Dentist-patient Communication Research Articles

Communication of dentists with geriatric dental patients

Dentist-patient communication has long been recognized as an important part of dental care. It has many positive outcomes, including reducing patient dental anxiety and increasing patient satisfaction and patient compliance. Above all, the need to communicate through conversation with dentist must be perceived as a basic dental patient's need for good clinical outcomes. In the future, increasing geriatric dental patients will pose challenges to dental profession. Factors influencing dentist-geriatric patient communication should be researched and relevant techniques should be shared among dentists.

Dentist-patient communication techniques used in the United States: The results of a national survey

Background The authors conducted a national survey to determine the communication techniques that dentists use routinely and variations in their use. Methods American Dental Association Survey Center staff members mailed an 86-item questionnaire to a random sample of 6,300 U.S. dentists in private practice. Participants reported routine use (“most of the time” or “always”) during a typical week of 18 communication techniques, of which seven are basic techniques. The authors used analysis of variance and ordinary least squares regression models to test the association of communication, provider and practice characteristics with the number of techniques. Results Dentists routinely use an average of 7.1 of the 18 techniques and 3.1 of the seven basic techniques. Two-thirds or more of dentists used four of the techniques (hand out printed materials, speak slowly, use models or radiographs to explain, use simple language). Less than one-fourth of dentists used any of the techniques in the teach-back method or patient-friendly practice domains. A dentist’s age, race/ethnicity, education outside the United States and area of dentistry affected use. Health literacy variables (awareness, education in communication, practice-level change, outcome expectancy) and lack of time were associated with the number of techniques used. Conclusions Routine use of all of the communication techniques is low among dentists, including some techniques thought to be most effective with patients with low literacy skills. Practice Implications Professional education is needed to improve knowledge about communication techniques and to ensure that they are used effectively. A firm foundation for these efforts requires the development, evaluation and dissemination of communication guidelines for dental care professionals.

Validation of implant stability: A measure of implant permanence

Implant stability is a requisite characteristic of osseointegration. Without it, long-term success cannot be achieved. Continuous monitoring in a quantitative and objective manner is important to determine the status of implant stability. Measurement of implant stability is a valuable tool for making decisions pertaining to treatment protocol and also improves dentist-patient communication. Owing to the invasive nature of histological analysis, various others methods have been proposed like radiographs, cutting torque resistance, reverse torque, modal analysis, resonance frequency analysis and Implatest® . This review focuses on objectives and various methods to evaluate implant stability.

The effect of undergraduate education in communication skills: a randomised controlled clinical trial

To determine whether students improve their communication skills as a result of supervised patient care and whether a newly implemented communication course could further improve these skills. We conducted a randomised, controlled trial including all participants of the first clinical treatment course (n = 26) between October 2006 and February 2007. Randomisation was balanced by gender and basic communication skills. The test group practised dentist-patient communication skills in small groups with role-plays and videotaped real patient interviews, whereas the control group learned in problem-based workshops both on a weekly basis. Before and after the interventions (two group pre- and post-design) all students conducted two interviews with simulated patients. The encounters were rated using a 10-item checklist derived from the Calgary-Cambridge Observation Guide I. Repeated measures ANOVA (alpha = 0.05) showed a significant difference of the sum scores of the ratings between test and control group (P = 0.004). The participants educated in communication skills improved significantly (Delta = +14.9; P = 0.004), whereas in the control group no accretion of practical communication competence was observed (Delta = -3.9; P = 0.23). It could be demonstrated that solely interacting with patients during a clinical treatment course did not inevitably improve professional communication skills. In contrast, implementation of a course in communication skills improved the practical competence in dentist-patient interaction.

