Understanding effective communication in dental primary care
: the dentally anxious patient, an example of special care dentistry

  • Jennifer Duncan Hally

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Background: More than 10% of UK adults suffer extreme dental anxiety. Effective verbal and non-verbal communication (VNVC) in the dental dyad following handover of a completed Modified Dental Anxiety Scale (MDAS) had been hypothesised to reduce dental state anxiety. This study aims to consider whether: (1) ‘MDAS completion and handover effects long term dental trait anxiety, and (2) ‘what VNVC elements influence patient anxiety reduction?’ Trial Design: Mixed methods: (i) a randomised cross-over study and (ii) an observational study. Methods: Six NHS Highland Salaried Dental Practices were randomised to start either with the experimental arm, where dentally anxious patients (MDAS score = 19 or 5 in any one question) complete and handover MDAS to the dentist, or the control arm where no handover occurred. Within the observational study, all participants had their dental treatment appointment videoed. The primary outcome was dental trait anxiety as measured by MDAS, pre-treatment and at 3 month follow-up. Secondary outcome was dental state anxiety, measured pre and post treatment using both the Spielberger State-Trait Anxiety Inventory (STAI-S) and Heart rate.The observational study analysed the first 2 minutes of video and related this data to the behavioural and affective outcomes. Results: 54 patients agreed to take part in the study with 47 completing 3 month follow-up. The randomised cross-over study found no difference in state or trait dental anxiety however observational outcomes showed dental state anxiety remained high when handover was blocked. A significant lack in decline in dental trait anxiety was shown when dentists blocked patient expressed cues and concerns; this occurred irrespective of patient gender, age or number of appointments received in a 3 month period (F[155.06]=7.51, P=0.009). Conclusions: VNVC flow is fundamental to dyadic balance even within the first two minutes of the patient-dentist interaction. The balanced dyad is key to dental anxiety reduction.
    Date of Award2011
    Original languageEnglish
    SponsorsChief Scientist Office
    SupervisorRuth Freeman (Supervisor), Gerry Humphris (Supervisor) & Nigel Pitts (Supervisor)


    • Communication
    • Dentistry
    • Dental Anxiety
    • Special Care

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