Dentist-patient communication: a review of relevant models

Determinants of Dentist-Patient Relationships: A Scoping Review

OBJECTIVES

The dentist-patient relationship (DPR) is considered to be a key element in dental clinical settings. This scoping review aimed to examine the extent of previous research on DPR, focussing on its determinants for the reification of the construct.

METHODS

This research was directed by the guidance for systematic scoping reviews from the Joanna Briggs Institute. The inclusion/exclusion criteria were based on participants of general adults and dentists, the concept of determinants of DPR, and the context of dental health care encounters. A literature search was performed in 6 major electronic databases in July 2023. Key information from included articles was extracted to chart the results, mainly to identify the determinants of DPR. Each determinant of DPR was classified according to the conceptual model of DPR.

RESULTS

A total of 1727 records were initially identified, and 16 articles were included in the review. Nine studies used a quantitative method and 7 were nonempirical articles. All but 2 articles were from the perspective of patients. Factors were grouped into 6 main domains: dentist, patient, society/environment, clinical structure, clinical process, and outcome. Amongst the 6 domains of DPR, most determining factors were related to the clinical process. "Communication" was most frequently counted, at 8 times, followed by "trust" (frequency, 6). At the patient level, "dental fear/anxiety" was frequently used to measure DPR.

CONCLUSIONS

Previous literature about DPR indicated a few common and dentistry-specific determinants from the patient perspective. Further studies are encouraged to develop a more comprehensive framework and evaluation scale of DPR.

A study of dentists' explanations and patient-dentist communication among older adults in Japan

BACKGROUND

In recent years, the proportion of elderly people in the total patient population has been increasing owing to the rapid aging of Japanese society. However, little is known about the age-specific healthcare communication challenges within the field of dentistry. Therefore, this study aimed to examine the relationship between dentists' explanations and patient-dentist communication among elderly patients.

METHODS

The study included 146 dentist-elderly patient pairs from Fukuoka Prefecture, Japan. A questionnaire was administered to pairs of dentists and patients. The survey was conducted between June 2021 and April 2022. We examined the relationships among the survey items: dentist demographics, patient demographics and sufficiency of the dentist explanations, and patient-dentist communication. The logistic regression analysis was conducted to examine the patient's mode of visiting the dentist as the objective variable, sufficiency of the dentist explanations, patient-dentist communication, dentist, and patient factors as explanatory variables.

RESULTS

About 30% of patients felt that explanations of "Comparison with other treatment methods," "Treatment period," and "Treatment prognosis" were not sufficient. Among these items, a significantly higher percentage of respondents found the dentist's explanations sufficient when they were treated by more than one dentist. Many good communication factors were significantly associated with the dentist being younger and having a preventive practice. Multivariate analysis revealed a significant association between sufficiency of the dentist explanations and patients' regular dental visits.

CONCLUSION

Adequate explanations by dentists for elderly patients were significantly associated with the dentist factor. Improving the quantity and quality of the dentists' explanations of treatment may improve patient satisfaction and promote regular dental visits.

An insight into clinicians' practices in breaking bad news of oral cancer diagnosis

Communication is an integral component of effective healthcare delivery to patients, and this includes breaking bad news (BBN). However, clinicians in dentistry are rarely exposed to diseases that can negatively and seriously affect an individual's view of their future and pose a mortality risk, except for oral cancer. The aim of this study was to assess clinician practices in BBN of oral cancer diagnosis in Malaysia. An exploratory sequential mixed-methods study design was used. A qualitative study was conducted among 12 clinicians to gather relevant information regarding their practices in BBN of oral cancer diagnosis using a descriptive-interpretive approach. The themes that emerged were preparation for BBN, BBN setting, communication, emotional aspects, and summarizing the session. These themes were used to develop a questionnaire with 34 items. In the quantitative study, this questionnaire was sent to 87 clinicians who had experienced BBN of oral cancer diagnosis in the past 5 years; the response rate was 100%. An arbitrary cut-off score between the third and fourth quartiles was set to distinguish 'good' and 'poor' practice in BBN among the clinicians. The data analysis was performed using IBM SPSS Statistics version 23.0. Overall, at least two-thirds of the clinicians had good practices in BBN of oral cancer diagnosis. The clinicians' designation (oral and maxillofacial surgery consultant/specialist vs dental officer) and BBN experiences were factors associated with their practices in BBN of oral cancer diagnosis.