An evaluation of the Dental 3D Multimedia System on dentist–patient interactions: A report from China

Objective The aim of this study was to evaluate the effect of introducing the Dental 3D Multimedia (D3DM) System on dentist–patient interactions. Design An initial version of the D3DM developed in a series of researches was applied to the current study. A longitudinal pre–post study was setup: volunteer patients answered questionnaires at three differing intervals during the course of the study: before the introduction of the D3DM during the first visit, after the introduction of the D3DM during the first visit, and after the introduction of the D3DM during the second visit. The questionnaires related to patient satisfaction and covered three main areas of interests: (1) satisfaction with visit components, (2) comprehension about dental issues, and (3) perceptions with regard to dental office computing. Results Compared with baseline, patient overall satisfaction increased significantly both immediately after the introduction of the D3DM and at the second visit. Patient's satisfaction with dentist's familiarity with them, and satisfaction with dental issues generally increased. On measures of psychological communication and available time, patients generally reported that no changes occurred during visits. A majority of participants reported that they preferred the D3DM more than traditional dentist–patient communication patterns. There were no significant changes in patient perceptions of the computer use over time. Conclusions the D3DM appeared to have positive effects on dentist–patient communications, improving the mutual understanding between them. There were no significant negative effects directly generated from the computer intervention. Further research is needed to update the current D3DM and investigate how the system might be best implemented in the dental office environment.

Perspectives of African Americans and dentists concerning dentist–patient communication on oral cancer screening

Objective Mortality rates for oral cancer have not improved appreciably in decades, with Blacks less likely than others to survive 5-years post-treatment. Oral cancer is the fifth most common cancer among African American males, representing a pressing public health concern. This study compared how dentists and African American adults view the current state of dentist–patient communication regarding oral cancer and its detection. Methods Five focus groups with 56 African American adults and two focus groups with 17 dentists were conducted in order to compare responses regarding oral cancer information needs and dentist–patient communication on oral cancer screening. Results African American adults showed little knowledge about oral cancer and cancer screening, and great need for information. However, dentists reported rarely engaging in information exchange with their patients even while performing the examination. Conclusion African Americans’ request for screening information and dentists’ reticence about performing the screening and initiating communication with patients indicate a need for both public education on oral cancer and improved continuing education courses for dentists. Practice implications The dental care community should develop clear guidelines for communicating with patients about oral cancer and engage in continuing education on oral cancer screening procedure. Increased public health efforts aimed at increasing oral cancer awareness and knowledge among the public are warranted.

Psychological considerations for complete denture patients

One of the most important factors in the diagnosis of prosthodontic patients is their mental attitude. This is not a mechanical or biological problem. It requires understanding of people and the ways in which they may react to situations. Dentists can use their training in psychology to detect patients' attitudes and reactions during diagnostic appointments. They can then modify their own attitudes and reactions so that mutual confidence can be established. This article reviews the importance of personality in dentist-patient communication and of the psychosomatic component in prosthodontic treatment.

Dentist‐patient communication in the multilingual dental setting

Communication between dentists and patients can be exceptionally challenging when the patient and the dentist do not speak the same language, as is frequently the case in multicultural Australia. The aim of this study was to describe the issues involved in dealing with limited-English speaking patients in order to formulate recommendations on how to improve dental communication. A cross sectional study was performed using a postal survey to Australian Dental Association member dental practitioners in Western Australia. Responses were collated and data analysis was performed using SPSS 11.5 for Windows. Most respondents encounter language-related communication barriers weekly or monthly, and the most satisfactory method of communication is informal interpreters. Despite reporting satisfaction working with professional chairside interpreters or dental staff interpreters, most respondents did not use them. The most common alternative communication methods were diagrams and models. Endodontics and periodontics provided the greatest challenge in communication. Informed consent was reportedly compromised due to language barriers by 29 per cent of respondents. Recommendations to improve communication included access to interpretation services, dentist technique/attitude to communication and patient preparedness for English-speaking encounters. Many respondents do not utilize the preferential communication methods, creating a potential compromise to both informed consent and the patients' best interests. The use of professional interpreters is recommended, and discussion should be supplemented with means of non-verbal communication. Dentists require access to lists of multilingual dentists and greater awareness of interpretation services to improve multilingual dentist-patient communication.

