Dental hygienists have a lot to cover in the scheduled appointment time: patient care, instruction, and education. To achieve successful health outcomes, the patient needs to follow the dental hygienist’s recommendations. Therefore, it is important that the dental hygienist communicates with the patient in a way that the patient (and the patient’s caregivers) understand.
This is difficult because everyone has their own ability to understand and process oral health information, known as oral health literacy (OHL). This article provides a brief overview of successful strategies used to increase provider-patient communication and understanding.
OHL is defined by the American Dental Association (ADA) as the degree to which individuals have the capacity to obtain, process and understand basic health information and services needed to make appropriate oral health decisions.”1
Determining a patient’s level of OHL is difficult, and the dental hygienist cannot assume that the information being communicated is understood.2 Patients make decisions based on what they know, and their oral health outcomes can be at stake.
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Ultimately, poor OHL results in patients not being an active part of their own health-care decisions. A patient with a lower level of OHL may not be able to read a prescription label or read and fill out forms, may have difficulty sharing information that could affect the management of disease, and may not fully understand the risks associated with a procedure.
Memory also plays a role in oral health outcomes. Research shows that patients have a decreased ability to accurately remember what was discussed with their health-care provider, especially with large amounts of information and when the patient is an older adult.3,4 While it may be impossible to know if a patient has low OHL, there are signs that may help gauge this, including:5
- Asking for help
- Bringing along someone who can read
- Inability to keep appointments
- Poor adherence to recommended interventions (e.g., hygiene behaviors during pregnancy)
- Postponing decision making (“May I take the instructions home?” or “I’ll read through this when I get home.”)
The ADA also lists watching others (mimicking behavior) as an additional clue for low health literacy.
Patients with low health literacy have an increased risk of poor dental health outcomes, such as periodontal disease.6 Low OHL can be difficult to determine; therefore, using positive oral health literacy with every patient is the best strategy to increase understanding.
There are many strategies that can be used to increase the dental team’s confidence in effectively communicating with patients. These strategies include reviewing pre- and post-appointment protocols, enhancing communication skills and techniques during patient interaction, and incorporating an after-visit appointment summary.
Pre- and post-appointment strategies
One of the first steps in helping patients of all literacy levels is to make sure the dental office itself is easy to find. When providing directions, use both drawings and text. Add in landmarks such as a well-known restaurant or other destinations. Ask a friend or family member to locate the office using the same directions given to patients. Signs, building markers, symbols, and logos should be well-posted and easy to identify.
Forms for registration, health history, and consent are particularly difficult for those with limited general literacy and health literacy skills. Older adults, and those with impairments and disabilities, may find it difficult to hold a pen or use a computer tablet.
Front desk staff can be available to privately ask the questions and write answers, explain consent forms, and make note of changes in health history. Simply asking if there are any new symptoms or if there is anything that “doesn’t seem right,” can provide valuable information. Encourage the patient to call the office after they get home if they need clarification of the treatment plan or if they have any questions about the appointment.
Enhancing communication skills during patient interaction
There are specific strategies that can be integrated to improve communication skills and increase the patient’s understanding. Creating an environment in which a patient with lower OHL does not feel embarrassed or judged, and allowing time for a patient to ask questions without interruption, will go a long way in increasing patient literacy.
By not making assumptions about your patients, being mindful of the terminology used, asking open-ended questions, and using the “teach-back” and “chunk-and-check” methods described below, you will increase understanding for both patient and clinician.
Dental terminology and jargon
Terms, acronyms, and technical language are part of the dental professional’s daily vocabulary. Terms such as composite, sealant, and scale and root planing are difficult to understand, and the patient may feel embarrassed to ask for a definition. Below are some of the more frequent terms used in the dental setting and their alternate word choices.
| Alternatives for common dental terminology | |
| Instead of: | Use: |
| Administer | Give |
| Gingivitis | Gum disease or inflammation |
| Scaling and root planing | Deep cleaning |
| Caries | Cavities |
| Analgesic | Pain relief |
| Halitosis | Bad breath |
| Sutures | Stitches |
| Hypertension | High blood pressure |
Open-ended questions
The use of open-ended questions allows for the patient to expand on the discussion and can alert the hygienist to possible gaps in comprehension. Open-ended questions are those that allow the patient to elaborate, without interruption, on the response,7 and can begin with the words what, how, where, and why. Closed-ended questions require the patient to answer yes or no, giving limited insight.