Contemporary dental student professionalism: moving towards a macro-level perspective

Defining professionalism and developing educational interventions that foster and assess student professionalism are integral to dental education. Nevertheless, conceptual, methodological and pedagogic differences define the academic field, leaving students, educators and the profession itself struggling to make meaningful progress on how best to elicit and monitor dental student professionalism. This article proposes that more progress can be made on this important issue when a contextualised, sociological assessment of dentistry and dental professionalism is undertaken. We contend that identifying some of the socio-cultural demands in UK dental students' lives, and acknowledging how these pressures shape their interactions with the UK dental education system, provides a nuanced and contemporaneous understanding of what it means to be an oral health care professional at a time of social and health care upheaval. Dental educators can use this insight to work towards being more understanding of and responsive to dental student professional development.

Maximizing Student Clinical Communication Skills in Dental Education—A Narrative Review

Dental student training in clinical communication skills and behavioral aspects of treatment are lauded as clinically meaningful in the dental education literature. However, many dental school curricula still only provide didactic, one-time coursework with multiple choice examination assessment and little or no student skill-activating activities. This article aims to review literature relevant to optimizing clinical communication and behavioral skills in dental education. The review summarizes findings of several relevant reviews and usable models to focus on four themes: (1) special characteristics of dentistry relevant to communication skill needs, (2) essential components of dental student learning of communications skills, (3) clinical consultation guides or styles and (4) optimal curricular structure for communication learning effectiveness. Contexts of communications in the dental chair differ from medical and other allied health professions, given the current mostly dentist-dominant and patient-passive relationships. Patient-centered communication should be trained. Dental students need more practical learning in active listening and patient-centered skills including using role-play, videotaping and ultimately, real patient training. Medical consultation guides are often unwieldy and impractical in many dental contexts, so a shortened guide is proposed. Communication skills need to be learned and taught with the same rigor as other core dental skills over the entire course of the dental curriculum.

[Oral health competence and its communication in "talking dentistry"]

The concept of health literacy has received much attention in recent years. Essential approaches are the provision of health information, teaching through educational programs, and transfer via communication techniques. From a dental point of view, the individual discussion between patient and dentist is of particular importance ("talking dentistry").The aim of our article is to present the current state of knowledge on the relationship between oral health literacy and talking dentistry, to present existing concepts for teaching communicative competencies, and to identify the further need for action from the point of view of the German Dental Association. Several health psychology models emphasize a positive relationship between oral health literacy, oral health behavior, and oral health. Further determinants seem to be the patient's self-efficacy beliefs and the individual interaction with the dentist. Therefore, it seems purposeful to intervene in an occasion-related manner in the sense of talking dentistry. The personal conversation between dentist and patient can cover counselling, education, motivation, and practical guidance and can lead to participatory decision-making.Offers for learning and deepening communication techniques represent important aids for the practice. Some are presented in this article as examples. However, in order to establish talking dentistry on a broad level, more far-reaching offers and incentives are needed. Through our suggestions, we would like to show ways in which talking dentistry can be further promoted and consolidated as an integral part of dental care.

A Presentation of Central Communication Aspects in the Patient-Provider Relationship-Potential Learnings for Community Pharmacists

Several studies have shown that communication between patients and HCPs is still not optimal in integrating patients’ perspectives on how best to manage their diseases and their medication. One such area where encounters between patients and professionals still needs to develop to better incorporate the patient’s perspective is pharmacy practice. The aim of this study was therefore to explore and present new typologies and communication aspects of HCP-patient relationships since a comprehensive literature search in 1997 conducted by Sondell and Söderfeldt, and relate the findings to pharmacy practice. In total, 11 articles were identified by applying the techniques of a purposeful literature search. The articles covered aspects of: shifting and adapting roles during the encounter, techniques to ensure individualizing in the encounter, avoiding inappropriate routines, coping with internet-informed patients, achieving mutual goals, dealing with uncertainty including avoiding rigid preconceptions, using social conversation, incorporating patients’ prior experiences, aligning language, adapting greetings and exploring the cultures and communication patterns of patients from other ethnic backgrounds. The variety of these communication aspects points to the immense complexity of communication as a practice discipline. This article has presented some of the literature that pharmacists can consult, in the endeavor of improving their communication practices.

