The Dentist’s Communicative Role in Prosthodontic Treatment Katarina Sondell, LDS, Odont Dr/PhDa/Sigvard Palmqvist, LDS, Odont Dr/PhDb/ Björn Söderfeldt, PhD, Dr Med Scc Purpose: Dentist-patient verbal communication is important for patient satisfaction. The aim of this study was to investigate the dentist’s role in the provider-patient relationship as to verbal communication and patient satisfaction with the treatment outcome in prosthetic dentistry. The dentist-specific properties were analyzed in random coefficient modeling. Materials and Methods: Sixty-one dentist-patient pairs were followed through 61 prosthodontic treatment periods. The treatment performed was fixed prosthodontic restorations on teeth or implants. One encounter at the end of each treatment period was tape recorded. The verbal communication on the recordings was analyzed using an interaction analysis instrument. Various measures of communication were used, summarizing the variational pattern of verbal interaction. Two different aspects of the patient satisfaction concept were used as dependent variables: cure (overall patient satisfaction with prosthodontic treatment), and care (patient satisfaction with a particular dental encounter during the prosthodontic treatment period). Results: In the multilevel model for care, the dentist variance was mostly explained by the communication variables. In the cure model, there was no dentist variance. The communication patterns used by the dentists thus influenced patient satisfaction in a short-term perspective but not in an intermediate perspective. Conclusion: Patient evaluation of the care during an encounter is dependent on the dentist’s verbal communication activity during the encounter, but this communication has no impact on the patient evaluation of overall prosthetic treatment outcome in the intermediate time perspective. Int J Prosthodont 2004;17:666–671. number of different factors contribute to an effi- factors directly related to comfort and function, several Acient clinical outcome in prosthetic dentistry. Ac- other patient factors seem to influence the final treat- curate diagnosis and a strict treatment protocol have ment outcome. These factors include patient person- proven to predict good long-term survival rates for ality, attitude, and expectations and dentist-patient ver- prosthodontics.1,2 Even if the prosthetic treatment is of bal communication.5–8 excellent clinical quality, some patients will still not be However, the other party in the relationship, the satisfied. Patient satisfaction with prosthetic dentistry dentist, has not been studied in these respects. Still, seems to have a multicausal character.3,4 In addition to some authors regard the clinician as being extremely important to the final treatment outcome in prosthetic aSenior Consultant, Department of Prosthetic Dentistry, Institute for dentistry, and they should therefore not be neglected Postgraduate Dental Education Center, Jönköping, Sweden. in outcome assessment.9 Technical routines and den- bProfessor Emeritus, Department of Prosthetic Dentistry, School of tist skills are in fact strongly correlated to prosthetic Dentistry, Faculty of Health Sciences, University of Copenhagen, treatment outcome.6,9–12 One of the many skills a den- Denmark. cProfessor, and Chair, Department of Oral Public Health, Malmö tist has to practice to achieve a good, predictable treat- 13–15 University, Sweden. ment outcome is communication. It has been stated that there is a communication gap Correspondence to: Dr Katarina Sondell, Department of Prosthetic Dentistry, Institute for Postgraduate Dental Education Center, between patients and dentists that likely causes patient 16 PO Box 1030, SE-551 11 Jönköping, Sweden. Fax: + 46 36 32 49 90. dissatisfaction, and clinician communication skills e-mail: [email protected] have consequently been shown to be important in 666 The International Journal of Prosthodontics Sondell et al limiting patient dissatisfaction in dentistry.17,18 It has number of quadrants were used as independent vari- also been shown in a multivariate model that dentist-pa- ables in the various analyses. tient verbal communication dimensions (eg, information The recordings were made with equipment placed in exchange from the patient and dentist points of view) the ordinary dental office room. All participants were in- are important for patient satisfaction with treatment formed that the visit would be recorded and were given outcome in an intermediate time perspective. A weak- the opportunity to decline participation. The study base, ness of this multivariate model specification is the ex- recording bias, interaction analysis instrument used clusion of dentist-specific properties to avoid the eco- (Roter Interaction