Examples of open-ended questions are: “How has your tooth been feeling since our last visit?” or “You mentioned that your tooth is painful. What does it feel like?” or “Do you have any thoughts on what might be causing this?”
Using open-ended questions allows patients to answer however they like, in their own words, giving providers more insight into what patients understand, think, and feel about the subject.
Teach-back method
The teach-back method is an evidence-based communication technique providers can use to make sure the patient understands important information. Putting the onus on the dental provider can decrease feelings of defensiveness or anxiety in the patient’s response. Examples of using the teach-back method are:
“We’ve gone over a lot of information today, and I want to make sure I explained it clearly. Can you explain it back to me so I can make sure I was clear?”
“I know that Grandma isn’t here today, and she takes care of your child during the day. What will you tell Grandma about how to give this medicine?”
By using the teach-back method, the dental hygienist can identify any misunderstandings and provide guidance and clarity.
Chunk-and-check
The basic premise of using the chunk-and-check method is to break down all of the information being conveyed to the patient into smaller, “bite-sized” pieces. This can be followed with an open-ended question to be sure that the information is understood.8
This can be accomplished by teaching or informing just two or three main points, checking patient understanding by incorporating the teach-back method, and then clarifying points as needed before moving on to the next concept. This strategy can be repeated throughout the appointment time.
Keep in mind that this is not a test of the patient’s knowledge; it is rather a feedback assessment of how well the dental hygienist has matched the explanation of concepts with the patient’s tools of understanding.
Summarizing the appointment
At the end of the appointment, summarizing what has been done and discussed can help bring everything together for the patient. An example of this is: “We covered a lot today, and I want to make sure that I explained things clearly. So, let’s review what we discussed,” or “Can you please describe the three things you agreed to do to help you control your gum disease?”
Patients with low OHL are at a greater risk for poor oral health outcomes,6 incompletely or inaccurately recalling information about recommendations,3 and suboptimal adherence to treatment plans.6 Dental hygienists are in a perfect position to increase oral literacy levels and help to empower the patient by reducing barriers to understanding dental care.9
During the dental appointment, there are evidence-based strategies and techniques that can help patients understand and communicate their questions and concerns. The use of everyday words instead of dental jargon and terminology, open-ended questions, and incorporating the teach-back and chunk-and-check methods can have positive impacts on patient oral health outcomes.
Honing new skills takes time. Incorporating health literacy strategies will take a little practice, but once part of the routine, these techniques can be used smoothly, without awkwardness, and will not lengthen a visit. Start slowly, and use the strategies consistently, and practice, practice, practice!
Editor's note: This article appeared in the July 2021 print edition of RDH.
References
- Health literacy in dentistry. American Dental Association.https://www.ada.org/en/public-programs/health-literacy-in
- Huda W, Grindrod K. Don’t assume the patient understands: qualitative analysis of the challenges low health literate patients face in the pharmacy. Res Social Adm Pharm. 2016;12(6):885-892.
- Kessels RPC. Patients’ memory for medical information. J Royal Soc Med. 2003;96(5):219-222.
- McGuire LC. Remembering what the doctor said: organization and adults’ memory for medical information. Exp Aging Res. 1996;94(4,):403-428.
- Safeer RS, Keenan J. Health literacy: the gap between physicians and patients. Am Fam Physician. 2005;72(3):463-468. https://www.aafp.org/afp/2005/0801/p463.html. Accessed March 18, 2021.
- Baskaradoss JK. Relationship between oral health literacy and oral health status. BMC Oral Health. 2018;18(1):172.
- Hashim MJ. Patient-centered communication: basic skills. Am Fam Physician. 2017;95(1):29-34.
- Cornett S. Assessing and addressing health literacy. Online J Issues Nurs. 2009;14(3):1-13. Manuscript 2. https://www.who.int/global-coordination-mechanism/activities/working-groups/Assessing-and-Adressing-Health-Literacy.pdf.
- Bress LE. Improving oral health literacy–the new standard in dental hygiene practice. J Dent Hyg. 2013;87(6):322-329. https://jdh.adha.org/content/87/6/322.short.