Patient autonomy in dentistry: demonstrating the role for shared decision making

Background

Evidence-based practice, decision aids, patient preferences and autonomy preferences (AP) play an important role in making decisions with the patient. They are crucial in the process of a shared decision making (SDM) and can be incorporated into quality criteria for patient involvement in health care. However, there are few studies on SDM and AP in the field of dentistry. This study explored patients’ autonomy preferences in dentistry in comparison to other medical domains, comparing them with patient preferences in two other cohorts of patients with different conditions and in different health care settings.

Methods

A sample of 100 dental patients attending 16 dentists was consecutively recruited in a university-based prosthodontic clinic. Patients’ and dentists’ preferences regarding their roles in dental decision making for commonly performed diagnostic and treatment decisions were compared using the Control Preference Scale (CPS). This was followed by cross sectional surveys to study autonomy preferences in three additional cohorts recruited from general practices (n = 100), a multiple sclerosis clinic (n = 109), and a university-based prosthodontic clinic (n = 100). A questionnaire with combined items from the Autonomy Preference Index (API) to assess general and the CPS to assess specific preferences was used in the additional cohorts.

Results

Dentists were less willing to give patients control than patients were willing to enact autonomy. However, decisions about management of tooth loss were considered relevant for a shared decision making by both parties. When comparing cohorts from different samples, the highest AP was expressed by people with multiple sclerosis and the lowest by patients in dentistry (means: dentistry 2.5, multiple sclerosis 2.1, general practice 2.4, p = .035). There were considerable intra-individual differences in autonomy preferences referring to different decision types (p < .001). In general, more autonomy was desired for treatment decisions in comparison to diagnostic decisions, for trivial compared to severe conditions, and for dental care compared to general practice (all: p < .001).

Conclusion

There is an important role of patient participation in decision making in dentistry. Furthermore, PA should be considered with respect to specific medical decisions instead of assessing autonomy preferences in general implying a need for communication skills training of health care professionals.

Patient satisfaction with dental treatment at a university dental clinic: A qualitative analysis

PURPOSE/OBJECTIVES

The aim for this study was to identify important factors influencing patient satisfaction in a university dental clinic, through qualitative analysis.

METHODS

From June 1, 2014 to January 30, 2018, 7827 patient satisfaction surveys were collected. A thematic analysis was conducted on the 10,956 patient responses to 3 open-ended questions. A thematic coding dictionary was inductively developed using thematic analysis managed with MAXQDA 2018 Standard, a qualitative data management software program.

RESULTS

The thematic dictionary included 12 categories, developed from 48 working codes, and enabled the patient annotations to be grouped and sorted based on common themes to highlight significant aspects of the patient experience. Four notable themes that emerged from patient comments include: (1) satisfaction with the emotional care felt during their appointments; (2) satisfaction with skills and treatment provided and the connections made with various personnel; (3) the importance of establishing and maintaining patient expectations throughout their care; and (4) the high value patients place on clear communication with the patient, as well as the communication between departments, dental student and faculty, providers, and front desk.

CONCLUSION

The results of this study highlight 12 key themes related to the patient experience at the College of Dentistry from the patients' perspective. These data provide insight into aspects of the dental experience that have a large effect on patient satisfaction. With this knowledge, steps can be taken to enhance the patient experience and, therefore, help dental schools move further in the direction of person-centered care.

