Journal of Indian Association of Public Health Dentistry

ORIGINAL ARTICLE
Year
: 2016  |  Volume : 14  |  Issue : 3  |  Page : 308--312

Use of hand signals for communication during dental procedure


R Vignesh1, T Sukanya2, Indra Priyadharshni2,  
1 Department of Pediatric and Preventive Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Meenakshi Ammal Dental College and Hospital, Chennai, Tamil Nadu, India

Correspondence Address:
R Vignesh
New No. 131; Old No. 55/1, Medavakkam Tank Road, Kilpauk, Chennai - 600 010, Tamil Nadu
India

Abstract

Introduction: Fear of dental treatment and anxiety about dental procedures are highly prevalent and have an impact on the quality of dental treatment. Use of a means of communication during the treatment procedure, which is the crucial point of communication, is not much studied. Aim: The aim of this study was to assess the perception of patients and practices of dentists regarding the usage of hand signals during dental procedure. Materials and Methods: A cross-sectional questionnaire study was conducted among 150 outpatients attending a dental institute and 150 dental practitioners practicing in North Chennai. The questionnaire constituted five questions based on difficulty in communication and attitude toward hand-sign usage. The data were subjected to Pearson's Chi-square statistical analysis. Results: About 76.7% (n = 115) of the respondents felt uncomfortable to communicate with dental practitioner when there is instrument in the mouth. About 66% (n = 99) of the respondents experienced fear, when they were unable to express their pain with instruments in their mouth during any dental procedure. Among the respondents, 71.3% (n = 107) agreed that using hand signals during a dental treatment might help them to overcome the difficulty in communication. About 30% (n = 45) of the dental practitioners preferred patients to talk, 54% (n = 81) preferred use of hand signals, and 16% (n = 24) preferred making sounds. About 63.3% (n = 95) of the dental practitioners informed their patients to raise their hand as a signal to stop the procedure. Conclusion: Majority of the practitioners and patients prefer the usage of hand signals over other means of communication to reduce fear and anxiety and improve rapport.



How to cite this article:
Vignesh R, Sukanya T, Priyadharshni I. Use of hand signals for communication during dental procedure.J Indian Assoc Public Health Dent 2016;14:308-312


How to cite this URL:
Vignesh R, Sukanya T, Priyadharshni I. Use of hand signals for communication during dental procedure. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2021 Jun 13 ];14:308-312
Available from: https://www.jiaphd.org/text.asp?2016/14/3/308/187173


Full Text

 Introduction



Fear of dental treatment and anxiety about dental procedures are prevalent and have an impact on the quality of life and the quality of dental treatment performed – both in terms of limiting attendance for treatment and in the nature of the dental treatment likely to be performed.[1] Dental procedures can elicit fear and anxiety, especially the more invasive ones. Caring for patients not only means treating their chief complaint and relieving them from pain, but also to handle and help them overcome their anxiety and fears.

Central to the provision of safe, reliable, and satisfactory dental treatment is a clear communication between dentists and patients. Verbal communication between dentists and patients is obviously significantly reduced during any procedure. This deficiency can lead to patient discomfort, dissatisfaction, and also can jeopardize patient dignity.[2]

Communication means exchange of information for some purpose(s), in a verbal or a nonverbal way. It has been said that 65% of all communication is nonverbal. Nonverbal communications or cues are more readily believed than those of the spoken words.[3]

Studies on communication between dentist and patient are commonly based on interactions during the consultation period.[4],[5] However, there is no data regarding communication during the treatment procedure, which is the crucial point of communication breakage. Hence, we opt a different way in communication, i.e., hand gestures. Not many studies had been done and not much data are available related to this subject. Thus, the present study was done as an attempt to assess the perceptions of patients and practices of dentists regarding the usage of hand signals during dental procedures in North Chennai.

 Materials and Methods



A cross-sectional questionnaire study was conducted among the outpatients attending a dental institute and dental practitioners practicing in North Chennai from April 13 to June 13. Ethical clearance was obtained from the Institutional Review Board of Meenakshi University, Chennai.

Sample size was calculated based on the pilot study using sampling software G* power 3.1.92 (Faul, Erdfelder, Lang and Buchner, Düsseldorf, Germany, 2007), and minimum sample size was estimated based on methodological assessment (alpha power –0.05, power –95%). The final sample size required for the main study was 150 outpatients attending a dental institute and 150 dental practitioners practicing in North Chennai. The study population included the outpatients of age group 18–70 years, attending a dental institute and dental practitioners of age group 22–65 years in North Chennai, who were randomly selected and were willing to participate in the study. The nature and purpose of the study were explained to the patients, and a signed consent was obtained.

The questionnaire was translated into Tamil. The validity was checked by a back translation method, involving blind retranslation into English. The validity of translation was verified by experts in both languages. Internal consistency of the questionnaire was found to be excellent (Cronbach's alpha 0.9), Assessment of the test-retest reliability of the questionnaire was carried out among 50 outpatients and dental practitioners. The questionnaire was administered on two occasions separated by an interval of 2 weeks. The questionnaire clarity and time necessary for filling it up were traced in the pilot study.

