Types of communication

1. Communication in dental practice. Behavioral medicine-appearances, physiognomic, suppression of negative emotions

5. Types of communication • Non-verbal communication includes facial expressions, the tone and pitch of the voice, gestures displayed through body language (kinesics) and the physical distance between the communicators • Verbal communication - The sharing of information between individuals by using speech

6. Types of non verbal communication • Kinesics- The word kinesics comes from the root word kinesis, which means “movement,” and refers to the study of hand, arm, body, and face movements. Specifically, this section will outline the use of gestures, head movements and posture, eye contact, and facial expressions as nonverbal communication. • Gestures -There are three main types of gestures: adaptors, emblems, and illustrators (Andersen, 1999). Adaptors are touching behaviors and movements that indicate internal states typically related to arousal or anxiety. Emblems are gestures that have a specific agreed-on meaning.

7. Types of non verbal communication Illustrators are the most common type of gesture and are used to illustrate the verbal message they accompany. For example, you might use hand gestures to indicate the size or shape of an object • Head Movements and Posture In terms of head movements, a head nod is a universal sign of acknowledgement in cultures. There are four general human postures: standing, sitting, squatting, and lying down. Within each of these postures there are many variations, and when combined with particular gestures or other nonverbal cues they can express many different meanings. Eye Contact We also communicate through eye behaviors, primarily eye contact. While eye behaviors are often studied under the category of kinesics, they have their own branch of nonverbal studies called oculesics, which comes from the Latin word oculus, meaning “eye.” The face and eyes are the main point of focus during communication, and along with our ears our eyes take in most of the communicative information around us. The saying “The eyes are the window to the soul” is actually accurate in terms of where people typically think others are “located,” which is right behind the eyes (Andersen, 1999). Certain eye behaviors have become tied to personality 

8. Types of non verbal communication •  Pupil dilation refers to the expansion and contraction of the black part of the center of our eyes and is considered a biometric form of measurement; it is involuntary and therefore seen as a valid and reliable form of data collection as opposed to self-reports on surveys or interviews that can be biased or misleading.  Pain, sexual attraction, general arousal, anxiety/stress, and information processing (thinking) also affect pupil dilation.   • Facial Expressions Our faces are the most expressive part of our bodies. Although facial expressions are typically viewed as innate and several are universally recognizable, they are not always connected to an emotional or internal biological stimulus; they can actually serve a more social purpose. For example, most of the smiles we produce are primarily made for others and are not just an involuntary reflection of an internal emotional state (Andersen, 1999). These social smiles, however, are slightly but perceptibly different from more genuine smiles.

10. Types of non verbal communication • Haptics There are several types of touch, including functional-professional, social-polite, friendship-warmth, love-intimacy, and sexual-arousal touch (Heslin & Apler, 1983). At the functional-professional level, touch is related to a goal or part of a routine professional interaction, which makes it less threatening and more expected. For example, we let barbers, hairstylists, doctors, nurses, tattoo artists, and security screeners touch us in ways that would otherwise be seen as intimate or inappropriate if not in a professional context.

11. Types of non verbal communication • Vocalics A louder voice is usually thought of as more intense, although a soft voice combined with a certain tone and facial expression can be just as intense. We typically adjust our volume based on our setting, the distance between people, and the relationship.  A voice at a low volume or a whisper can be very appropriate when sending a covert message or flirting with a romantic partner, but it wouldn’t enhance a person’s credibility if used during a professional presentation. Speaking rate refers to how fast or slow a person speaks and can lead others to form impressions about our emotional state, credibility, and intelligence. As with volume, variations in speaking rate can interfere with the ability of others to receive and understand verbal messages. A slow speaker could bore others and lead their attention to wander. A fast speaker may be difficult to follow, and the fast delivery can actually distract from the message. Speaking a little faster than the normal 120–150 words a minute, however, can be beneficial, as people tend to find speakers whose rate is above average more credible and intelligent (Buller & Burgoon, 1986).

12. Types of non verbal communication Appearance Our choice of color, clothing, hairstyles, and other factors affecting appearance are also considered a means of nonverbal communication. Research on color psychologyhas demonstrated that different colors can evoke different moods. Appearance can also alter physiological reactions, judgments, and interpretations.

13. Types of non verbal communication • Proxemics Proxemics refers to the study of how space and distance influence communication. We all have varying definitions of what our “personal space” is, and these definitions are contextual and depend on the situation and the relationship. Although our bubbles are invisible, people are socialized into the norms of personal space within their cultural group. Scholars have identified four zones for US Americans, which are public, social, personal, and intimate distance (Hall, 1968). The zones are more elliptical than circular, taking up more space in our front, where our line of sight is, than at our side or back where we can’t monitor what people are doing.

