Working in dentistry means we often wear many hats—caregiver, educator, cheerleader, and sometimes, crisis manager. While our days are usually filled with smiles and patient education, there are moments that test our patience and emotional strength. One such moment? When a patient lashes out physically.
Let’s talk about a difficult but real scenario: a 23-year-old autistic man strikes a dental assistant during a routine appointment.
This situation is both emotionally charged and ethically complex. It brings up questions about safety, inclusion, compassion, and preparedness. How do you protect yourself? How do you support the patient? And what does the team learn from it?
Understanding Before Reacting
Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that affects communication, sensory processing, and behavior. Many individuals with autism experience heightened sensitivity to sound, touch, light, and changes in routine—all common triggers in a dental environment.
When an autistic patient becomes overwhelmed, the result can sometimes be a “meltdown” or physical outburst. This is not aggression in the traditional sense—it’s often a form of communication or a stress response to sensory overload.
Important: Hitting is never okay, and no dental assistant should feel unsafe at work. But understanding the “why” behind the behavior helps us respond with professionalism rather than fear or anger.
Step 1: Ensure Immediate Safety
If you or another team member is struck, the first priority is to de-escalate and protect everyone in the room, including the patient.
Here’s what to do in the moment:
- Stay calm. Your reaction matters. Raising your voice, rushing out of the room, or confronting the patient can escalate the situation.
- Back away slowly. Put distance between yourself and the patient while using a calm, soft tone. Avoid sudden movements.
- Call for support. Alert another team member or the dentist immediately.
- If necessary, pause the appointment. If the patient is unable to continue safely, gently end the session and offer to reschedule for another time.
Step 2: Address the Team and Document the Incident
After the patient has left or the situation has stabilized, the team must take the next steps:
- Report the incident internally. Your dental practice should have a formal incident report form or a documentation procedure. Include the time, what happened, who was present, what actions were taken, and any visible injuries.
- Seek medical attention if needed. Even a minor strike to the face or arms can cause injury. Never hesitate to be evaluated, especially if bruising, swelling, or emotional distress is involved.
- Talk as a team. Have a team huddle to review what happened and how it could have been prevented or handled differently.
Remember, if you feel unsafe or unsupported, speak to your office manager or the dentist. Your emotional and physical safety is non-negotiable.
Step 3: Contacting the Caregiver or Guardian
If the autistic patient has a caregiver or guardian, they need to be informed about the incident—in a professional, non-judgmental way. Avoid blame or shaming language.
Instead, try something like:
“During the appointment today, [Patient’s Name] became overstimulated and struck one of our team members. We want to ensure that future visits are successful and safe for everyone. Could we talk about strategies that help him feel more comfortable in unfamiliar settings?”
This opens the door to collaboration, not confrontation.
Step 4: Review the Patient’s History and Triggers
If the patient is a returning one, review past records:
- Were there signs of anxiety during previous visits?
- Did they express discomfort with certain tools or sounds?
- Was sedation ever recommended?
- Have you used social stories, visual schedules, or pre-appointment prep before?
For new patients, consider adding intake questions about sensory sensitivities, behavioral strategies, and preferred calming techniques.
Step 5: Create a Personalized Safety Plan
If the caregiver and dental team agree that future appointments are possible, create a clear plan that outlines:
- Pre-appointment preparation – Send photos, walk-through videos, or use visual stories to prepare the patient.
- Quiet scheduling – Book during low-traffic times.
- Noise-reducing tools – Offer headphones or limit use of loud equipment.
- Minimal touch techniques – Use tell-show-do, allow the patient to hold tools before they are used, and get permission before any contact.
- Signal words or breaks – Create a code word or hand gesture that lets the patient pause the visit if overwhelmed.
Be sure the assistant assigned to that patient feels supported, trained, and prepared.
Step 6: Take Care of Yourself
Being physically harmed by a patient—even unintentionally—can leave emotional scars. It’s okay to feel shaken, angry, or discouraged.
Ways to process the experience:
- Talk to someone. A supervisor, mentor, or trusted peer can help you process your emotions.
- Seek mental health support. A brief counseling session or support group can make a big difference.
- Set boundaries. If you feel unable to work with a particular patient again, it’s okay to say so.
No job is worth sacrificing your peace or well-being.
Final Thoughts: Compassion with Boundaries
Dental assistants are on the frontlines of patient care. We advocate, educate, and support every kind of patient—including those with neurodiverse needs. But compassion does not mean sacrificing your safety. Boundaries, training, and clear communication help create an inclusive environment without compromising staff well-being.
This incident with the autistic young man is a reminder that while our hearts are big, our policies must be strong.
We serve best when we feel safe, respected, and empowered—and when every patient, no matter their challenges, is given the best chance to succeed in the dental chair.
Resources for Further Support:
- Autism Speaks Dental Toolkit
- The American Academy of Pediatric Dentistry: Patients with Special Health Care Needs
- Occupational Safety and Health Administration (OSHA) Guidelines on Workplace Violence
Have you ever experienced a situation like this? How did your office handle it? Share your story in the comments or inside the Dental Assistants Network Facebook group. Let’s learn from one another and grow stronger together.
Works Cited
"Autism Speaks Dental Toolkit." Autism Speaks, 2021, https://www.autismspeaks.org/dental-toolkit.
"Treating Patients with Special Needs." American Dental Association, 2021, https://www.ada.org.
"Workplace Safety: Guidelines on Workplace Violence." Occupational Safety and Health Administration (OSHA), 2021, https://www.osha.gov/workplace-violence.