Patient-related violence reaches routine exposure in dental training
Patient-related violence emerged as a common part of clinical education for dental students in this cross-sectional study, with 76.0% of 129 participants reporting at least one experience during training. The finding is difficult to dismiss as an isolated disciplinary issue or a rare interpersonal conflict. It points to a repeated occupational hazard in the patient care environment, one that can shape how novice clinicians communicate, perform procedures, and perceive safety at the chairside.
Verbal violence accounted for most of the exposure, affecting 51.2% of students, while physical violence was rare at 0.8%. Threat-related behaviors were assessed as part of the survey, placing the emphasis on a broader spectrum of hostile encounters rather than only overt assault. Even in the absence of frequent physical injury, repeated verbal aggression can erode concentration during treatment, increase anticipatory stress before patient encounters, and alter the learning climate in a setting where precision and trust are central to care.
Female students reported markedly higher exposure than male students, with rates of 85.6% versus 53.8% and a statistically significant difference (_p_ < 0.001). The study does not explain why this gap appeared, but the pattern is clinically important because differential exposure to aggression can translate into unequal psychological burden during training. In a procedure-driven specialty, where students already operate under close supervision and performance pressure, repeated hostile interactions may carry consequences that extend beyond discomfort and into training confidence, participation, and willingness to engage with complex patients.
Endodontics and treatment procedures carried the greatest burden
Patient-related violence was reported across multiple clinical specialties, and endodontics was the most frequently reported specialty. Treatment procedures were the setting in which violence most often occurred. Those two observations fit a familiar clinical logic: endodontic care often involves discomfort, time pressure, and expectations that may not align with the patient’s experience in the chair. When pain, anxiety, and procedural intensity overlap, the consultation can shift quickly from cooperation to confrontation.
The study’s distributional pattern matters because it identifies where preventive measures may have the greatest effect. A waiting-room lecture alone will not address the moments when distress rises during active treatment. Communication failures, unmet expectations, and poor tolerance of procedural pain can all escalate a visit into a hostile exchange. In that context, patient-related violence is not merely a behavioral problem; it is also a signal of strained communication and insufficient protective scaffolding around students who are still learning how to manage difficult encounters.
A single hostile appointment can dominate a student’s clinical memory.
The survey also found a substantial proportion of students reporting perceived patient bias. While the abstract does not specify the nature of that bias, the presence of perceived unfairness adds another layer to the working environment. Bias can intensify the sense that aggression is not random but directed, which may worsen fear and weaken a student’s willingness to return to similar clinical situations. For a trainee population, that kind of cumulative exposure is especially relevant because education depends on repeated hands-on participation, not avoidance.
Prevention will depend on training, policy, and security
Students most often suggested three preventive strategies: stronger legal regulations, better patient education, and enhanced security measures. Those responses suggest that trainees see the problem as systemic rather than personal. They are not asking only for resilience training; they are asking for a safer institutional frame in which communication failures and violent behavior are less likely to be normalized.
The study’s conclusions point toward a layered response. Communication training can prepare dental students to de-escalate tension, set expectations before procedures, and respond when anxiety turns into aggression. Institutional policies can define reporting pathways and establish consequences for abusive behavior. Security measures may be necessary in some settings, especially when repeated incidents occur during active treatment, where staff members and students have limited ability to disengage quickly.
The absence of external funding may reduce concerns about sponsor influence, but the more important limitation is structural: this was a cross-sectional questionnaire study. It captures exposure, not causation. It cannot determine whether certain clinical environments, patient mixes, student workloads, or supervision styles increase risk. It also cannot separate isolated events from repeated exposure over time. Even so, the data offer a practical warning for dental schools: patient-related violence is not confined to emergency departments or general hospital wards. It is present in routine dental training, and it clusters around the very moments when students are expected to perform under pressure.
The ethical framework was straightforward, with institutional approval and informed consent documented before participation. No competing interests were declared. Those details do not change the clinical message. A majority of students in active patient care reported violence of some kind, verbal aggression dominated, female students reported higher exposure, and endodontics was the most frequently named specialty. For dental educators and clinic directors, the implication is immediate: prevention has to be built into the training environment before hostile encounters become normalized as part of becoming a dentist.