15. Types of non verbal communication • Public and social zones refer to the space 120 sm. away from our body, and the communication that typically occurs in these zones is formal and not intimate. Public space starts about 360 sm. from a person and extends out from there. Communication that occurs in the social zone, which is 120 sm. to 360 sm. away from our body, is typically in the context of a professional or casual interaction, but not intimate or public. This distance is preferred in many professional settings because it reduces the suspicion of any impropriety. • Personal and intimate zones refer to the space that starts at our physical body and extends 120 sm. These zones are reserved for friends, close acquaintances, and significant others. As we breach the invisible line that is 60 sm. from our body, we enter the intimate zone, which is reserved for only the closest friends, family, and romantic/intimate partners.

16. Why good patient communication is important? • The goal of effective communication is simple: To empower your patients with the knowledge required to make an informed decision about their oral health. It is up to you to communicate your goals and expert opinions about your patients’ oral health so that you and your patient can determine the best treatment plan • If you include your patients as fully informed partners in their care, they’ll return the gesture by being loyal and continuing care with you. As an added bonus, you’ll discover more satisfaction in your work, renewed motivation and increased productivity

17. How to improve communication with patients • Increased patient satisfaction: Medical evidence has demonstrated a positive association between a patient’s satisfaction with the care they receive and their provider’s ability and willingness to communicate and empathize with them. • Reduced complaints: Open dialogue with patients results in better patient retention and a reduction in complaints. • Improved efficiency: Improved communication with your patients will make your practice more efficient. For example, giving patients time to express their concerns doesn’t take any longer but can significantly reduce the likelihood of late-arising concerns

18. Communicating with care • The first law of patient care is: Patient Satisfaction = Perception – Expectations If your patient perceives care at a certain level but expected something more or different, then they will be dissatisfied. Both perception and expectation are states of mind and you need to consider these if you want to keep your patient happy • In its most basic form, good patient care consists of listening to, understanding and responding to your patients’ needs. While your oral health knowledge and clinical skills may be exceptional, few of us are taught the ‘soft skills’ of patient communication

19. While there are a multitude of patient needs-six basic needs stand out Friendliness: Basic courtesy and politeness; being warm and caring. Empathy: The patient needs to know that the dentist appreciates their wants and circumstances and provides personal attention. Efficiency and punctuality: The patient wants to feel they are respected. Control : The patient wants to feel that they are an important part of their own treatment plan. Options and alternatives: The patient wants to know what treatment options are available; explaining options thoroughly Information: The patient wants to know about fees and services but in a pertinent and time-sensitive manner

20. The fundamentals of patient relations • Patients want to be treated as individuals, not numbers. Here are a few rules of thumb for patient relations, which you and your staff should be mindful of: • The patient is never an interruption to your work – the patient is your work. Everything else can wait. • Even if you are delegating a task to a member of your staff, a casual “How are you feeling” gesture while your colleague does the work will comfort your patient. • Never argue with a patient. The patient is always right (in their own eyes). Be a good listener, agree with your patient where you can, and do what you can to make them happy. • Never make the first point of contact with your patient about finances. Too often the first question asked is “Do you have insurance?” Discuss money matters at the appropriate time – only after

21. Portrait of the ideal dentist from the patients perspective • Confident:The dentist’s confidence gives me confidence. • Empathetic:The dentist tries to understand what I am feeling and experiencing, and communicates that understanding to me. • Humane:The dentist is caring, compassionate and kind. • Personal:The dentist is interested in me, interacts with me, and remembers me as an individual. • Frank:The dentist tells me what I need to know in plain language and in a forthright manner. • Respectful:The dentist takes my input seriously and works with me. • Thorough:The dentist is conscientious and persistent

22. Touchpoints of patient communication • There are five key moments of interaction with your patients during their visit to your clinic. Each component can influence your patients’ overall experience and their level of satisfaction • The initial contact Get the patient encounter off to a good start. As we know, first impressions matter. Try to spend a few moments to slow down and focus your attention on meeting your patient’s needs. • Be the first to greet your patient in the operatory – even if they are having hygiene work done first. • Explain what will happen during their visit and introduce them to staff members who will be providing care. • Greet every patient with a friendly smile. • Call patients by name. • Introduce any colleagues who may accompany you. • Sit at eye level. • Listen attentively to their concerns. • Don’t use technical jargon or terms that convey value judgments. • Ask permission to examine the patient. • Take the leadership role and guide the patient through the appointment.

23. Key moments of interaction with your patients during their visit to your clinic • The dental examination and discussing the treatment options The dental examination is one of the most important, under-appreciated or even mis-understood components of the dental visit. For most this is a routine procedure, but for many patients it is perhaps the highlight of their visit and the only point at which they will have to interact directly with you. It is an opportunity to educate your patients as to what is involved in the examination process. INFORMED CONSENT In the context of a dental office, informed consent is “permission obtained as a result of the process of information sharing in ongoing dialogue between the dentist and patient”. No treatment should be performed without the express or implied consent of the patient. The onus is on you, the health care provider, to ensure that whatever decision a patient makes, to accept or decline treatment, it must be informed. Consent must be obtained in advance of treatment – not in the middle and not after the fact. Remember to document consent decisions in the patient chart. Discussing treatment options: In order for your patients to feel like true partners in their oral health care, they must be fully informed of the treatment options available to them. Be thorough in your explanation of treatment options so the patient understands the pros and cons of each. This is an opportunity to demonstrate your clinical expertise and to build trust in your abilities and motivations.