A self-administered, pretested questionnaire in the vernacular language that included five close-ended questions on fear, anxiety, and usage of any hand signals was given to the outpatients. Another self-administered, pretested questionnaire was given to the dental practitioners in North Chennai, which included five close-ended questions which were based on the usage of any hand signals. The filled questionnaires were collected back and the results were tabulated and subjected to statistical analysis.

Pearson's Chi-square test was used to analyze the responses for the questionnaire, among those who responded to the study. P < 0.05 was considered statistically significant.

 Results



A total of 150 outpatients of the dental institute were randomly selected, of which 80 were males (53%) and 70 were females (47%). Out of the 150 outpatients, 112 (75%) were <30 years of age, 31 (21%) were 30–50 years of age, and 7 (4%) were more than 50 years of age.

A total of 150 dental practitioners from North Chennai were randomly selected, of which 81 were males (54%) and 69 were females (46%). Out of the 150 practitioners, 28 (19%) were <30 years of age, 115 (77%) were 30–50 years of age, and 7 (4%) were above 50 years of age.

Assessment of response from dental patients

When questioned on discomfort in responding to dental practitioner when there is instrument in the mouth, 76.7% (n = 115) of the respondents felt uncomfortable to communicate. About 66% (n = 99) of the respondents experienced fear, when they were unable to express their pain with instruments in their mouth during any dental procedure. Among the respondents, 71.3% (n = 107) agreed that using hand signals during a dental treatment may help them to overcome the difficulty in communication. When questioned about the usage of hand signals by any dental practitioner, 58% (n = 87) of the respondents said that the dental practitioner does not advice to use hand sign to communicate during the dental treatment. About 86.7% (n = 130) of the respondents agreed that it will be good to make hand signals as a universal protocol to be followed by all the dental practitioners [Table 1].{Table 1}

Statistical significance was observed among age groups when questioned on discomfort in responding to dental practitioner with any instrument in the mouth. About 78.6% (n = 88) of the respondents who were below 30 years of age felt more discomfort with instrument in their mouth than respondents above 30 years of age (P = 0.008).

Assessment of response from dental practitioners

When questioned on what was the preferred mode of communication from the patients during the procedure, 30% (n = 45) of the dental practitioners preferred patients to talk, 54% (n = 81) preferred the usage of hand signals, and 16% (n = 24) preferred making sounds. About 63.3% (n = 95) of the respondents informed their patients to raise their hand as a signal to stop the procedure. Among the respondents, 64.7% (n = 97) denied the use of other hand signals during the procedure. About 81.3% (n = 122) of the dental practitioners accepted that usage of hand signals during the dental procedure will help reduce patients' fear and anxiety. Among the respondents, 94.7% (n = 142) believed that usage of hand signals will be helpful in understanding patients' response during the procedure [Table 2].{Table 2}

A statistical significance was observed among the age groups between 30 and 50 years in 3 of 5 questions. About 66.1% of the patients were informed to raise their hands, 33% were advised usage of other hand signals, and 84.3% of the patients considered that the usage of hand signals could reduce patients' fears (P < 0.05).

Based on gender, a statistical significant difference in responses was observed for two questions. There were more female practitioners who preferred hand signals for response (63.8%) and also considered that the usage of hand signals could reduce patients' fears (88.4%) (P < 0.05).

 Discussion



Effective doctor–patient communication is a central clinical function, and the resultant communication is the heart and art of medicine and a central component in the delivery of health care. Research in the medical field on doctor–patient communication suggests that effective communication has the potential to help regulate patients' emotions, facilitate comprehension of medical information, and allow for better identification of patients' needs, perceptions, and expectations.[6]

There are studies which mention about the significance in communication between dental practitioners and patients, which help to build up a good patient–doctor relationship.[4],[5],[7] These studies have taken the communication prior to treatment and exchange of information after the completion of treatment. There are no studies which take the communication during the dental procedure into account.

The interventive nature of dental procedures lends itself to short or long periods of nonverbal communication between dentists and patients [2] because the procedure is exercised in the region, which is not only needed for verbal expressions but also that is extremely sensitive and highly charged with emotional significance.[8] In particular, patients undergoing restorative treatment (e.g., fillings, crowns, bridges, etc.,) often have a rubber dam used for tooth isolation. This leads to long periods of mouth opening and an inability to verbalize. The lack of any dependable or recognized communication system during operative procedures can lead to misunderstanding, patient dissatisfaction, or an impaired patient experience.[2] Riley et al. further suggest that dentists can usually predict a satisfied patient's journey, they conclude that for improved patient-centered care, dentists should seek to understand patient values.[9] Most of the dental schools do not teach communication. Dentists, thus, graduate without appreciating how well the information is being received, understood, and applied during communication.[10]

Patients experience discomfort when a dental practitioner expects a response after placing any instruments in their mouth. Even for a simple question of “Are you alright?” they have to move their head to notify their response or even try speaking with the instrument in the mouth. Thus, there is a difficulty in speaking and expressing their personal views during the treatment, which eventually lead to the development of fear of unable to express pain or anything, which could be threatening to the patient.

