The role of non-verbal communication in oral health
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Aims and objectives
The aim of this article is to explore the role of non-verbal communication that may prove successful alongside the spoken word.
On completing this CPD session, the reader will:
• Understand that communication, broadly speaking, can be divided into verbal and non-verbal behaviours
• Understand why non-verbal communication may be more effective than the spoken word when it comes to communication
• Understand how to make the most of non-verbal interactions with patients
• Understand why being able to demonstrate active listening is so important to the communication process
• Understand that a blend of constructive verbal and non-verbal communication will benefit both DHCPs and patients.
The role of non-verbal communication in oral health
Given that contemporary evidence suggests a significant percentage of communication is non-verbal,1 this piece will explore non-verbal cues that may prove successful alongside the spoken word.
The General Dental Council (GDC) expects registered dental health care professionals (DHCPs) to, ‘Communicate effectively with patients – listen to them, give them time to consider information and take their individual views and communication needs into account.’2
Considering this requirement in practical terms, Hanks and colleagues (2016) wrote: ‘Communication is a vast and complex field, which can be broadly divided into two categories: verbal and non-verbal.’3
They continued: ‘Verbal communication involves the use of language transmitted through both writing and speech. Non-verbal communication refers to wordless communication including tone and pitch of the voice and body language. It is accepted that non-verbal communication plays an important role in communicating emotion and forming relationships.’3
Indeed, according to Dalonges and Fried (2016), a number of researchers consider non-verbal behaviours to be more effective when it comes to communicating immediacy, when compared to what may be spoken.1 It is further considered that 93% of communication is non-verbal, which has been divided as 60% attributed to facial expression and body language and 33% ascribed to vocal signals beyond what is being said.4
Examining the significance of communication between the dental hygienist and patient, Dalonges and Fried (2016) broke the process down to include the following elements:1
• Body movements when communicating
• Gestures, facial expressions and proximity
• Skin sensitivity
• Physical aspects, such as clothing (e.g. uniform versus casual wear)5
• Physical characteristics
• Eye movement
• Tactile behaviour.
As for vocal signals (paralinguistics), this includes tone of voice and volume, as well as the speed at which one speaks and the use of fillers such as ‘um’ and ‘ah’.5 Each of these may contribute to a patient’s perception of the importance of the message being conveyed to them.6
Show that you are listening
Paralinguistics, body language and what is said are all strong indicators of empathy. On this, Asimakopoulou and colleagues (2018) wrote: ‘Empathy refers to the feeling that the listener is making an effort to understand the situation from the speaker’s point of view. Empathy may be conveyed in body language and tone of voice, and also the way that the dental HCP talks about the patient’s problems.’6
Thus, active listening is an important part of effective communication between DHCPs and patients, requiring verbal interaction as well as paralinguistics and body language. Wanless (2006) suggests making use of the acronym SOLER to help show patients that they are actively being listened to:5
• Sit squarely – face the patient square on
• Open posture – do not cross arms or legs
• Lean in – slightly tilting your body forwards indicates eagerness
• Eye contact – this shows interest and helps to build rapport
• Relaxed – being at ease is important.
DHCPs may be worried that this kind of process is time-consuming. However, as Waylen (2017) explained: ‘Concerns that good or patient-centred communication takes time are unfounded: research suggests that the time taken for a patient-centred consultation is, at worst, the same as for a biomedical (disease focused) consultation and, at best, is reduced because the main point of the consultation is accessed more quickly.’7
Finally, offering an overview of the situation regarding verbal and non-verbal communication in dental practice, Dalonges and Fried (2016) concluded: ‘Successful and meaningful professional encounters require ef¬fective communication between the patient and the clinician. Developing approaches that improve com¬munication allows the clinician to build trust, promote healing, and ultimately improve health outcomes. Specific communication skills to motivate patients to achieve optimal oral health are critical. Sending a supportive and caring message will contribute to the development of trust between the patient and the clinician, creating pathways conducive to learn-ing and motivation. Oral health providers continually communicate to patients through body language, gaze, and facial expressions; therefore, care must be exercised to portray positive and caring gestures. A combination of productive verbal and non-verbal patterns will benefit educators, students, health care providers and patients.’1
Top tips for improving communication8
• Focus on the patient; position your shoulders and legs toward the patient, place arms in a relaxed position and uncrossed, sit on the edge of your seat, maintain eye contact
• Show interest - listen
• Provide feedback by paraphrasing, summarising and praising
• Be aware of your patient's body language
• Make your message simple, brief, and direct. Enunciate clearly, keep your words simple, repeat the most important part of the message
• Laughter stimulates endorphin release and reduces anxiety, so use humour when appropriate
• Use aids such as models, radiographs, and printed materials with engaging pictures
• Consider any cultural differences.
Dalonges DA, Fried JL. Creating immediacy using verbal and nonverbal methods. The Journal of Dental Hygiene 2016; 90(4): 221-225
Standards for the dental team. General Dental Council 2016; Standard 2.1
Hanks S et al. Reflections on learning and enhancing communication skills through community engagement: a student perspective. BDJ 2016; 221(2): 81-85
Dougall A, Fiske J. Access to special care dentistry, part 2. Communication. BDJ 2008; 2015(1): 11-21
Wanless M. Can you help your patients through better communication? Vital 2009; 6: 23-26
Asimakopoulou K et al. Manual of Clinical Procedures in Dentistry. Wiley-Blackwell 2018 (eds Wilson N, Dunne S); chapter 4
Waylen A. The importance of communication in dentistry. Dental Update 2017; 44: 774-780
Macri D. The expert advice: Dental patient compliance hinges on effective communication strategies. RDH 2016; 36(6). Available at: https://www.rdhmag.com/articles/print/volume-36/issue-6/contents/the-expert-advice.html