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British Dental Journal volume 239, pages 760–761 (2025)
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Prav Solanki and Andy Sloan explore how understanding the psychology behind patient decisions can help dental teams ethically improve treatment acceptance by focusing on trust, empathy and communication.
Prav Solanki, MD of The Fresh UK, Agilio Software
Dr Prav Solanki is Managing Director of The Fresh at Agilio Software. He graduated from the University of Oxford, having studied Medicine, followed by a PhD in Pharmacology, before venturing into the world of dental business growth. Prav combines his role as a marketing scientist and the owner of multiple dental practices to craft impactful marketing campaigns and unique patient journey experiences to optimise growth and customer experience. Prav has worked with over 500 clinics and corporate dental groups to help elevate their patient journey, marketing campaigns and impact growth.
Andy Sloan, Managing Director EMEA, Agilio Software
Andy Sloan took the helm of Agilio’s Dental business in December 2022, bringing over 15 years of senior leadership experience across the dental sector. Before joining Agilio, Andy was Business Development Director at Portman Dental Care (now PortmanDentex), where he led the acquisition of more than 100 practices, and earlier served as Director of Business Solutions at Henry Schein, overseeing practice brokerage, financial services and business solutions across 11 European markets. Under Andy’s leadership, Agilio have launched an end-to-end patient growth solution by integrating DenGro’s intelligent CRM with The Fresh’s marketing suite, a move that Andy describes as ‘transforming dental marketing’.
Every dental practice faces the same challenge: plenty of enquiries come through the door, yet not every patient follows through. While some accept treatment plans immediately, others hesitate or quietly drift away.
Understanding why patients say yes, and what causes them to say no, is less about persuasion and more about psychology, as well as about ensuring every recommendation is communicated in an ethical, patient-centred way.
Dental professionals are trained to present evidence, explain risk and obtain informed consent. However, behavioural research shows that people rarely make health decisions on information alone.
Kahneman’s (2011) research in behavioural thinking demonstrates that human decision-making operates through two systems: one intuitive and emotion-driven, the other analytical and deliberate.1 While clinicians tend to communicate in the language of logic, patients often decide through emotion.
A review by Armfield and Heaton (2013) concluded that fear and anxiety are significant barriers to treatment acceptance, often outweighing factors such as cost or complexity.2 In other words, how a patient feels during the consultation can outweigh what they understand about the treatment.
Another study, this time by Schouten and colleagues (2003), found that empathic, participative communication during dental consultations predicted higher patient engagement, whereas socioeconomic factors had little influence.3
These insights suggest an important truth, namely that patients are not rejecting treatment. Rather, they are rejecting discomfort, uncertainty, confusion or a sense of pressure. Overcoming that barrier requires a shift from presenting treatment to helping patients feel psychologically safe enough to accept it. Recognising these emotional dynamics is the first step towards building trust.
Trust underpins how patients make decisions. In healthcare psychology, it is defined not only as belief in the clinician’s competence but also as belief in their motives.4 Patients are more likely to proceed when they perceive that recommendations are made in their best interests, not for commercial gain.
Clarity is an essential part of that trust equation. Evidence from the King’s Fund shows that patients are more likely to consent to treatment when they fully understand their options and outcomes, and when decisions are made collaboratively.5
However, in busy practice environments, time pressure can lead to information overload or rushed explanations. This is where communication frameworks such as teach-back or shared decision-making can make a measurable difference. By asking patients to summarise their understanding and encouraging questions, clinicians reinforce comprehension and partnership.
Empathy also carries measurable weight. A 2013 systematic review across general practice and primary care settings found that empathic communication improves both adherence and satisfaction.6 In dentistry, this can be as simple as acknowledging patient anxiety before discussing cost or validating their past experiences. These small verbal cues lower perceived threat and increase openness to discussion.
Perceived value is the third element. While financial barriers are real, they are often mediated by the patient’s sense of worth and trust. Framing treatment around outcomes rather than procedures, for example, ‘helping you feel confident eating and smiling,’ rather than, ‘placing a crown,’ helps the patient connect the clinical recommendation to a meaningful personal benefit. Behavioural science frameworks highlight that understanding and addressing the psychological factors influencing decision-making can enhance motivation and engagement with care.7
Together, clarity, empathy and perceived value create the conditions for trust. When any one of these is missing, hesitation is more likely. When all three are present, patients feel more confident to proceed.
Applying these insights ethically requires structure. The aim is not to persuade but to support informed decision-making by addressing the factors that hold patients back from accepting care.