Communication-based behaviour support for adults with intellectual disabilities receiving dental care: A focus group study exploring dentists' decision-making and communication

A better understanding of how communication-based behaviour supports are applied with adults with intellectual disabilities may reduce reliance on restrictive practices such as holding, sedation and anaesthesia in dentistry. In this study, we explore how communication is used by dentists who provide treatment for adults with intellectual disabilities. A descriptive qualitative study, adopting synchronous online focus groups, was undertaken with six expert dentists in Ireland. Members were contacted again in pairs or individually for further data collection, analysed using thematic content analysis. Two relevant categories emerged from the data, relating to the selection and application of communication-based behaviour support for adults with intellectual disabilities. Decision-making processes were explored. Building on these categories, a co-regulating process of communication emerged as the means by which dentists iteratively apply and adapt communicative strategies. This exploration revealed rationalist and intuitive decision-making. Implications for education, practice and research are identified.

Dog-Assisted Therapy and Dental Anxiety: A Pilot Study

Simple Summary

The participation of animals, specifically dogs, in therapeutic activities has been demonstrated to improve individuals’ physical and mental health. However, few investigations have been carried out in the area of dentistry. This study was conducted to evaluate the effect of dog-assisted therapy for individuals with a history of anxiety related to dental visits. During preventative dental procedures (cleaning), a therapy dog accompanied the participant. After this intervention, people reported lower perceived discomfort at dental visits. The participation of therapy dogs in this area of health could help improve people’s experiences in dental offices.

Abstract

Animal-assisted therapy aimed at improving individuals’ mental or physical health has been widely reported. However, the data on how a therapy dog could help control anxiety during dental procedures is scarce. The objective of this work was to evaluate the effect of dog-assisted therapy on people with a history of dental anxiety while receiving preventive dental treatment. Twelve adults participated (women: n = 11 (91.7%) and men: n = 1 (8.3%), mean age = 31.25 years, D.E. = 5.78). The Corah Dental Anxiety Scale was applied, the patient’s mood was assessed with a Likert scale before and after receiving the dental treatment, and their blood pressure was recorded for each of the three stages of treatment. A therapy dog accompanied the participants during the dental procedure. The main results indicated that a decrease in discomfort was perceived during the intervention, and there was also an improvement in the patient’s evaluation of the experience. The results are based on the decrease in patients’ blood pressure when taken in the middle of the dental treatment.

Dentists' perceptions of a practical model of patient-centred care: providing information and choice in a dental consultation

Adopting a patient-centred approach when engaging with patients has been linked to positive outcomes in medicine. However, in the field of dentistry, patient-centred care (PCC) has been understudied. The aim of this study was to explore dentists' opinions about the usefulness of a theoretical model of PCC and its applicability to a dental setting. Twenty semi-structured interviews were conducted with dentists working at a major university hospital in south London. The interviews were audiotaped and analysed using thematic analysis. The analysis showed that dentists found the PCC model to be useful for practical application but mostly for 'other' dentists. They viewed the lowest and highest levels of PCC that the model advocates as 'out-dated' and 'ideal', respectively. Dentists felt that giving patients full choice and control over their treatment was not applicable to everyday clinical practice. They expressed that a tool developed on the basis of this hierarchy of PCC could be useful for self-assessment purposes, although with some reservations. In conclusion, dentists seemed to embrace the practice of PCC and felt that their provision of PCC was at an acceptable standard. They believed that a moderate level of information and choice was most suitable for patients.

A communication-focused curriculum for dental students - an experiential training approach

BACKGROUND

Successful interaction and communication with patients is as vital for dentists as it is for physicians. Therefore, the aim of this study was the development and evaluation of an interactive, experiential training curriculum with an emphasis on communication for dual degree seekers of medicine and dentistry.

METHODS

A pre-clinical course with an emphasis in physician/dentist-patient communication and interaction was adapted by a team of subject experts based largely on the propositions of Experiential Learning Theory. After attending the course, dental students (N = 81) rated the course on a Likert- style scale and answered two open questions.

RESULTS

Students found the interactive course curriculum to be very helpful and vital. Many students reported that their initial interest in the course was mainly because it is a dual degree requirement, but later on rated the course as highly important in terms of later physician/dentist-patient interaction. One aspect of the curriculum course participants regarded as very important, yet neglected during dental studies, was (self-) perception.

