Strategies for Effective Dentist-Patient Communication: A Literature Review

Introduction

The success of high-quality dental care predominantly depends on the communication between dentist and patient. Dentist-patient communication is the process of sending, receiving, and interpreting information through verbal and non-verbal channels between dentists and patients.¹ In the modern global dental setting, dentist-patient communication can take place through either traditional face-to-face interactions or remote means of communication facilitated by telecommunication technologies. Telecommunication is an innovative method that holds immense potential for transforming the delivery of dental services. It is crucial that we fully embrace and utilize this telecommunication technology to improve the quality of dental care. Effective dentist-patient communication is a crucial element in oral healthcare delivery. It guarantees that patients receive the right dental care, comprehend their diagnoses and treatment alternatives, and feel supported throughout the entire process.² On the other hand, patients may not receive the appropriate dental care if there is insufficient communication. They may fail to comprehend their diagnoses and treatment options, and experience a lack of support over the course of the entire treatment. Furthermore, inadequate communication between dentists and patients significantly increases the risk of dental malpractice claims.^3–5 The field of dentistry has seen increased exploration in professional communication, largely because dental treatment choices are often perceived as more optional compared to medical treatment decisions. Furthermore, the rise of consumerism and a more informed public have led to a shift towards a more interactive communication dynamic.⁶ In fact, more dentists have been referring to the individuals they serve as “clients” instead of “patients”.⁶ This shift in perspective denotes that care receivers deserve greater involvement in the decision-making process regarding their oral care.

Self-Assessment of Communication Skills

Many practicing dentists believe that their communication style with patients is effective,^7,8 viewing the patient relationship as a critical element in developing trust. They often base this trust on principles of transparency, openness, and communication. Nevertheless, patients frequently report receiving contradictory information^9,10 and feeling neglected by the dentist’s response.¹¹ Additionally, they often express that they are unaware of the actions performed by the dentists during the oral examinations. To facilitate effective communication between dentists and their patients, it is beneficial for dentists to refer to a self-assessment tool for patient communication. The Canadian Dental Association developed a self-assessment tool for patient communication. The tool contains an essential checklist that helps dentists evaluate their communication skills when consulting with patients.¹² It is designed to remind dentists of the key elements of effective communication that they should incorporate into their consultations with patients. Table 1 is a simplified version of the self-assessment tool, consisting of nine closed-ended questions.

Table 1 Self-Assessment Tool of Communication Skills

Measuring Dental Satisfaction 

Patients who are satisfied with their dental experience tend to develop a strong sense of loyalty; and are more inclined to refer their friends and relatives.¹³ A dental satisfaction survey is an easy tool that dentists can use to identify areas for improvement in their dental practices. By addressing these areas, they can enhance patient care, foster patient satisfaction, and promote a harmonious working environment for their staff. Table 2 is a dental satisfaction questionnaire with 23 items to measure patient satisfaction.¹⁴ It is a multi-dimensional and comprehensive evaluation of dental satisfaction, apart from evaluating interpersonal quality. Patients’ satisfaction with their past dental care holds significance for their service utilization patterns.¹⁴ The study demonstrated that patients who were highly satisfied with their dental care exhibited improved compliance, fewer broken appointments, as well as reduced pain and anxiety. There is a growing acceptance that patients’ satisfaction should be one of the key factors in evaluating the quality of care. Patient satisfaction is often influenced by the healthcare system. It is crucial for clinicians to carefully monitor patient satisfaction due to the intricate relationship between patients’ perception of the healthcare system and their behavior towards health and illness. Both the cognitive and emotional aspects of dentist-patient interactions have significant impacts on patients’ adherence to clinical advice and their likelihood of returning for follow-up visits.

Table 2 Dental Satisfaction Questionnaire

Essence of Dentist-Patient Communication 

The aim of effective communication for dentists is to equip their patients with the knowledge required to make informed decisions about their patients’ oral health. This involves a collaborative discussion between the dentist and patient about clinical care objectives and professional opinions, with the aim of determining the best treatment option for the patient’s oral health. Effective communication has to be bidirectional,¹⁵ allowing information to flow from both directions. This information flow or message should contain five essential qualities, namely clarity, correctness, conciseness, completeness, and cohesiveness, which are known as the 5 Cs of effective communication.¹⁶ Clarity means that the message being sent out is easily understood and is free from confusion. Correctness necessitates ensuring the accuracy and absence of errors in the message being conveyed.  Conciseness refers to the quality of the message being concise and devoid of unnecessary information. Completeness means that the message intended to be delivered is complete with all necessary information required for the audience to fully understand its intended meaning. Cohesiveness denotes the organization and logical connection of each component within the message.  Table 3 shows the 5 Cs of effective communication in quality dental care.¹⁶

