How to Smile Through A Mask and Build a Great Patient and Team Experience

Angela Davis Sullivan


Since the beginning of the COVID-19 pandemic, many of the teams I work with have been having problems relating to their patients and to each other. Everyone is stressed and nervous. Increased social distance has caused increased emotional distance. Suddenly, the practice isn’t a great place to be. It’s scary and stressful, and everyone’s on edge.

Many of my clients think that pandemic-related stress is bringing long-secret tensions and animosities out into the open. But when I meet their teams and really get to the root of the issues, I find that the problem is much simpler.

People don’t know how to build and maintain relationships when everyone is in a mask. Masks are here to stay, at least for the next year or so. But the good news is that you and your team can learn to live with them and make your practice feel like home once again.

You’re Never Fully Dressed Without a Smile

We’re in the dental industry. Smiles are our business, and we spend a lot of time telling people how important it is to have a warm, welcoming, healthy smile. It’s not just a marketing gimmick. Scientists recognize that smiles are important to people around the world.

According to Paula M. Niedenthal, a psychologist at the University of Wisconsin who specializes in human emotions, there are three types of smiles.

Reward smiles feel good for the person who smiles and for anyone who sees that smile. They include the smiles we smile when we’re genuinely pleased to see someone. They also include those huge grins babies give you when they want you to smile back and play with them.

Affiliative smiles are the smiles that we use to tell people that we’re not dangerous, that we’re here to help, and that we’re on their team. They set people at ease.

Dominant smiles include smirks and nasty grins. They’re the smiles you might see on a villain in a movie, the ones that make people nervous and afraid because the smiler is saying that they’re in charge and that they can hurt people.

All three of these types of smiles are necessary for social communication. They help us know how other people are feeling and how we should feel in unusual or uncomfortable situations. So what happens when everyone is wearing personal protective equipment all of the time, and we can’t see each other’s smiles?

Smiles in the Time of Coronavirus

Wearing masks affects our view of other people’s smiles and how we interact with them, but they don’t affect all smiles the same way.

Reward smiles make us feel good and are inextricably linked to our feelings that somewhere is a good place and we’re happy there. Think about the smile your grandmother gives you when you show up for a visit. It lets you know you’ve come home.

In a world with no reward smiles and flat facial expressions, people become depressed. You can see this in action in the “still face” experiment where babies encounter a flat expression on their mothers’ faces. We all need reward smiles.

When we mask, we can’t see the lower half of the face, but the good news is that people can still recognize reward smiles if they pay attention to the eyes. These are genuine smiles. They reach the eyes, and we don’t need to see them to know that they’re there.

However, we’re less likely to smile back when we and our patients and teammates are masked, and slowly we get into a spiral where these reward smiles are less common. Work seems like a less friendly place.

Masks are even worse when it comes to affiliative and dominant smiles. These smiles don’t engage the eyes the same way as reward smiles do, so people can’t tell them apart when the other person is masked. This is especially problematic in high-stress situations when someone is scared, worried, angry, or annoyed. In a mask, the smile that usually defuses tension may become a smile that escalates it instead.

Think about your day at the office. Do you have patients who come in nervous? Are you used to smiling to set them at ease? Suddenly they can’t tell whether your smile means “I’m on your side and will take care of you” or “I can’t wait to drill into your teeth and cause you pain!”

Think about conversations with your teammates. Do you smile to help resolve problems? Well, now they may be interpreting your attempts at team spirit as cruel and aggressive. Masks ratchet up the tension in already tense situations, like a practice where patients and team alike are trying to adjust to a global pandemic.

Communicating from Behind the Mask

Fortunately, people are adaptable. There are ways you can let people know you’re on their team and on their side without having to remove your mask and risk spreading disease:

  • Body language: People process the big picture and will look at other parts of your body besides your mouth. Use body language to convey that you’re on their side. Pay attention to your posture, how you move, and your hand gestures. Use bigger gestures to say what your smile can’t.
  • Voice and language: I know. We all hate talking in masks. But when you’re setting teammates and patients at ease, think of it as a dramatic challenge. Use more expressive language and vocal tones. Use words where you would have used a smile. Say things like “I’m so glad to see you and I can’t wait to help you feel better,” or “We’re a team. We can figure this out together.” Yes, a smile may be worth a thousand words, but that means we’re just going to have to use extra words.
  • Ask more questions: Since the masks may also obscure patient faces, you may miss signs that someone is scared or confused. Ask more questions. Use verbal check-ins to make sure people are okay.
  • Make smiles more rewarding: Try to make a higher percentage of your smiles reward smiles. Before you see a patient, think about good things you remember about them and how happy you are to see them. If you remember that you are happy and delighted that they’re there, your smile will be genuine and they’ll see it in your eyes. Do the same when you have to talk to your teammates. Remember that it is good that they exist, and greet them gladly.
  • Go with a picture: In some practices, team members are putting their smiling faces on buttons or badges. That way, people can remember that there’s a smiling face behind the mask.
  • Get different masks: The Food and Drug Administration recently approved several brands of single-use clear surgical masks. These masks protect while also letting the people around you see your face. While these masks target people working with hearing impaired or special needs patients, you might find they’re a good option for all your patients, especially since we’re in an industry that revolves around smiles.

 COVID-19 has changed a lot of things about how we run our practices and relate to our patients and our teammates. But it’s important to remember that social distance doesn’t have to become emotional distance. By thinking about how we smile and how to share those smiles with the people who come into our practice each day, we can get back to feeling safe and happy in our work families.

Ms. Sullivan is a dental practice business and development coach with more than 30 years of experience in both the clinical and business sides of the dental industry. She has a special passion and skill for bringing out the best in team members and developing outstanding office managers as well as helping dentists become better leaders. She is a certified trainer for Forte’ communication styles and for John Maxwell’s management philosophy. She is the author of Coming Home to a Better Practice: A no-nonsense guide to becoming a leader and building your work family, available through She is the founder and owner of Adaptive Dental Solutions as well.

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