CONCLUSION

In the view of dental students, the rigorous structure of the pre-clinical dental curriculum does not allow for time spent on topics such as (self-) perception and awareness, but training one's ability to self-reflect and think critically about one's own actions, conduct or position can aid with advanced medical and dental studies and practices later on. Experiential courses with an emphasis on patient-physician/dentist communication should be offered early on during pre-clinical medical and dental studies as a regular part of the curriculum.

Association Between Dentist-Dental Hygienist Communication and Dental Treatment Outcomes

Communication between physician and patient is critical in all fields of medicine, and various types of communication exist in healthcare settings. Cooperation among healthcare professionals is thought to be essential in providing high-quality services. Dental hygienists are key team members in the provision of dental care, and are known to play an important role in the health of their patients. This study aimed to determine the effect of communication between dentists and hygienists on patient satisfaction. Study subjects were dentists, patients, and dental hygienists, and we examined how dentist-dental hygienist communication affected patient outcome indices. A significant difference was observed only for satisfaction in terms of meeting expectations (p = 0.035). Results for patient satisfaction indicated significant differences in explanatory behavior in dentist-dental hygienist evaluations (p = 0.001). The results showed improved health and reduced fear, indicating significant differences for the dentist-dental hygienist evaluations in explanation behavior (p = 0.016). Our evaluation of the effects of dentist-dental hygienist communication on patient outcomes indicated a significant correlation, suggesting that inter-professional communication in the field of dentistry affects patient satisfaction.

Healthcare professional-patient relationships: Systematic review of theoretical models from a community pharmacy perspective

OBJECTIVE

To identify health care professional-patient relationship theoretical models and individual factors that may have an influence on this relationship and be relevant to community pharmacy practice.

METHODS

Using the recommended methodology by Prisma Statement, a search was undertaken in PubMed for health care professional-patient relationship theoretical models that included individual factors.

RESULTS

Eight theoretical models met the inclusion criteria. These models were classified based on their aim, their focus on the interaction process, external factors influencing the process, and their practical applications. The most common influential modifiable factors were knowledge, needs, values, expectations, beliefs and perceptions.

CONCLUSION

'The Theory of Goal Attainment' (TGA) appears to be the most useful model for community pharmacy practice. The perceptions and expectations of both patients and pharmacists could be the two most interesting modifiable factors to apply in pharmacy practice. These modifiable influential factors could be altered by specific training such as behavioral aspects.

PRACTICE IMPLICATIONS

No theoretical model has been specifically developed for analyzing the community pharmacist-patient relationship. TGA may be appropriate for community pharmacy practice, since it takes into consideration both, attaining patients health outcomes, as well as improving patient-pharmacist relationship.

A review of communication models and frameworks in a healthcare context

This paper reviews six key communication models and frameworks in healthcare contexts. Comparison suggests key inter-relationships between the different stages of the clinical consultations. Implications are identified for future study in healthcare provider-patient communication. Clinical Relevance: To understand the healthcare provider-patient interaction through communication models.

Denture wearer's perception of ambient care. Part 2. Analyses of data

OBJECTIVE

The aim was to investigate to what extent denture wearers were satisfied with the ambient care (care) received.

MATERIALS AND METHODS

A study sample of 117 completely edentulous and 56 partially edentulous patients, who had received their dentures in the period 1997-2005 at Bergen School of Dentistry, completed a questionnaire containing eight specific items regarding different aspects of care, each with two positive (a and b) and two negative (c and d) categories, and four global items. The care items, including confidence in the dental team, information, waiting time and cost, constitute the Ambient Care Scale; the global items were concerned with overall care, satisfaction with dentures, self-reported oral and general health.

RESULTS

Between 91-100% of Ambient Care Scale responses were in the two positive categories. The completely edentulous group was significantly more satisfied than the partially edentulous group regarding several Ambient Care Scale items and oral health. Also, ratios between categories b and a showed systematic higher degrees of satisfaction for the completely edentulous group than the partially edentulous group. Fifty-six per cent in the completely edentulous group and 36% in the partially edentulous group were very satisfied, i.e. with ≥ 6 of 8 possible responses in category a. Analysis of the very satisfied showed that the highest degrees of satisfaction for both groups were found regarding students and staff, the lowest regarding cost and waiting times.