Emergency dental services — patient expectations

Objective To describe the expectations of walk-in patients seeking emergency dental care out-of-hours. Basic design Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the 'framework' method of applied qualitative data analysis. Subjects and setting Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend. Results In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological — especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary. Conclusions Emergency dental services, some of which are still dominantly treatment-focussed, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group.

Patient expectations of emergency dental services: a qualitative interview study.

To describe the expectations of walk-in patients seeking emergency dental care out-of-hours. Consecutive patients attending two emergency dental clinics at weekends were interviewed prior to seeing the dentist. The audio-recorded interview transcripts were analysed using the "framework" method of applied qualitative data analysis. Forty-four walk-in emergency dental patients at a community-based dental clinic and a dental hospital emergency clinic at the weekend. In addition to symptom relief, the main desired outcome for emergency dental patients may be informational and psychological--especially reassurance that the problem is not serious, and reduced uncertainty about the cause of the pain. In general, patients' stated expectations for specific treatments (such as antibiotics, or tooth extraction) were not absolute: rather, they implied these expectations were conditional upon the dentist deciding they were necessary. Emergency dental services, some of which are still dominantly treatment-focused, should reflect that many emergency dental attenders want advice and reassurance as much as relief from symptoms. This reinforces the importance of effective and sympathetic dentist-patient communication within emergency or out-of-hours consultations. It also implies that dentists' skills in listening, explaining and reassuring should be captured in any patient satisfaction or outcome measure designed for this patient group.

Beliefs about professional ethics, dentist–patient communication, control and trust among fearful dental patients: the factor structure of the revised dental beliefs survey

The revised version of the Dental Beliefs Survey (DBS‐R), intended to measure three dimensions of the patient–dentist relationship as perceived by the patient, namely Ethics, Communication and Control, was tested in a confirmatory factor analysis. Five different models for the internal structure of the questionnaire were tested. The final model, a 5‐factor solution, basically including the 3 assumed dimensions as well as the re‐introduced dimension Trust covered in the first version of the DBS plus a global factor including all items, yielded an acceptable fit. This model also omits 4 items from DBS‐R, i.e. items 3, 11, 18, and 28. The reduced DBS‐R is recommended for clinical use when assessing the patient's perception of the relationship to the dentist, including both trust and ethical behavior.

Development and evaluation of a cd‐rom to support student learning in dentist–patient communication

The interaction between dentist and patient is central to the provision of effective healthcare. A multidisciplinary team containing expertise in the social and behavioural sciences, medicine, dentistry, education and information technology was formed to design a CD‐ROM to support more traditional teaching and learning in this area. The final version of the program consists of a ‘virtual’ patient from whom students are asked to take a medical history. The ‘patient’ interacts with the student and responds to the style of their questioning by changes in anxiety, or degree of annoyance. To date, the CD‐ROM has been evaluated in two stages. The first stage was a predictive formative evaluation by the research/development team, and the second stage was a formative evaluation by 144 dental students of the first full prototype. A third stage, to be conducted next year, will involve measuring the longer term impact of the CD‐ROM through the assessment of students' abilities to communicate with patients. The evaluation had two components: students made rates of how useful and easy to use they found the program, and students' attitudes towards interacting with patients were evaluated adopting constructs from the theory of Planned Behaviour. Students were positive about the use of the CD‐ROM, though they requested some changes in the functionality of the program. Compared to a sample of students who had not used the CD‐ROM, the students who used the CD‐ROM felt more positive about communicating with their patients, at the end of the course, and expressed stronger intentions to communicate well with patients. We conclude that the CD‐ROM we have developed in a useful adjunct to learning in dentist–patient communication.