Usage of hand signals can help in overcoming the problem of incomplete communication. Hand signals are simple gestures, which are commonly used by people who have impaired hearing and speaking ability. They tend to communicate with simple signals which convey the required information within few seconds. This can be practically applied in our field so that communication is not hampered with our treatment methods.

There is still a majority of respondents who claim to say that dental practitioners do not advice the patients to lift their hands when they require to pause the treatment. This could be because while performing treatment in the mouth, the dentist focuses on the success of completing the immediately pressing work and not on maintaining verbal interactions with the patients except for information-gaining purposes that will affect the immediate treatment procedures.[8]

Research conducted in Britain suggests that language barriers are often identified as the most frequent impediment to dental care.[11] There is a break in language barrier with the usage of hand signals as anyone can easily understand sign language and easily apply it for the dental setting. Hence, making hand signals as a universal protocol can help every practitioner during the dental procedure.

Preference of dental practitioners

Majority of the dental practitioners expect their patients to respond by hand signals rather than making sound or talking. This could be explained that expecting the patient to talk with instrument in their mouth is practically not possible, and the noise from hand piece or suction can mask the sound created by the patient.

Most of the practitioners advice their patients to raise their hand in-between to stop the procedure if they feel any discomfort. Hand signals are faster to recognize by the practitioner or by the assistant, and the practitioner can immediately respond to the situation. Usage of other hand signals such as using a “thumbs-up” to denote they are alright, “thumbs-down” to denote some discomfort are also preferred by some practitioners, but not by most of the practitioners.

Majority of the practitioners believe that usage of hand signals by the patient can help in reducing their anxiety and fear of communication gap and also help in better understanding of their patient's experience during the procedure. Patients gain trust on the practitioner that he/she is concerned about their experience in the dental setting. This increases the doctor–patient relationship, which is highly essential for a successful dental appointment.

This questionnaire study was carried out in a relatively small sample size. Thus, carrying out the study on a larger population is intended. This study also gave us an idea about the suggestions from the dental practitioners and general population. Further, clinical studies are required to assess the efficacy of hand signals in reducing the anxiety and fear levels.

Recommendations

Although any dental practitioner can use any hand signal of his/her convenience, following a universal set of hand signals can be helpful around the world. Raymond Cadden is the creator of the eight-sign method, the DentiSign. This method is designed to restore control to the patient during dental procedures, by creating a channel of communication with the dentist. DentiSign hand signals can be learned in <15 s and are suitable for all practices. The method can also have a positive impact on workflow and on practice referrals.[12]

 Conclusion



Majority of the patients and practitioners preferred the usage of hand signals over interrupted talking for reducing their fear and anxiety during a treatment procedure. They also jointly agree to the point that these hand signals can improve dentist–patient rapport.

Efficient dentist–patient relationship is required for successful treatment experience in a dental setting. Hand signals can provide a unique way to understand patient's discomfort and respond immediately to their discomfort. This can help patients to gain confidence on their dentists and they would approach the same dentist for further treatment requirements.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: Time for a sense of proportion? Br Dent J 2012;213:271-4.
2O'Dwyer P. Improving and Safeguarding Patient Communication During Dental Procedures Using an Original Hand-signal System – The Helping Hand [Masters Dissertation]. Dublin: Royal College of Surgeons in Ireland; 2015.
3Freeman R. The psychology of dental patient care 9. Communicating effectively: Some practical suggestions. Br Dent J 1999;187:240-4.
4Al-Mobeeriek A. Dentist-patient communication as perceived by patients in Riyadh, Saudi Arabia. Int J Occup Med Environ Health 2012;25:89-96.
5Misra S, Daly B, Dunne S, Millar B, Packer M, Asimakopoulou K. Dentist-patient communication: What do patients and dentists remember following a consultation? Implications for patient compliance. Patient Prefer Adherence 2013;7:543-9.
6Ha JF, Longnecker N. Doctor-patient communication: A review. Ochsner J 2010;10:38-43.
7Maybury C, Horowitz AM, Wang MQ, Kleinman DV. Use of communication techniques by Maryland dentists. J Am Dent Assoc 2013;144:1386-96.
8Sondell K, Söderfeldt B. Dentist-patient communication: A review of relevant models. Acta Odontol Scand 1997;55:116-26.
9Riley JL 3rd, Gordan VV, Hudak-Boss SE, Fellows JL, Rindal DB, Gilbert GH; National Dental Practice-Based Research Network Collaborative Group. Concordance between patient satisfaction and the dentist's view: Findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2014;145:355-62.
10Parker MA. A perspective on doctor-patient communication in the dental office. N C Med J 2007;68:365-7.
11Goldsmith C, Slack-Smith L, Davies G. Dentist-patient communication in the multilingual dental setting. Aust Dent J 2005;50:235-41.
12ITP Digital Group; c2015. Available from: http://www.m.arabianbusiness.com/hand-signals-may-cut-dental-anxiety-48504.html. [Last accessed on 2014 Aug 15].