CONCLUSIONS

Patient satisfaction with care was very high. Completely edentulous patients were systematically more satisfied than partially edentulous ones.

Denture wearer's perception of ambient care, part 1: validation of a preliminary scale

OBJECTIVE

The aim of the present study was to investigate if a preliminary Ambient Care Scale (ACS), intended to measure ambient care in complete denture wearers, had acceptable reliability and validity.

MATERIALS AND METHODS

A sample of 117 patients who had received complete dentures in both jaws in the period 1997-2005 at Bergen School of Dentistry completed a questionnaire containing eight items regarding the patients' relationship with the student and clinical personnel, to what extent they were informed and consulted during treatment, waiting times and cost. In addition, information was gathered regarding demographics, The Psychological General Well-Being index (WHO-5), global ambient care, satisfaction with dentures and how patients viewed their oral health.

RESULTS

Cronbach's alpha coefficient was 0.76 for the ACS, indicating acceptable internal consistency. From principle component analysis, three factors were extracted, correlating with ACS with coefficients of 0.72, 0.58 and 0.59, respectively. Acceptable construct validity was indicated by the fact that items were formulated by common agreement among three experienced prosthodontists, the extremely low frequency of missing data (<2%) and that ACS, as expected, was able to discriminate between patients satisfied and dissatisfied with their dentures (p = 0.005) and oral health (p = 0.042), but not between those who had high or low WHO-5 scores (p = 0.77).

CONCLUSIONS

The ACS appears to have acceptable psychometric properties.

Experiences of dental care: what do patients value?

BACKGROUND

Dentistry in Australia combines business and health care service, that is, the majority of patients pay money for tangible dental procedures such as fluoride applications, dental radiographs, dental fillings, crowns, and dentures among others. There is evidence that patients question dentists' behaviours and attitudes during a dental visit when those highly technical procedures are performed. However, little is known about how patients' experience dental care as a whole. This paper illustrates the findings from a qualitative study recently undertaken in general dental practice in Australia. It focuses on patients' experiences of dental care, particularly on the relationship between patients and dentists during the provision of preventive care and advice in general dental practices.

METHODS

Seventeen patients were interviewed. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.

RESULTS

Patients described their experiences when visiting dental practices with and without a structured preventive approach in place, together with the historical, biological, financial, psychosocial and habitual dimensions of their experience. Potential barriers that could hinder preventive activities as well as facilitators for prevention were also described. The offer of preventive dental care and advice was an amazing revelation for this group of patients as they realized that dentists could practice dentistry without having to "drill and fill" their teeth. All patients, regardless of the practice they came from or their level of clinical risk of developing dental caries, valued having a caring dentist who respected them and listened to their concerns without "blaming" them for their oral health status. These patients complied with and supported the preventive care options because they were being "treated as a person not as a patient" by their dentists. Patients valued dentists who made them aware of existing preventive options, educated them about how to maintain a healthy mouth and teeth, and supported and reassured them frequently during visits.

CONCLUSIONS

Patients valued having a supportive and caring dentist and a dedicated dental team. The experience of having a dedicated, supportive and caring dentist helped patients to take control of their own oral health. These dentists and dental teams produced profound changes in not just the oral health care routines of patients, but in the way patients thought about their own oral health and the role of dental professionals.

Patient satisfaction in prosthodontic treatment: multidimensional paradigm

A number of different factors contribute to an efficient clinical outcome in prosthetic dentistry. Differences between patient's and prosthodontist's perception of treatment display great variability. Patient satisfaction in prosthetic dentistry is a multidimensional concept as is patient's perception of dental care. Patient satisfaction can be assessed if it is carefully defined. In the prosthodontic treatment context patient satisfaction can be expected to interact with the patient's entire life situation. This article highlights the issues that reflect the different dimensions of patient satisfaction in prosthodontic care.