A Qualitative Analysis of Patient-Centered Dentistry in Consultations with Dental Phobic Patients

Dental phobia is regarded as one of the greatest obstructions to adequate dental care. It has long been established that fearful dental patients are particularly sensitive to dentists' behavior and performance of dental care. There is a need for the establishment of a systematic theory of dentist-patient communication and new methods analyzing how dentists interact with their patients. In this qualitative study, thirty semi-structured interviews were conducted in 1998 and 1999 with five dentists (three male and two female). Dentists consulted on two occasions with 15 newly enrolled, consecutive dental phobic patients (2 male and 13 female) in a Swedish clinic specializing in the treatment of odontophobia. The time interval between consultation one and two was approximately 2-3 weeks. Analysis of the transcribed interviews was based by the principles of Grounded Theory. The study identified one core category, "Holistic perception and understanding of the patient", two categories, "The dentist's positive outlook on people" and "The dentist's positive view of patient contact", and six further subcategories. Findings support previous models of patient-centered medicine and contribute to a better understanding of how patient-centered dentists interact with dental phobic patients.

Patient Satisfaction with Three Dental Speciality Services: A Centre-Based Study

Objective: To assess the level of patient satisfaction with three dental speciality services: oral surgery, periodontics, and fixed prosthodontics. Subjects and Methods: A sample of 1,242 patients, aged 16 years and over who received dental care at least twice at the main dental centre, Al-Amiri, Kuwait, were interviewed during May–August 1998 by independent researchers concerning their experience of previous visits. Patients reported their level of satisfaction on a 5-point Likert scale for the items in the questionnaire, which focused on four areas: access, dentist’s communication, staff helpfulness, and structural aspects of the practice. Results: On average 49.4% (25.9–89.6%) of participating patients rated the level of care received as excellent. Areas rated poorest included waiting time for an appointment and waiting time in the clinic to access the dentist. Participants were less satisfied with doctor’s explanation of illness, dental treatment and confidentiality of medical records. The areas that received excellent ratings by patients included: (a) communication (listening and understanding complaints 40.0% and courteous treatment 57.8%), and (b) structural aspects (availability of infection control and safety measures 89.6% and packed sterilized instruments 78.9%). Conclusion: Findings indicate that the level of patient satisfaction was reasonably high. Areas identified as needing improvement included: dentist-patient communication skills, medical records, appointment systems, and shortening of the waiting time to access the dentist.

“Tooth worms”, poverty tattoos and dental care conflicts in Northeast Brazil

While medical anthropologists have studied doctor–patient clinical conflicts during the last 25–30 years, dentist–patient communication clashes have received scant attention to date. Besides structural barriers and power inequities, such conceptual differences further dehumanize dental care and lower service quality. Potential for dentist–patient discordance is greater in developing regions—such as Northeast Brazil—where there exists a wider socio-economic gap between professionals and laypersons. A critical anthropological evaluation of oral health services quality is undertaken in two rural communities in Ceará, Brazil where the PAHO-inspired Local Oral Health Inversion of Attention Program was implemented in 1994. This 6-month qualitative field study utilized ethnographic interviews with key informants, participant-observation and projective techniques to probe professionals’ and patients’ explanatory models (EMs) of oral health. Despite the recent expansion of services into rural regions, the authors conclude that the quality of dental care remains problematic. Patients’ culturally constructed EMs of teeth rotted ( estraga) by “tooth worms” ( lagartas) differ substantively from dentists’ model of dental decay by Streptococcus mutans. “Exploding chins” ( queixo estourado), “spoiled, rotting teeth” ( dente pôdi) and “false plates” or teeth ( chapas) tattoo and stigmatize the poor, reinforcing gross class inequities. Dentists’ dominant discourse largely ignores lay logic, ridicules popular practices and de-legitimates, even castigates, popular healers despite their pivotal role in primary oral health care. Poor parents are not only barred from clinics but are blamed for children's rotten teeth. In sum, universal access to dental care is more a myth (even nightmare) than a reality. Dentists all too often “avert”—not “invert”—attention from poor Brazilian patients. In order to improve oral health in this setting, both “societal decay” and bacteria-laden plaque deposits must be removed.