24. Key moments of interaction with your patients during their visit to your clinic • Discussing fees and insurance • Concluding the visit The last few minutes of the patient consultation are just as important as the first. Ask your patient if they understand the treatment options discussed or have any questions. Watch for those last minute questions people have as they leave the operatory. • Look at your patient when speaking to them and avoid turning your back while anyone is speaking to you. • Confirm your patient’s treatment plan or follow-up. • End the consultation with a reinforcing-type of physical contact. When appropriate, personally escort your patient to the reception area. • • At a minimum, use your patient’s name at the beginning and at the end of the interaction. See a sign of hesitations as your opportunity to ask “Do you have any other questions or concerns?”

25. Dealing with difficult patient situations • Learn to see each problem as an opportunity for improvement. Here are some steps in dealing with patients. By following these simple steps, a disgruntled patient can become your most valuable patient. Experience shows that a dissatisfied patient will share their story with more people than will a satisfied patient. Avoid downplaying the seriousness of the patient’s complaint. • Let the patient tell you their side of the story without interruption. Sometimes all they need is to be heard. • Express empathy. Let patients know that you understand the problem and are concerned about their feelings. Patients need to hear that you are on their side and are willing to do whatever it takes to solve their problem. • Do not go on the defensive. You are certain to lose the patient if you become confrontational. • Take control of the situation. Once you have heard the patient’s side of the story, take the appropriate action to resolve the problem. • Ask the patient what they want. You may be surprised to find that the patient’s solution to the problem is both fair and simple.

26. Dealing with difficult patient situations Once you have established a plan of action, sell it. Explain to your patient how the plan will solve the problem. Ensure that the plan has been carried out and the results are acceptable to your patient – follow-up to ensure your patient is happy with the way you have handled the problem

27. Fear and dentophobia •  The fear of dentists results from direct or indirect negative experiences. Dental work often involves painful root canal treatments, cavity filling, extractions etc. • Phobia is persistent, unrealistic, and intense fear of a specific stimulus, leading to complete avoidance of the perceived danger.

28. Fear and dentophobia Dentophobia leads to a variety of physical and mental symptoms: • Feeling like crying, screaming, shaking, sweating. • The phobic experiences a full blown panic attack. • Avoidance is the most common symptom: one might put off seeing the dentist for so long that it could lead to various complications. Gum disease, cavities, or worse, heart problems can also occur in such individuals. • Often, the fear of dentists leads to greater expenses: worsening oral health could lead to more expensive treatments including root canal therapy, costly bridges, implants, crowns etc. This becomes a vicious cycle as the phobic, due to this knowledge, refuses to get treated, leading to greater health problems. • Poor teeth can impact other areas of the individual’s life: getting a job where one is expected to have clean, shiny teeth or even dating and relationships can be impacted negatively. The person often becomes socially withdrawn, depressed, isolated or turns into an Agoraphobic.

29. Fear and dentophobia • Milgrom et al identified four different groups of anxious patients based on their origin or source of fear (the “Seattle system”, developed at the University of Washington). They were 1) anxious of specific dental stimuli, 2) distrust of the dental personnel, 3) generalized dental anxiety, and 4) anxious of catastrophe.

30. Fear and dentophobia Identifying dentally anxious or phobic patients • Semistructured interview and subjective assessment using questionnaires • Anxiety questionnaires Multiple- and single-item self-reporting questionnaires are available for assessing anxious and phobic patients. A few such popularly used multi-item scales are Corah’s Dental Anxiety Scale (CDAS), Modified Dental Anxiety Scale (MDAS),Spielberger State–Trait Anxiety Inventory,Kleinknecht et al’s Dental Fear Survey (DFS),Stouthard et al’s Dental Anxiety scale • Objective measures Objective measures involve assessment of blood pressure, pulse rate, pulse oximetry, finger temperature, and galvanic skin response. An extremely accurate objective method used in various 

31. Management of dental anxiety • The dental office environment • Communication skills, rapport, and trust building • Psychotherapeutic management -Behavior-management techniques, Relaxation techniques • Hypnotherapy • Pharmacological management Pharmacological control of pain and anxiety can be achieved by the use of sedation and general anesthesia, and should be sought only in situations where the patient is not able to respond and cooperate well with psychotherapeutic interventions. Patients with special needs (mental retardation, autism, mental illness, traumatic brain injury) and clinical situations can also necessitate pharmacological management.