some patients walk in already convinced they know exactly what’s wrong.

They tell me they need a root canal, or a crown, or a veneer, or some obscure laser treatment they found on TikTok. They don’t want an examination; they want confirmation. Such patients often come armed with a stack of their previous dental records.

When my findings don’t match their late‑night research, they look at me as though I’m hiding the “real” answer.

Suddenly dentistry becomes a negotiation instead of a diagnosis. I’m no longer the clinician — I’m the second opinion to an algorithm.

8. Patients who treat time as optional.

These are the ones who drift in ten or fifteen minutes late, breezily not apologising as though they’ve arrived fashionably late to a party.

They still expect the full treatment that they were booked in for. They will complain repeatedly if you tell them you don’t have enough time left to do all their treatment.

“Oh, Doctor, can’t you please do it?”

If I suggest rescheduling, they look personally offended. Good dentistry requires time and preparation — not improvisation. When someone treats my schedule like a suggestion, they inevitably treat my treatment the same way.

But, don’t forget, if you’ve trained you patients that your schedule can’t be relied upon because you are chronically late, you can’t complain too much when they return the favour. Read my deep dive on why dentists run late.

9. Patients who ask for the price before the problem.

Before I’ve even looked in their mouth they want to know the cost of a filling, or a crown, or:

“Whatever the cheapest option is.”

They’re not comparing treatment options — they’re comparing me to the hardware store.

No matter how carefully I explain longevity, quality, or the reasoning behind my recommendations, they only hear numbers.

When the cheapest option fails, they’re the first to blame me. They forget the long conversation we had where I told them that the cheapest option might not last.

10. Patients who bring a companion who answers for them.

Some patients arrive with a spouse, friend, or relative who acts as their spokesperson, bodyguard, and legal counsel all at once.

The patient barely speaks. The companion answers every question, interrupts every explanation, and hovers over the chair like a watchdog. Helicopter parents answering every on behalf of a 16-year old child can be very annoying.

I’m no longer communicating with the person receiving the treatment — I’m navigating the anxieties or control issues of the person standing beside them.

It’s impossible to build rapport or gain genuine consent when someone else is running interference. Am I getting the real story? It’s hard to tell because every answer goes through a filter.

11. Patients who want miracles on impossible timelines.

These are the ones who book in two days before their wedding, or the night before a job interview, or the week before a holiday, and expect me to reverse years of neglect in a single appointment.

They want whitening, bonding, crowns, extractions — all urgently, all perfectly, all without compromise.

When I explain what’s realistic, they look disappointed, as though I’m withholding magic rather than offering dentistry. They don’t need a dentist; they need a time machine.

12. Patients who treat the appointment like a therapy session.

The moment they sit down, they unload every detail of their personal life — relationship dramas, workplace grievances, medical sagas stretching back to childhood. Ten minutes disappear before I’ve even reclined the chair.

While empathy is part of the job, dentistry requires focus.

When someone uses the appointment as therapy, I end up running behind, mentally drained, and unable to give the next patient the attention they deserve. Dentistry is demanding enough without doubling as a counsellor.

13. Patients who lavish you with praise “You’re the best dentist ever!”

Every now and then a patient walks in overflowing with compliments.

Before I’ve even picked up a mirror they’re telling me I’m the best dentist they’ve ever had, that I’m a genius, that no one has ever made them feel so comfortable. It sounds flattering, but experience has taught me to be wary.

Excessive praise at the start is often followed by excessive disappointment later. These patients swing from adoration to frustration with breathtaking speed.

The moment something doesn’t feel perfect — a slight sensitivity, a temporary crown that feels “a bit weird,” a shade that’s a tiny bit off — they forget every compliment they ever gave me.

I go from “the best dentist ever” to someone who “did something wrong” in record time. I’ve learned that genuine trust is quiet and steady. Over‑the‑top praise is usually a warning sign, not a compliment.

In conclusion…

The lesson is simple: dentistry isn’t just about teeth — it’s about people.

The right patients make your days smoother, and your results better. The wrong ones erode your time, your standards, and your sanity.

After decades in practice I’ve learned that choosing who not to treat is important. If I find the hairs standing up on the back of my neck when talking with a new patient I take notice of that.

Permit yourself the well-earned luxury of deciding, a few times a year, not to treat a problem patient.