Factors affecting dental attendance following treatment for dental anxiety in primary dental care.

To explore factors affecting patients' dental attendance behaviour following referral from a dental anxiety clinic to a general dental practitioner. A four-year follow up of patients who completed a course of treatment for dental anxiety by conducting semi-structured interviews, face-to-face or by telephone, with confirmation of dental attendance from the dental records. Forty-one patients who had completed a course of treatment for dental anxiety, in a specially designed community clinic. Mean time since last dental visit before treatment was 7.8 years (range 0.5-29). Twenty-three patients were successfully followed up and 11 (47%) were receiving regular asymptomatic dental care. The dental anxiety scores of those who subsequently became asymptomatic attenders were significantly lower at follow-up than the patients who became symptomatic attenders (P = 0.01). Effective dentist-patient communication was a common theme of the interviews. At four-year follow-up, dental anxiety was substantially lower in those who subsequently became asymptomatic attenders than those who became symptomatic attenders. A positive dentist-patient relationship had developed with the asymptomatic attenders.

A method for communication analysis in prosthodontics

Particularly in prosthodontics, in which the issues of esthetic preferences and possibilities are abundant, improved knowledge about dentist patient communication during clinical encounters is important. Because previous studies on communication used different methods and patient materials, the results are difficult to evaluate. There is, therefore, a need for methodologic development. One method that makes it possible to quantitatively describe different interaction behaviors during clinical encounters is the Roter Method of Interaction Process Analysis (RIAS). Since the method was developed in the USA for use in the medical context, a translation of the method into Swedish and a modification of the categories for use in prosthodontics were necessary. The revised manual was used to code 10 audio recordings of dentist patient encounters at a specialist clinic for prosthodontics. No major alterations of the RIAS manual were made during the translation and modification. The study shows that it is possible to distinguish patterns of communication in audio-recorded dentist patient encounters. The method also made the identification of different interaction profiles possible. These profiles distinguished well among the audio-recorded encounters. The coding procedures were tested for intra-rater reliability and found to be 97% for utterance classification and lambda = 0.76 for categorization definition. It was concluded that the revised RIAS method is applicable in communication studies in prosthodontics.

Stroke and the Denial Patient

This article alerts dental practitioners to the challenge of working with patients who have suffered a cerebrovascular accident. The stroke patient struggles with many physical, neurological and psychosocial problems and needs effective dentist-patient communication. Specific techniques are presented to help the dental team interact more productively.

A simple procedure to assess esthetic preference for dentofacial treatment

A procedure is described in which lateral facial photographs were cut apart and reassembled in ways that approximated desired esthetic change. Two groups of subjects were asked to complete the Sassouni “cut-up-paste-back” procedure. Group 1 consisted of 20 adult dental professionals; group 2 comprised 18 college students unacquainted with dental studies. Both groups made similar alterations on a photograph at the beginning and at the end of a 2-week period. Photographic alterations were highly similar to written descriptions of intended changes. The “cut-up-paste-back” procedure is a simple and inexpensive way to facilitate dentist-patient communication during treatment planning. The procedure also has applicability for research in facial esthetic preference.

Communication tendencies of senior dental students

Although the importance of dentist-patient communication is generally recognized, the dental literature does not specify what interpersonal behaviors can be used as a basis for evaluating dental students' communication skills. A set of behaviors based on clinical observations is described, and an evaluation of 25 senior students' behavioral skills is presented. Students often did not: (1) spend much time orienting patients before beginning treatment; (2) update medical histories; (3) ask patients if they had any questions before beginning treatment; (4) explain the operation and use of equipment; (5) forewarn patients about uncomfortable procedures; (6) attend to signs of patient discomfort; (7) reinforce praiseworthy patient behavior; (8) caution patients about numbness, chewing, and sensitivity; (9) thank patients for their time; and (10) use leading/motivating questions. There is a need to provide students with systematic feedback on their interpersonal behaviors.