I’ve seen this play out so many times in practice—patients come in already tense, and you can almost see them bracing for pain before they even sit down. It’s a huge barrier to regular care. I remember one patient who’d avoided the dentist for almost a decade after a rough extraction as a kid. She needed a lot of work, but her anxiety around pain was so high that she’d put off even basic cleanings.
It’s interesting because, technically, we have a lot of options now—local anesthesia, nitrous oxide, oral sedation… but unless you bring it up directly, some dentists just focus on the procedure itself and assume you’ll speak up if you’re uncomfortable. That’s not realistic for everyone, especially if you’ve had bad experiences before. I do think it’s on us as practitioners to ask about pain tolerance and previous experiences upfront. It makes a big difference in trust.
On the flip side, there are definitely cases where patients get so focused on not feeling anything that they’ll want sedation or anesthesia for simple things like cleanings. That’s where the long-term health conversation comes in—sometimes the fear of pain leads people to avoid care altogether, which ends up causing bigger issues down the line. I try to strike a balance: acknowledge their concerns about pain, lay out what we can do to manage it, but also explain why certain treatments are important for keeping their teeth healthy long term.
I don’t think it should be an either/or question. If someone’s terrified of pain, talking about prevention and long-term health doesn’t matter much—they just won’t come back. But if all we do is focus on comfort without discussing why we’re doing what we’re doing, that’s not helping either. It has to be both: proactive pain management and honest conversations about long-term outcomes.
Funny enough, after my own wisdom teeth removal (with local only), I realized how much my own anxiety colored my memory of the event versus what actually happened. It made me rethink how I talk about pain with patients—sometimes just knowing there’s a plan in place makes all the difference.
