MPS Foundation
Estimated read time: 5 mins
Patients’ bodies sometimes speak more clearly than their words when it comes to anxiety. Subtle signals – shifts in posture, fleeting expressions, or the rhythm of breathing – reveal discomfort long before a patient admits it. Dentists who learn to notice these ‘tells’ can reduce distress, prevent treatment delays, and avoid miscommunication that leads to complaints.
To take this further, we designed a study funded by The MPS Foundation to observe anxiety in action and to build a taxonomy of anxious tells. Over 70 hours of video ethnography in real clinics, combined with camera testing in a simulation lab, allowed us to see anxiety as it unfolded, in context. Along the way, we also had to tackle a very practical problem: how do you actually film a dental surgery, with all its equipment, staff, and moving parts, without missing the subtle cues?
This article shares both sides of that learning. First, the taxonomy of non-verbal anxiety cues. Second, the practical guidance on how cameras can help dentists, whether for self-reflection, team training, audit, or research.
Our study identified four broad categories of non-verbal signals that reveal patient anxiety. These are not meant as rigid checklists, but rather as lenses to help you notice when something seems ‘off’ in the flow of treatment.
The first group, embodied movements, includes the restless tapping of feet or bouncing of legs beneath the chair, the clenching and unclenching of fingers, the sudden stiffening of shoulders, or even a reflexive pull away from instruments. Each of these movements reflects the body’s instinctive response to discomfort.
Next are facial and ocular cues. Patients may press their lips tightly together, furrow their brows, or display fleeting, asymmetrical micro-expressions. Rapid blinking or a fixed stare can also signal unease, as can the subtle wince or flinch that follows a sound or the touch of a dental tool.
Shifts in vocal tone and breathing form a third category. Forced laughter, nervous joking, or a sudden sigh can punctuate the conversation. Some patients hold their breath, exhale quickly, or unconsciously raise the pitch of their voice. Others may slow their speech, or respond with short, clipped answers that suggest a withdrawal from engagement.
Finally, we observed how patients interact with their environment. Hands gripping the chair’s armrests, eyes locked onto ceiling lights or distant objects, repeated clarifying questions, or interruptions that delay treatment. All of these behaviours reveal the struggle to regain a sense of control.
The key principle is this: a ‘tell’ becomes significant when it disrupts the normal rhythm of the appointment. A patient who fidgets throughout may not be anxious at all, but one who suddenly goes still as the drill begins is likely signalling something important.
Noticing anxiety in real time is rarely straightforward. The demands of treatment often take precedence, leaving subtle cues of unease overlooked. Yet when we replay consultations, the missed signals become clear. Dentists who watch back their own practice - whether alone or with colleagues - often find themselves surprised by the micro-movements, glances, or shifts in breathing that escaped their attention in the moment. Video allows us to see what we otherwise fail to see.
Of course, how you set up the camera matters. An overhead wide-angle lens captures the overall atmosphere of the surgery and the ebb and flow of team movement. A light-mounted camera, by contrast, brings into focus the patient’s face and upper body, revealing small expressions that may otherwise go unnoticed. A tripod set at the side shows the synchrony - or lack of it - between dentist and patient. For those who want to go further, a body-mounted view places you in the moment, showing instruments and hand movements exactly as they unfold.
Getting started requires some practical preparation. It begins with simply evaluating your space: lights, equipment, and staff can all block the view in unexpected ways. Choosing the right setup follows, whether a single wide-angle for patient feedback or multiple angles for team training. Testing the system with actors before using it in real consultations helps ensure that faces, hands, and posture are clearly visible. Consent, of course, is essential. Patients must be given genuine choices about how their footage will be used - whether restricted to training, anonymised for study, or deleted after analysis. And when the time comes to review, the spirit must be reflective rather than critical. The right questions are not “who got it wrong?” but “what signals were there, and how did we respond?”
Used thoughtfully, cameras are not a replacement for empathy but a tool to sharpen it. They help us reflect, see with new eyes, and, in time, become more attuned to our patients as the consultation unfolds. Table 1 provides an overview of key issues.
Table 1 – Tips for optimal camera placement in dental practice
Best camera placements
Overhead wide-angle: captures overall atmosphere and team movement.
Chair light-mounted: shows facial expressions and upper body.
Side tripod angle: records synchrony between dentist and patient.
Body-mounted (optional): first-person view of hands and instruments.
Five practical steps for using cameras
Evaluate your space: note where lights, equipment, or staff might block shots.
Choose your setup: a single wide-angle for patient feedback – multi-angle for training.
Test with actors: run mock procedures to check visibility of faces, hands, and posture.
Consent clearly: give patients a choice about how footage is used (training only, anonymised, or deleted after analysis).
Review reflectively: watch as a team, not to criticise but to notice. Ask: what signals were there? How did we respond?
Using video in practice
For training: Replay consultations at different speeds. Watch in slow motion to catch fleeting micro-expressions or watch on fast-forward to see patterns of movement.
For patient conversations: Use a simple wide-angle shot to talk through comfort and future care planning.
For improvement and audit: Build a small library of anonymised clips to compare patterns across procedures and patients.
Anxiety in dentistry isn’t just in the mind. It’s in the micro-movements, glances, and breaths that make up the choreography of each appointment. By learning to notice these tells and by using cameras to practice noticing, dentists can create calmer, safer, and more empathetic care.