Caring for the grieving dental patient

Grief is a natural response to a significant loss, an experience all of us will go through at some point in our lives. Although commonly associated with the death of a loved one, grief can also arise from the end of a job, the loss of an important experience or status, or the conclusion of a friendship. Grieving is the natural process of recognizing change in our lives because something has ended, and mentally, we’re not sure how to move forward. This normal emotional process involves a range of feelings that reflect the profound impact of what has been lost. Our cultural differences, life experiences, and spiritual beliefs can shape grief, making it a distinct experience for everyone.^1–3

The five stages of grief

The grieving process is divided into five distinct stages. Psychologist Elisabeth Kübler-Ross first outlined these stages in her 1969 book Death and Dying. The five stages of grief are denial, anger, bargaining, depression, and acceptance. These stages may not appear in this order for everyone, and there is no exact time limit for how long a grieving person will stay in each stage.

In the denial stage of grief, a patient may not be able to accept the reality of the loss or that the life they once knew will be different from this point forward. Angry emotions often occur once a person accepts their loss, but they can point the anger at a variety of sources. For example, if a loved one died from cancer, a patient may be angry at the cancer itself, at the deceased for not beating cancer, at the oncologists for not curing their loved one of cancer, or even at themselves for not being there for their loved one as much as possible during their battle with cancer. Throughout the third stage, bargaining, people try to promise transformations as their mind processes something they cannot change. An example of bargaining is, “I will start exercising if you bring me back to good health.” Depression is the fourth stage of grief, and it is defined as a feeling of prolonged sadness. Depression may make a person feel confused about their future or how to make decisions. Feelings of sadness during any loss are normal, according to Dr. Kübler-Ross. During the final stage of grief, a person reaches a level of acceptance and starts to make healthy choices, realizing that their old life is not moving with them into the future. While a person may still feel a certain way about their loss, they are trying to move on.¹

Types of grief

Grief has diverse types that a person may experience depending on what type of loss is impacting their life. Anticipatory grief is when a person knows that a loss will occur. They start grieving long before the actual event of loss. Think of a caretaker to someone with an incurable disease. Complicated grief or prolonged grief is when the grieving process is so powerful it interferes with a person’s life and makes them unable to function at all. This grief complicates a patient’s life so intensely that it may require mental health therapy.⁴

Physiological effects

No matter what type of grief a person is experiencing or where they are in the stages of grief, research shows that grief alters the body. Common physical symptoms seen in a grieving person include headaches, racing heartbeat, weight loss or weight gain, insomnia, exhaustion, nausea, and appetite loss. Undisclosed symptoms in a grieving body include generalized inflammation, weakened immune system, and high blood pressure.

Specifically, when it comes to the mouth, grief can cause bruxism and xerostomia. Dental professionals must also recognize that grieving patients may be so overwhelmed with emotion that they may have stopped eating and caring for themselves; routine habits like brushing and flossing may have suddenly ceased to exist. Dental clinicians should understand and be prepared to see changes in a grieving patient. Documentation in a patient’s medical health record is vital.^3,5–8

When dental patients are grieving

Dental professionals may not always feel equipped to care for grieving patients like other health professionals. Grief and death are not commonly discussed in continuing education courses for dental team members. Although this ar ticle of fers some enlightenment, it does not fully guide oral care experts on treating patients experiencing grief. It is essential for dental team members to understand that a grieving patient may not recognize their stage in the grieving process or what they truly need. Sometimes, the best course of action is to listen to the patient as they express their feelings. Dental professionals should avoid judgment if a patient’s oral hygiene routine has been disrupted due to their emotional journey through grief. Instead, they can make simple suggestions on how patients can return to their normal oral care routine.

In addition to listening, dental practitioners should document any physical oral changes resulting from the grieving process in the patient’s medical history. Responding appropriately to a grieving patient’s feelings may help the appointment run more smoothly. For example, if a patient begins to cry when discussing their grief, a dental professional who recognizes that further dental services such as prophylaxis or radiographs may not be feasible due to the patient’s emotional state can provide better care than a dental professional who attempts to continue with the appointment as scheduled.

Dental team members should consider taking any available training or CE courses on death, dying, and grieving patients. Being experienced in this complex situation is beneficial. By learning more about grief and its effects on oral health, dental professionals can better assist their patients, their community, and themselves.^4,9,10

Editor's note: This article appeared in the March 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. The 5 stages of grief after a loss. Cleveland Clinic. March 21, 2022. https://health.clevelandclinic.org/5-stages-of-grief
2. What is grief? National Hospice and Palliative Care Organization. https://www.nhpco.org/about-nhpco/patients-and-caregivers/the-grief-experience/what-is-grief/
3. What does grief feel like? National Hospice and Palliative Care Organization. https://www.nhpco.org/about-nhpco/patients-andcaregivers/the-grief-experience/what-does-grief-feel-like/
4. Diaz J. Grief literacy promotes compassionate care in dentistry. RDH. November 1, 2022. https://www.rdhmag.com/patient-care/patient-education/article/14279227/grief-literacy-promotes-compassionate-care-in-dentistry
5. Hairston S. How grief shows up in your body. WebMD. July 11, 2019. https://www.webmd.com/balance/grief-stages-specialreport/20190711/how-grief-affects-your-body-and-mind
6. Nall R. Understanding the physical symptoms of grief. Healthline. July 25, 2022. https://www.healthline.com/health/grief-physical-symptoms#takeaway
7. Raymond C. What does grieving do to your body? Healthline. March 28, 2023. https://www.verywellmind.com/physical-symptoms-of-grief-4065135
8. What to do when you’re (literally) sick with grief. Cleveland Clinic. January 26, 2023. https://health.clevelandclinic.org/can-grief-make-you-sick
9. Lupoli E. The dos and don’ts of death: interacting with grieving patients. DentistryIQ. July 20, 2017. https://www.dentistryiq.com/dental-hygiene/article/16366228/the-dos-and-donts-of-death-interacting-with-grieving-patients
10. Carpenter K. Grief relief: how to encounter grieving patients at dental appointments. Today’s RDH. January 17, 2023. https://www.todaysrdh.com/grief-relief-how-to-encounter-grieving-patientsat-dental-appointments/