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.

Form and semantics of communication in dental encounters: oral health, probability and time

The purpose of this article is twofold. First, it introduces a new method for capturing the intricacy of communication in contemporary healthcare encounters. The method, termed 'form analysis', was developed from the systems theory of Niklas Luhmann. It is hoped that the paper will introduce form analysis as a new method to help understand complex communications in health systems. Second, the paper demonstrates an application of form analysis in communications in dental encounters. Data were collected through 36 observed encounters between five dentists and 20 patients in UK NHS primary and secondary care dental clinics. The study found a range of semantic forms relevant for these encounters, three of which are discussed at length in this article. The forms of communications illustrate how the dichotomy of dental professional and patient perspectives transforms into complex, non-linear observations about oral health. Dentistry, it seems, remains up to date not only through the emergence of new technologies, but also through reflexivity in observing and assessing oral health. These observations are exposed to the contingency of clinical decisions and the temporal aspects of the clinical system.

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

PURPOSE

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.

METHOD

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.

RESULTS

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).

CONCLUSION

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.

Dentist preferences for patients: dimensions and associations with provider, practice, and service characteristics

Provider-patient relations may influence the nature of care provided. The aim of this study was to examine dentist preferences for patients, relate these to characteristics of dentists and practices, and to services provided. A random sample of Australian dentists completed mailed questionnaires (response = 60.3%). Four factor-based subscales and an overall scale (Selectivity) were derived from a 37-item battery. The 4 subscales comprised treatment adherence (behavior relevant to the treatment situation), personal adaptability (willingness to cooperate when expected to do so), social interactiveness (positive affect, communicativeness, and appreciativeness), and enabling characteristics (willing and able to pay, and good dental knowledge). Reliability was adequate (Cronbach's alpha = 0.71-0.90). Treatment adherence was associated with higher orthodontic rates, but a lower extraction rate; social interactiveness was associated with higher extraction and denture rates; personal adaptability was associated with higher orthodontic rates, but lower general/miscellaneous service rates; enabling characteristics was associated with higher endodontic and crown and bridge rates; selectivity was associated with higher rates of diagnostic, preventive, and total services per visit. The associations with service rates indicated that provider preferences were related to treatment behavior that could affect the mix of services, indicating that the nature of care provided may be influenced by the provider-patient relation.

Adolescents' views of oral health education. A qualitative study

The objective of this study was to investigate adolescents' perceptions and desires with respect to oral health education. A series of focus group sessions was conducted with adolescents in schools. The groups comprised an average of 6 individuals, with a total of 34 participants. The main themes of the discussions were the informants' perceptions of the oral health education in different settings and under varying circumstances. The discussions were transcribed verbatim and analyzed according to the basic principles of Grounded Theory. One of the most important issues appeared to be the dental personnel considering the individual as a subject and not as an object. The adolescents in the study were uncertain about their knowledge of oral health. Often, the participants expressed a wish to be taught more at the dental visit. Information in schools was sparse. The support of parents was acknowledged but little discussed. The methods used in advertisements to describe dental products were met with skepticism. These should not be imitated in oral health education as this might undermine the credibility of the dental services. Girls were perceived to be more interested in health than boys were. Two core categories labeled "credibility" and "confidence", which interacted continually, emerged from the data in the analysis. The results indicate that the credibility of the intermediary of the health messages is essential, as is their ability to create confidence. Thus, oral health education among adolescents is more likely to be successful when credibility and confidence are perceived.

Underlying dimensions of verbal communication between dentists and patients in prosthetic dentistry

The study explores whether the task-focused and socio-emotional dimensions of clinical communication is recognizable in the verbal communication context of prosthetic dentistry, as well as if there are other dimensions of communication in that context. Sixty-one audio recordings were made at three specialist clinics of prosthetic dentistry in Sweden. Sixty-one patients and 15 dentists participated. Sixty-one prosthetic rehabilitation periods were followed. Tooth- or implant-supported fixed prostheses were placed during this time. One visit near the end of each rehabilitation period was audiorecorded. The verbal communication was analyzed with the Roter Interaction Analysis System (RIAS)-dental. The categories were subjected to exploratory factor analysis. Patient and dentist verbal behavior could not be defined exclusively as socio-emotional or task-focused but had to be defined in other dimensions; Emotional exchange, information exchange-patient horizon, relation building exchange, information exchange-dentist horizon, and administrative and counseling exchange. Since the 'emotional exchange' factor was found to capture the largest share of the variance in the communicated patterns, the present study suggests that prosthetic care in dentistry is basically a human relationship with strong emotional communicative content.

