PhD Abstract on Dental Communication

Communication is central to all health professional practice. Over several decades, principles and models of communication have been developed to support Person-Centred Care and Shared Decision Making. However, these models have largely been developed within medical contexts. This thesis explores communication in dental practice by examining how dentists communicate in everyday clinical encounters, how they perceive communication in their work, what they consider important in clinical communication, and whether dominant health communication ideals align with the specific realities of dental care.

Using ethnographic methods, the study draws on observations of 110 dental appointments and in-depth semi-structured interviews with 27 dentists working across public and private clinics in metropolitan and rural Victoria, Australia. Data were thematically analysed, generating a set of interrelated findings that illuminate how communication is both enabled and constrained within dental practice. Dentists demonstrated strong awareness of patient anxiety and expressed a clear desire to build trust, reassurance, and positive therapeutic relationships with patients. However, these relational intentions were consistently shaped by the realities of dental practice. The dental environment, characterised by invasive procedures, time pressure, patient discomfort and anxiety, workflow demands, medico-legal considerations, and financial discussions, often promoted a more instrumental, task-oriented approach to interaction. Dentists also described uncertainty about how best to respond to patient anxiety, alongside perceived mistrust and negative assumptions directed towards the profession. These challenges were further compounded by the need to manage patient expectations and by dentists’ preference to lead and retain control of the communication agenda, commonly as a means of maintaining efficiency, professional authority, and risk management.

Taken together, the findings suggest that dental communication operates along a dynamic continuum, ranging from highly dentist-led, instrumental exchanges to more dialogical, patient-inclusive interactions. Dentists moved along this continuum in response to clinical context, appointment type, patient characteristics, and professional role demands. Although dentists expressed a consistent commitment to building rapport and connection, systemic pressures such as time constraints, workflow demands, and procedural priorities often shifted communication towards greater control and direction by the dentist. Importantly, the findings indicate that assumptions underpinning many health professional communication models, including Person-Centred Care, frequently clash with the realities of dental practice, where communication occurs under intense time constraints, heightened patient anxiety, and high procedural intensity.

In response to these empirical insights, the thesis introduces a practice-based communication approach termed Empowering Contextualised Dialogue (ECD). ECD is intended to better reflect the realities of dental practice and to contribute to the health professional communication literature by articulating how dentist-patient communication can be understood and enacted in real-world dental settings. The approach legitimises both relational and instrumental forms of communication, recognises professional autonomy, and emphasises adaptive, context-sensitive dialogue to support both dentists and patients. Beyond dentistry, ECD may offer relevance to other health professions in which communication, power, and relational care intersect.