One practical model comes from motivational interviewing, a counselling technique shown to be effective in improving oral health behaviours and periodontal outcomes.8 Motivational interviewing focuses on collaboration rather than persuasion, helping patients articulate their own motivations for change. In a treatment discussion, this might mean asking, ‘what would it mean to you to be able to chew comfortably again?’ rather than, ‘would you like to go ahead with this option today?’ The first question invites reflection, the second requires a decision.
Non-verbal communication also matters. Eye contact, open posture and facilitating comfortable silence all help patients to feel at ease and build interpersonal trust.9 Similarly, small environmental cues such as comfortable seating, privacy and clear visual aids can significantly reduce anxiety and foster engagement. A patient who feels at ease is more likely to process information accurately and ask clarifying questions, both of which support informed consent.
Beyond the chair, follow-up systems play a vital role. Too often, patients who delay treatment are simply lost to follow-up. Automated yet personalised communications, such as reminders, check-ins, or educational content can keep patients connected without applying pressure. Consistent, empathetic follow-up has been shown to improve patient engagement and increase treatment acceptance over time.10 The key to success is the tone adopted, with follow-up messages that reaffirm patient autonomy and gently reinforce the benefits of care so that patients feel supported rather than pressured to proceed.
Finally, data can help teams identify where psychological drop-offs occur. Tracking metrics such as consultation-to-treatment conversion rates, follow-up response times and patient feedback highlights patterns that may otherwise go unnoticed. If a certain procedure has consistently low uptake, or if cancellations peak after particular touchpoints, these are clues to investigate communication gaps. By translating behavioural science into everyday communication, teams can make lasting changes without adding time or pressure.
At its heart, improving treatment acceptance is about empathy, not economics. Patients are more likely to say yes when they feel heard, respected and confident in their choices. The science of psychology provides the tools to make that possible, turning what can feel like a transactional discussion into a shared decision built on trust.
Agilio’s 30-minute webinar, The psychology of yes: how to increase treatment uptake without selling, on 9 December explored these behavioural insights in greater depth. Designed for time-pressed dental teams, the session demonstrated how small, evidence-based adjustments to language, systems and follow-up can transform patient relationships and support sustainable growth across the practice. To view it free of charge on-demand, visit tinyurl.com/psychology-of-yes.
Clarity – use the teach-back approach: after explaining treatment options, ask patients to describe what they have understood in their own words. This confirms comprehension and highlights where further explanation may be needed
Empathy – acknowledge emotion before information. Simple phrases such as, ‘it’s understandable to feel unsure about this’, or ‘many people find this part a bit daunting’, help reduce anxiety and make patients more open to discussion
Perceived value – frame treatment around outcomes, not procedures. Instead of talking about ‘placing a crown’, link it to personal benefits such as, ‘feeling comfortable eating and smiling again’. This helps patients connect clinical care to what matters most to them.
Small shifts in communication can make the difference between hesitation and confidence, turning a clinical recommendation into a shared decision built on trust.
Kahneman D. Thinking, Fast and Slow. London: Penguin Books, 2011.
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Schouten B C, Hoogstraten J, Eijkman M A J. Patient participation during dental consultations: the influence of patients’ characteristics and dentists’ communication behaviour. Community Dent Oral Epidemiol 2003; 31: 368–377.
Hall M A, Dugan E, Zheng B, Mishra A K. Trust in physicians and medical institutions: what is it, can it be measured, and does it matter? Milbank Q 2001; 79: 613–639.
Coulter A, Collins A. Making shared decision-making a reality: no decision about me, without me. 2011. Available at https://www.kingsfund.org.uk/insight-and-analysis/reports/making-shared-decision-making-reality (accessed 29 October 2025).
Derksen F, Bensing J, Lagro-Janssen A. Effectiveness of empathy in general practice: a systematic review. Br J Gen Pract 2013; DOI: 10.3399/bjgp13X660814.
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Cascaes A M, Bielemann R M, Clark V L, Barros A J. Effectiveness of motivational interviewing at improving oral health: a systematic review. Rev Saude Publica 2014; 48: 142–153.
Ambady N, Rosenthal R. Thin slices of expressive behaviour as predictors of interpersonal consequences: a meta-analysis. Psychol Bull 1992; 111: 256–274.
Levin R P. Dental case acceptance: the growing importance of follow-up. 2013. Available at https://www.dentistryiq.com/practice-management/marketing/article/16354176/dental-case-acceptance-the-growing-importance-of-follow-up (accessed 29 October 2025).
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The psychology of yes. Br Dent J 239, 760–761 (2025). https://doi.org/10.1038/s41415-025-9421-9
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