This study evaluated student-providers’ and patients’ communication preferences during caries management discussions in the HDC teaching practice, noting differences between student-providers and patients. Both groups favored simple language, but patients showed greater preference for motivational interviewing and visual aids such as models/x-rays. Despite student-providers reporting frequently conduct caries management during visits, patient responses showed limited understanding of caries, its risk factors, and management strategies.
Applying the Tseng et al.13 communication framework, we assessed student-providers’ communication with patients during their most recent visit. All used simple language, around two-thirds explained 2–3 concepts at a time (65.6%) or spoke slowly (62.5%), and over half (59.4%) used the teach-back method. Preferences for each method may stem from various factors. Simple language and concise explanations can make information clearer for patients, especially for those without a medical background.14 Slow speech engages patients and ensures they understand the information.23,24 Some providers might lean towards certain methods over others because of their training or because they find them easier to implement.25
Conversely, patients showed a preference for simple language (54.8%), motivational interviewing (47.1%), and visual aids like models/x-rays (40.4%) during caries discussions. The shared preference for simple language between patients and providers highlights its importance in effective communication.14 Despite being less utilized by students, patients valued motivational interviewing (MI), a technique effective in the medical field for behavioral change, such as in alcoholism treatment and smoking cessation.27 Its potential in dental care, especially for modifying behaviors in groups like children with Early Childhood Caries (ECC), is an area of ongoing research.28 Traditionally, dentistry has preferred surgical to behavioral methods, possibly leading to MI’s underuse in caries management.29 Additionally, it is unclear as to which oral health behaviors benefit most from an MI approach.30 However, given MI’s success in other health fields, its integration into caries management discussions could be beneficial.
Patients also expressed a strong preference for the use of models and X-rays during caries management discussions, even though fewer than half of the student-providers reported using them in their most recent visit. Traditionally, physical dental models have often been used in the field of orthodontics to demonstrate the process of orthodontic treatment planning to patients.31 They can be helpful in providing clear visual explanations, which is especially beneficial for patients who may face language barriers.32 Additionally, given that radiographs are crucial for cavity diagnosis,33 using them as an educational tool may be beneficial in enhancing patient understanding of their dental health.
Notably, printed instructions, visual aids, and references to the internet were the three least employed techniques by student providers, despite patients preferring these techniques more than what they received during caries management sessions. This disparity may contribute to a misalignment in communication between student providers and patients. The literature suggests that visual aids are more engaging and easier to absorb than written text when It comes to communicating health risks.16 In fact, many dental providers and hygienists consider visual communication to be highly effective in patient education.13 Additionally, communication studies in the context of prostate cancer have found that providing patients with online resources can offer a sense of empowerment and control over their condition.34 Employing these techniques may help boost patient engagement in their own care. Since behavior change benefits the most from continual reinforcement over time,35 the utility of these resources’ within caries management discussions merits further investigation.
Of the 104 patients surveyed, 43.6% of patients reported that they were unable to recognize when they developed a cavity, and 43.3% believed that fillings are the necessary treatment for all dental caries. When probed about basic oral hygiene habits, 90.1% correctly identified all the cavity risk factors contributing to dental caries, and 89.0% understood that untreated caries can lead to tooth loss. These findings suggest that more than half of the patient respondents are unfamiliar with the concept of patient-centered caries management, even though most are aware of the basic caries risk factors and potential consequences of untreated caries. These results indicate a clear need for improved communication with patients about their personal role in managing caries.36
Our study’s limitations include convenience sampling, a small sample size, and reliance solely on English and Spanish questionnaire translations. The clinical experiences of third- and fourth-year dental students also vary, which might affect their communication skills usage – something future studies could investigate. Additionally, our examination of patient communication techniques did not consider broader personal contexts, such as visit frequency, educational background, and age. Future studies should examine how these factors interact with OHL to better understand the interplay of these complex dynamics.
Our study utilized a quality improvement approach to evaluate communication technique practices in the teaching clinic, aiming to help refine both educational and clinical practices at our institution. The inclusion of simple language and motivational interviewing techniques should be key components of caries management communication training. The use of radiographs, dental models, and educational materials such as infographics and pamphlets can also be helpful during caries management discussions with patients. Integrating a “soft skills” learning component on motivational interviewing into the pre-doctoral training can be beneficial. Such focused communication skills training will help prepare students to effectively discuss caries management and promote comprehensive caries prevention. There is evidence suggesting that dental students not only enjoy active learning but find it advantageous, since interpersonal skills are just as crucial alongside technical skills.37–39 Furthermore, other studies indicated that newly graduated dentists often feel ill-equipped to communicate with patients who have lower literacy levels.18,40 Therefore, incorporating communication training in the predoctoral dental education is essential for advancing patient-centered caries management.