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More than just teeth

31 May 2019

The ability to effectively communicate with patients only improves and develops with experience. But as young dentists, we are often more concerned with the highly technical aspects of dentistry rather than patient management, and we can easily forget that patients are more than just teeth, says Dr Safinah H Hambali


What we need to recognise is that our management of patients will contribute more to our ultimate success or failure as dentists, than our technical skills and overall intelligence.[i] To achieve success, open and sincere communication should be the cornerstone of a patient centred approach.

Dentists are widely characterised as being remote, only interested in money and unfortunately, as inflictors of torture.[ii] My favourite animated film, Finding Nemo, depicts a dentist performing root canal treatment on a screaming patient and is one of many examples of negative stereotyping of dentists throughout mass media. Although the intention is to be humorous, it influences how society perceives the dental experience and we become conditioned to view dentists as a source of pain.

After 15 months working in private practice in metropolitan Melbourne, I have come to expect that nine out of ten patients who sit in my dental chair will be anxious. Many recall a particularly traumatic experience, that has caused some to avoid going to the dentist ever since. As dentists, we can easily lack emotional compassion, but a patient’s emotional reaction to pain is often the most memorable aspect of treatment.

We must remind ourselves that most patients do not have an extensive dental education, which underpins irrational fears and perceptions they may have. Therefore, communication is critical in the development of trust between the clinician and patient.[iii] A clear and concise explanation will improve and maximise a patient’s confidence and understanding, leading towards a successful treatment outcome.

Communication can act as a vital coping mechanism and when patients present with varying levels of dental anxiety, effective communication becomes an invaluable skill. Non-verbal communication is also an aspect we cannot ignore. Rouse emphasises the importance of clinicians learning to regulate the unconscious message they send to patients, as this lack of awareness can convey a sense of frustration with the patient that can fracture the dentist-patient relationship.

Open, attentive posture, good eye contact, active listening and encouraging cues are all important non-verbal communication skills we should implement.[iv] In addition, dentists who practise empathic non-verbal behaviours, such as the use of a reassuring touch, can help minimise patients’ anxiety. The communication skills of a clinician, both verbal and non-verbal, are linked to positive health outcomes and patient satisfaction.[v]

There is no denying that there is high competition in private practice, with dental clinics in metropolitan regions operating only metres from one another. It is estimated that there are 1,200 Australian dental graduates each year, compared to only about 550 dentists retiring in the same period.[vi] As a result, there will be a continuous struggle in the private sector with an oversupply of dentists and graduates facing increasing competition for jobs.

With every new patient that walks through my doors, I always like asking when their last dental visit was and when I hear that they have been to a dentist in the past 24 months, it makes me wonder why they haven’t returned to the last dentist they’ve been to. A personal liking for a dentist is a major contributing factor to patient satisfaction. Patients much prefer a dentist who is reassuring, friendly and who puts them at ease, over professional skill. In our early years of practice, we can become consumed by our focus on getting the dentistry right and forget the critical components of effective communication, despite the fact that poor interpersonal skills will lead to a loss of patients and profitability. You would think that we would be more concerned as dentists if half our patients do not return because of poor communication. Private dentistry is a consumer driven industry, and we can only blame ourselves if we ignore the importance of delivering a high level of service to the patients who do walk through our doors.

Communication with care and attention has been cited as the most influential in maintaining patient loyalty.[vii] Open communication is also the key to the process of informed consent that is part of our duty of care with every patient we treat.  This shared decision-making process should involve providing clear understandable information without dental jargon, in order to facilitate patient autonomy and establish confidence in the treatment and in the clinician. This confidence is invaluable to a positive outcome, especially when dealing with anxious patients, and should be a foundation of one’s patient-centred approach. Our limited experience can impact our own confidence as young dentists, but if we don’t create trust that our primary focus is on the patient’s welfare, then we are further putting ourselves on the back foot, even before commencing treatment. 

What can undermine the confidence of a young dentist is the fear of facing litigation and the impact that can have when establishing a lifelong career. Is this an irrational fear to have? Practising while this is at the back of your mind can make one overly cautious and prevent us from reaching our absolute potential as clinicians. In reality, compromised relationships, devaluing patients and delivering information poorly are more likely to lead to litigation.[viii] I recall many instances during my first year of practice, overwhelming patients with all the risks possible when doing an extraction, whether likely or unlikely in their specific circumstance. In many cases, this approach was more detrimental to a highly anxious patient and would negatively impact treatment outcomes.

For example, administering local anaesthetic became less effective and more challenging had I not spiked my patient’s adrenaline levels. According to Rouse, 74% of dentists learn how to talk to the anxious patient through trial and error, and Bridges et al found that giving reassurance and having empathy was an area of communicative weakness for undergraduate dental students.[ix] These areas are crucial for us as young graduates to improve on, and with experience we will recognise the varying emotional needs of patients, effectively meeting their expectations and establishing strong dentist-patient relationships.

The initial years as young graduates are about determining what kind of dentist we would want to be. We should always recognise our strengths and improve on our weaknesses if we want to be successful. Whether we like it or not, in a highly competitive industry, general dentistry requires you to deal with people, as patients are more than just teeth.

Understanding and addressing the nature of our patients’ concerns through effective communication and with empathy, will go a long way to the development of trust and the establishment of long patient relationships. As Hippocrates said, “Cure sometimes, treat often and comfort always”: words that are as relevant as ever today.

Dr Safinah Hambali graduated with a Doctor of Dental Surgery from the University of Melbourne. She is currently in her third year of general private practice and splits her time working at Plenty Valley Family Dental in South Morang and the Smile Centre in Heidelberg. Safinah is also passionate about widespread oral health education for children outside the dental chair and is the managing director of Powering Future Smiles, an innovative dental education program she co-founded in 2015. 

[i] Quieng, MC, Lim, PP, & Lucas, MD 2015, 21st Century-Based Soft Skills: Spotlight on Non-Cognitive Skills in a Cognitive-Laden Dentistry Program, European Journal of Contemporary Education, vol. 11, no. 1, pp. 72-81


[ii] Rouse, RA 1989, A Paradigm of Intervention: Emotional Communication in Dentistry, Health Communication, vol. 1, no. 4, p. 239-252


[iii] Hamasaki, T, Kato, H, Kumagai, T, & Hagihara, A 2017, Association Between Dentist–Dental Hygienist Communication and Dental Treatment Outcomes, Health Communication, vol. 32, no. 3, pp. 288-297


[iv] Warnecke, E 2014, The art of communication, Australian Family Physician, no. 3, p. 156-158


[v] Horowitz, AM, Wang, MQ, & Kleinman, DV 2012, Opinions of Maryland Adults Regarding Communication Practices of Dentists and Staff, Journal of Health Communication, vol. 17, no. 10, pp. 1204-1214


[vi] Bite Magazine 2017, The Future of Dentistry, viewed 8 April 2018,


[vii] Rattan R 2017, Great expectations, Riskwise, Issue 36, November, pp. 12-13


[viii] Reid, KI 2017, Informed Consent in Dentistry, Journal of Law, Medicine & Ethics, vol. 45, no. 1, pp. 77-94


[ix] Bridges, S, McGrath, C, Yiu, C, & Cheng, B 2010, Reassuring’ during clinical examinations: Novice and expert talk in dentistry, Journal of Asian Pacific Communication (John Benjamins Publishing Co.), vol. 20, no. 2, pp. 185-206


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