Building Trust, One Appointment at a Time

Treating anxious or neurodivergent patients can feel challenging as an early career dentist, ADA SA Councillor Dr Gabrielle Smart shares a case study to highlights how patience, flexibility and relationship-building can completely change a patient’s dental experience over time.

A 14-year-old patient first presented in October 2023 after self-referring for a check-up. Her medical history included ASD, depression, pathological demand avoidance, a latex allergy and previous ENT surgery. She had not seen a dentist recently (it had been years) and preferred to wait in the car park with her mother rather than in the clinic before her appointment.

Rather than pushing for treatment, the focus of the first appointment was simply connection and trust. Dr Smart met the patient in the car park, discussed her concerns and confirmed there was no pain or urgent treatment needed. Eventually, the patient agreed to briefly enter the clinic and look around while her family interacted with staff.

At the second appointment, the team focused on creating comfort and predictability. Establishing a point of connection through the patient’s favourite TV shows and using a ceiling-mounted television helped reduce anxiety. Open conversations about gloves and sensory concerns also helped the patient feel more in control. The patient had also not brushed her teeth for months. Non-judgemental and open conversations about why toothbrushing was hard for the patient but also about why we brush our teeth was important at this time. The worst thing we could do at this point was “tell the patient off” or make them feel embarrassment or shame.

An ultrasonic scaler was used for cleaning while the patient watched a movie, avoiding prophy paste due to taste and texture sensitivities. These small and individualised changes can have a significant impact on making neurodivergent patients feel more comfortable.

Treatment planning also considered the patient’s coping capacity, family circumstances and financial limitations. A staged approach using 3-monthly appointments during school holidays was chosen, with care funded through the Child Dental Benefits Schedule (CDBS). The patient’s younger sister and case worker also played an important role in modelling positive dental experiences.

Over several appointments, the patient gradually tolerated radiographs, restorative treatment, fissure sealants, fluoride applications and local anaesthetic. Glass ionomer cement was initially used to stabilise caries and slow progression while building treatment tolerance.

By February 2025, the patient had completed all restorative treatment needed, was attending regular maintenance appointments and had developed a trusting relationship with the dental team.

While oral hygiene remains a work in progress, the most significant outcome was that the patient now has a “dental home”, something that once seemed unlikely at the first appointment.

Key Takeaways:

• Trust and rapport are often the first stage of treatment.
• Flexibility and patient-centred care can dramatically improve outcomes.
• Sensory sensitivities should be acknowledged and accommodated where possible.
• Small wins matter — progress may be gradual, but it is still progress.
• Family, carers and support people can play a valuable role in successful care.
• For some patients, simply attending the dental clinic is already a major achievement.