Analysis System [RIAS]–Dental), and logic fallacy.5 As there are more patients than dentists, coding procedure have been reported in previous stud- dependency is introduced between those patients who ies.19,20 A local research ethics committee approved the have a common dentist. In effect, an analysis of dentist study before its commencement. variables means crossing a level of analysis, necessi- The seven dimensions of verbal communication tating random coefficient modeling, such as multilevel found to summarize the variational pattern of verbal in- models. The bivariate differences observed (eg, be- teraction in prosthetic dentistry were used as measures tween male and female dentists) in the previous study of communication. These dimensions are described in indicate that there are good reasons for performing an detail in a previous paper.21 They are: analysis with such analytic methods.5 The aim of the present study was to find an answer 1. Emotional exchange, describing both supportive to the question of what role the dentist might have in and nonsupportive, negative emotional exchange the provider-patient relationship, with special concern between dentists and patients for patient satisfaction with the treatment outcome in 2. Information exchange–patient horizon, describing prosthetic dentistry. More specifically, the study applied mainly task-focused informational exchange, pri- multilevel modeling to investigate if the satisfaction marily from the patient’s horizon with care, satisfaction with cure, and total number of 3. Relation-building exchange, describing a verbal utterances during an encounter were related to den- relation-building strategy comprising greetings, tists’ characteristics and verbal communication. friendly statements, and small talk 4. Information exchange–dentist horizon, describing Material and Methods dentists’ information-gathering strategy as well as dentists’ verbal behaviors favoring the proceed- Sixty-one dentist-patient pairs (61 patients and 15 ings of the encounter dentists) were followed through prosthodontic treat- 5. Administrative and counseling exchange, describ- ment periods at three Swedish specialist clinics for ing dentists’ and patients’ information-gathering prosthetic dentistry during 1998 and 1999. One en- behaviors about the administration, clinical rou- counter at the end of each treatment period was tines, and paperwork recorded. Dentist ages were 37 to 55 years (mean 45 6. Task-focused exchange, describing mainly patient years). Ten dentists were men (mean age 45 years), information-giving behaviors and dentist back- and 5 were women (mean age 46 years). The dentists channeling behaviors worked with patients on average 30 hours per week 7. Socioemotional exchange, describing mainly emo- and had regular daily contact with other dentists at tional communication, but also dentist-patient in- their clinics. formation-seeking behaviors in the form of closed- Of the 61 patients, 51% were men (mean age 53 ended questions years), and 49% were women (mean age 54 years). Data concerning the length of the treatment periods and Two separate questionnaires were presented to the amount of fixed prosthodontic work performed were col- patients at two different times during the treatment pe- lected from the patient records at the time the treatment riod; consequently, two different aspects of the patient period was finished. The mean length of the treatment satisfaction concept were constructed. From an inter- period was 20 months (range 1 to 51 months). The pa- mediate time perspective, “patient satisfaction with tients and dentists met a mean of 14 times before the treatment outcome” was defined; this was called “cure,” prosthodontic restorations were placed (range 3 to 46 general patient satisfaction with the overall prostho- times). Ten patients received treatment in three or four dontic treatment. From a short-term perspective, “pa- quadrants. Forty patients received prosthodontic treat- tient satisfaction with care” was defined; this was called ment in two quadrants. Eleven patients received “care,” patient satisfaction with a particular dental en- prosthodontic treatment in only one quadrant. The pros- counter during a period of prosthodontic treatment. thetic treatment comprised either implant- or tooth- The basis for the development of the care mea- supported prosthodontics. The type of treatment and sure was a questionnaire distributed to the patients Volume 17, Number 6, 2004 667 The Dentist’s Communicative Role in Prosthodontics immediately after the recorded encounter. This • Dentist-patient age difference (in years) questionnaire contained 11 questions, 8 of which • Quantity of prosthetic treatment (No. of quadrants) were derived from the Dental Visit Satisfaction