Required qualifications in the Swedish Public Dental Health Service as indicators of organizational ideology

The manifestly required qualifications in job advertisements in the Journal of the Swedish Dental Association were analyzed as indicators of the organizational ideology in the Swedish Public Dental Health Service from the employers' viewpoint. All job advertisements that concerned dentists and managers on different hierarchical levels in general dentistry from January 1990 to December 1998 were included (n = 1152). The number of vacancies was 1856. The textual material was analyzed by content analysis, permitting quantitative descriptions of the text and analysis of the latent characteristics. Words and phrases were classified into categories on different levels of abstraction developed from the theoretical background and the purpose of the study. Altogether 5705 required qualifications were categorized. The inter-coder reliability of the first-level categorization resulted in 81% correspondence of the classification, and lambda = 0.90. Qualifications were more frequently required with higher hierarchical job positions, and personality characteristics were more frequent than technical competence and knowledge. Qualifications interpreted as related to economic goals occurred more frequently than those related to odontological goals. The qualification demands reflected the language of human resource management (HRM), emphasizing the 'soft' people-centered approach and was interpreted as an 'ideal' model of HRM. Dentists were regarded as a profitable organizational asset rather than participants in relations with patients. In conclusion, the results indicate an organizational ideology primarily of economic character.

Model of the dentist-patient consultation in a clinic specializing in the treatment of dental phobic patients: a qualitative study

Thirty semi-structured interviews were conducted with 5 dentists (3 male and 2 female) after first and second consultations with 15 newly enrolled dental phobic patients (2 male and 13 female) in a clinic specializing in the treatment of odontophobia. Analysis of the transcribed interviews was influenced by the principles of grounded theory. Five concepts/higher-order categories were grounded in the data: 1 core category: 'Relatedness, based on affective resonance and concordant roles' and 4 additional higher-order categories: 'the dental phobic patient's emotions'; 'the patient's verbal and non-verbal cues'; 'the dentist's role as a clinician: professional interpersonal skills'; and 'the dentist's role as a fellow-being: general interpersonal skills'. The model developed describes the dynamics of the dentist patient interaction and has a theoretical application.

A psychodynamic understanding of the dentist-patient interaction

This paper describes various elements of the dentist-patient relationship, how they interact and illustrates them with case studies.

Breaking bad news: a guide for dental healthcare professionals

During their professional career most dental practitioners will be faced with a situation in which they have to break 'bad news'. This article examines the communication skills involved in breaking bad news to patients. The process is broken down into three broad stages: preparation; discussing the information; and reviewing the situation. Within each of these stages specific and practical recommendations are given. The importance of recognising the impact which such interactions have upon the dental practitioner is emphasised.

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.

Does the quality of advanced prosthetic dentistry determine patient satisfaction?

In a clinical follow-up study 42 patients were selected from an original sample of 335 individuals who had undergone extensive prosthetic treatment. The selection was done in accordance with a treatment satisfaction measure. The selected patients' appliances were classified in accordance with the California Dental Association (CDA) quality assessment system. Altogether, most of the new reconstructions were rated as satisfactory. The removable partial dentures had a somewhat higher share of non-acceptable appliances according to the CDA criteria. There was an association between the CDA categories and patient satisfaction. Using logistic regression analysis and knowing the CDA rating, we could correctly classify 67% of the patients with regard to the satisfaction measure. The satisfaction measure was modified on the basis of an interview, improving the model to 83% correctly classified. It was concluded that the technical quality of the prosthodontic treatment was associated with patient satisfaction.