Table 3 5 Cs in Effective Communication for Quality Dental Care

Verbal Communication

Communication can take various forms, including verbal and non-verbal. Verbal communication involves the use of words to convey a message and can be either oral or written. Oral communication, in particular, includes an instantaneous feedback mechanism, as both the speaker and listener are involved in the simultaneous transmission and reception of messages. This makes it an efficient form of communication, as it allows for prompt feedback. In the case of doubts or uncertainties, clarifications can be made directly. These interpersonal elements in oral communication make it an effective form of communication.¹⁵ In addition, they also help individuals build relationships. Thus, oral communication is ideal for dental consultations. However, oral communication can be inconvenient when clinicians have to deliver lengthy messages, or in situations of dental diaspora, where individuals relocate and reside in a different country or region. This hinders verbal communication between dentist and patient when they do not share a common first language.

Written communication is ideal for conveying lengthy and complex information, as the complex information is laid down clearly and precisely. In addition, it is a permanent means of communication that serves as a record for individuals to refer to at any time and from anywhere. Written communication, as such, carries legal validity and enables patients to retain it for future reference.¹⁷ Written informed consent is preferred over oral consent because it provides a permanent record of the patient’s agreement to the procedure or treatment, ensures clarity of the risks and benefits involved, standardizes the consent process for all patients, and allows for easy verification of the consent process by both the patients and dentists. A consent form should be written in plain language that patients can easily comprehend. It should avoid using complex medical terminology, but if necessary, it should provide explanations for any technical terms used. The form should include all pertinent information about the procedure or treatment being performed, such as potential risks, benefits, alternatives, and expected outcomes. Table 4 shows a list of essential elements that should be included in a consent form.

Table 4 Essential Elements to Be Included in a Consent Form

Non-Verbal Communication

Non-verbal communication, on the other hand, includes a range of communicative behaviors that do not contain linguistic content.¹⁸ It serves as an effective means of expressing and acknowledging emotional context as well as contextualizing the meaning of verbal communication.¹⁹ Non-verbal communication is powerful, as emotion plays a critical role when individuals speak. The receiver will learn the message by assessing the pace, tone of voice, volume, pitch, and body language of the sender. Dental care is grounded in interpersonal interactions, which include emotional and cognitive processes. Non-verbal behavior can convey a wide range of emotions and related phenomena such as feelings, moods, and desires, making it a crucial role in dental care. Other forms of non-verbal communication, such as posture, gesture, facial expression, and eye contact, can be valuable tools for expressing emotions, conveying meaning, and building relationships.¹⁸

Merits of Proficient Communication 

Proficient communication skills with patients can greatly enhance a dentist’s job, increase motivation, and enhance productivity.^20,21 When dentists effectively communicate with their patients, it fosters patient loyalty and encourages them to continue seeking dental care from the same professional.²² Beyond mastering effective communication skills, successful dentists must also adapt their approach to meet the unique needs of each patient. The manner in which a dentist interacts with their patients often shapes the patients’ perception of them. By providing a positive dental experience, patients are more likely to accept recommended treatments, return for future care, and refer friends and family to the same dentist. This not only helps build the dentist’s reputation and practice; but also enhances the overall image of the profession.

Strategies to Improve Dentist-Patient Communication 

While most dental schools and professional organizations offer continuing dental education courses to enhance dentists’ oral health knowledge and clinical skills, there is often a lack of emphasis on communication and interpersonal skills. Many dentists experience the negative consequences of poor communication techniques. Factors such as time constraints, dentists” perceptions,^23,24 patients’ emotional issues,²⁵ patients’ lack of oral health literacy,²⁶ dentists’ inadequate communication skills,^9,27 language barriers,^28,29 and the physical settings of dental practices can all impede effective dentist-patient communication. To overcome the challenges, dentists should employ a variety of strategies. These include listening attentively to patients, using clear and simple language, encouraging questions, using visual aids, providing reassurance and empathy, being patient and giving ample time for each appointment, taking a patient-centered approach, showing positive body language, following up with patients, encouraging feedback, using information technology, and receiving continuing education and training.

Listen Attentively 

Dentists should practice active listening by giving their full attention to patients.³⁰ Listening goes beyond hearing the words. Dentists should listen carefully to the content, pay attention to how the words are delivered by the patient, avoid interrupting the patient, and look for cues as to how the patient feels and what he or she tries to imply in the narration. Dentists should ask follow-up questions if they need to clarify answers from their patients. For example, dentists may ask patients to describe their symptoms in detail and listen carefully to their responses.

Use Clear and Simple Language 

Dentists should use simple and succinct language^31,32 when discussing dental procedures and treatments with their patients. Jargon and vague terms should be avoided. For example, dentists can use the word “germ” instead of “bacteria/virus”; use the words “not cancer” instead of “benign”. Dentists should deliver their messages slowly and clearly, in particular to patients who are old or have limited oral health literacy.³² It is easier for patients to catch and digest messages with clear and simple language.³³

Encourage Questions and Feedback

Dentists should create an open and welcoming environment that encourages patients to ask questions about their dental health, procedures, and treatment options.³² Cultural practices or deference to authority can sometimes make patients hesitant to ask questions or openly discuss their medical histories due to feelings of shame or embarrassment. Dentists can address this issue by asking patients open-ended questions at the beginning of the consultation, for example: “What is the reason for your visit today?” or “How would you describe your dental concerns?” By doing so, dentists can dispel anxieties for patients and encourage them to ask questions concerning their oral health. Dentists should make it a routine practice to seek feedback from patients. A direct insight can highlight areas of healthcare services that need improvement and suggest ways to enhance them.³⁴ It is important for dentists to maintain an open mindset when receiving feedback from patients, as it provides valuable opportunities for reflection and continual improvement in the delivery of oral healthcare services.

Use Visual Aids 

The use of patient-friendly materials, such as printed handouts, radiographs, models, and videotapes, can significantly increase patients’ understanding of oral health-related information. This, in turn, can lead to improved adherence to dental care. A study has suggested that intraoral scans can be employed as visual aids to enhance the understanding of patients and their guardians in pediatric dentistry, especially with regards to treatment-related issues.³⁵ Multiple studies have also found that communication with the use of pictures and symbols can increase cooperation^36,37 and reduce stress³⁸ in patients with autism during dental treatments. Oral health experts have confirmed the positive effects of visual aids on patients in their communication with dental professionals. However, dentists should be aware that the design and usage of written materials can greatly impact their effectiveness in helping patients understand oral health-related information. Expanding on the groundwork laid in patient education research in medicine, health care professionals are advised to choose a familiar handout to use, and tailor the messages to meet each patient’s specific needs.^39,40 It is also recommended to write down important instructions and highlight them for easy reading.

Provide Reassurance and Empathy

It is crucial for dentists to not only provide necessary dental information; but also incorporate emotional components such as care, empathy, and friendliness into their interactions with patients. This is particularly important as most treatments are often negatively perceived, and patients commonly face emotional challenges during the process. Dentists can empathize with patients who may feel anxious or fearful about dental procedures. They can say, “I understand that many patients feel nervous about dental treatments. I will do my best to make you feel comfortable and address any concerns you may have”. By showing empathy and understanding towards patients’ concerns and fears, dentists can help them build resilience⁴¹ and navigate their dental journey more comfortably. A study reported that a dentist’s verbal reassurance can alleviate a child’s distressed behaviour.⁴² Dentists should show support and encouragement to patients without judgement or highlighting shortcomings in the patient’s diet or lifestyle.⁴¹

Give Ample Time and Be Patient

Ample time should be allocated in each consultation for patients to consult their oral health and discuss their concerns. Dentists should be patient and avoid rushing through appointments. For example, dentists can take breaks during consultations to give patients time to process information or to take a moment to relax. They can ask the patient if they need a break or if they would like to ask any additional questions. Although no literature was found in dentistry, a study showed that longer medical consultations allow patients to ask more questions and physicians to explain more details regarding the medical problem and its management.⁴³

Take a Patient-Centered Approach

Patient-centered care (PCC) originated in the field of medicine and was later incorporated into the practice of dentistry. PCC is defined in many yet similar ways in the dental literature, one of which is that it has two key attributes: it closely aligns with and addresses the patients’ desires, needs, and preferences, while also considering the psychological, social, cultural, and economic aspects of the patient alongside their physical findings.⁴⁴ The patient-centered approach encourages dentists to not only specialize in the oral cavity, but also to consider the patient as a whole. Some literature proposes that a patient-centered approach comprises three main principles: understanding the illness, shared decision-making, and intervention with mindfulness of the patient’s fears, pace, and expectations.^45,46 The process of understanding illness involves exploring and identifying the disease, explaining concepts of preventive dentistry and dental promotion, and inviting patients to share their personal experiences with illness. Under the patient-centered approach, decision-making is a shared responsibility between the dentist and patient. Patients are encouraged to participate in discussions, evaluations, validations, and co-authoring of the treatment plan. Dentists are advised to provide decision-support and share dental health information with patients to foster a therapeutic alliance.⁴⁷ For example, dentists can involve patients in the decision-making process by presenting treatment options, explaining their pros and cons, and discussing the potential outcomes. They can encourage patients to ask questions and provide their input before finalizing a treatment plan. Interventions are carried out with consideration of the patient’s value, their own pace, and their existing fears.⁴⁵ Dentists need to respect the autonomy of patients by acknowledging their right to make informed decisions about their oral health. They can provide all the necessary information and support the patient in making choices that best align with their values and preferences.

Show Positive Body Language

Body language serves as a key indicator of a person’s true feelings⁴⁸ and includes elements such as tone of voice, eye gaze, facial expressions, body posture, hesitations, and laughter. Non-verbal communication constitutes a significant portion of overall communication.⁴⁹ If verbal and non-verbal cues are not congruent, the non-verbal elements, such as body language, are often given more credence.⁴⁹ Negative body language can undermine positive verbal communication. Dentists should greet patients with a smile at the beginning of the dental visit. A genuine smile not only shows friendliness and builds trust, but also fosters an interpersonal relationship between dentists and patients. Dentists are advised to lean forward when talking to the patient, as it demonstrates interest in listening, creates positive energy, and fosters trust between dentist and patient.⁵⁰ Maintaining good eye contact with patients is essential, as it shows respect.⁵¹ Avoiding eye contact can be perceived as untrustworthy or dishonest. Dentists should also avoid crossing their arms and legs during conversations, as these actions can signal disinterest or authority, which may come across as condescending.⁵⁰ The physical positioning of the dentist also matters. It is recommended for dentists to sit at or below the patient’s height, as this can influence perceived power dynamics.⁵⁰ Mirroring a patient’s body language can also put the patient at ease and convey understanding.⁵⁰

Follow Up with Patients 

Dentists should make it a practice to follow up with patients after appointments. This allows the dentist to monitor the patient’s progress, address any concerns or questions, and ensure patient satisfaction with the care provided. Timely follow-ups enable dentists to identify potential misunderstandings and confirm the dental healthcare regimen with their patients.⁵² For example, dentists can follow up with patients after a procedure to ensure that they are healing well and to address any concerns or questions the patient may have, or they can remind patients about upcoming appointments via phone, email, or text message. This not only helps to reduce missed appointments but also shows that the dentist cares about the patient’s oral health.

Use Information Technology

People nowadays are using messaging applications such as WhatsApp, Instagram Direct Messenger etc. to send messages, images, audio, or video for communication. Many dentists and their dental office colleagues also use messaging applications in their communication with their patients. This can be a form of teledentistry. Effective use of these communication applications can enhance patient engagement by allowing patients to communicate with their dentists more frequently and remotely.^53,54 Studies have validated that the use of communication can aid in the early detection and prevention of oral malignant disorders.^55–57 It enables dental professionals to send information, including radiographs, and monitor their patients’ oral health more closely. Dentists can better explain to patients their oral health conditions with the use of images and videos. Patients, on the other hand, can ask questions, report issues, and receive feedback instantly. They can also send images and videos of their oral conditions to their dentists for remote diagnosis. This is not only a convenient way of communication, but also reduces the costs associated with a dentist visit due to time and resource savings. Dentists can use secure messaging platforms to communicate with patients. This can be used for appointment reminders, follow-up instructions, or answering non-urgent patient questions.

Receive Continuing Education and Training

Contrary to the common misperception that dentists are naturally expert communicators, not every dentist is innately equipped with effective communication skills. Communication is a learned skill that can be honed with practice.⁵⁸ It often takes many years of learning and practice throughout a dentist’s career to master excellent communication skills. These skills are multifaceted and include aspects such as building dentist-patient relationships, structuring interviews, and expressing empathy, all of which require the development of communication and interpersonal skills. Research has found that dental students’ interpersonal skills can be improved through integrated training programmes.⁵⁹ Dentists can participate in online courses that focus on patient communication and engagement. These courses can be completed at the dentist’s convenience and provide valuable training on effective communication techniques.

Conclusion  

Dentist-patient communication is fundamental to providing quality dental care. Effective dentist-patient communication is a bidirectional process involving the exchange of clear, correct, complete, concise, and cohesive information. To foster effective dentist-patient communication, dentists should listen attentively, use clear, simple language, encourage questions, use visual aids, provide reassurance and empathy, be patient and give ample time, take patient-centered approach, show positive body language, follow up with patients, and encourage feedback from patients. It is also important for dentists to take courses and trainings continuously for professional development. Dentists who prioritize effective communication and build good relationships with their patients are more likely to achieve positive outcomes and experience practice growth in their practice.