Dental patients young and old

Jane Merivale a dento-legal adviser at Dental Protection offers some ideas to eliminate any communication gap between you and some of your patients.

As a dental student you may have the well known maxim that says, "Teeth are a trouble when they come and a trouble when they go"; indeed the treatment of the young and elderly does create its own particular technical and communication challenges.

However, dentistry is a people business and when embarking upon a career in general practice it is the sheer variety of patients we are likely to see on a daily basis that promises to enrich our experience and thereby increase our job satisfaction.

Even though you may not have much experience of either age group, maintaining a natural curiosity about patients' lives will enable you to develop both understanding and empathy. Encouragingly, research confirms the most powerful precursor for effective communication is to display both competence and a caring approach in order to develop the trust which is so vital to enable treatment of patients both young and old.

Similarities

You may have observed that when a large number of people meet in a social setting, it is the young and the old who seem to have an affinity towards one another and, as we shall see in this brief article, there are some characteristics that are common to both groups which may explain this natural rapport.

When it comes to dentistry, most people seek dental treatment more out of necessity than choice. This is particularly so for the very young patient and the elderly. Patients in both these categories are very likely to be accompanied by a family member or carer and immediately we are involved in a three way consultation. However, it is important to remember the child or elderly person is the patient but it is the parent or carer who will be the key to the communication process. Consequently always try and start an appointment by addressing the patient personally to recognise that you are there to deal with their particular needs. Allow them to tell their story uninterrupted, unless of course they would prefer their parent/carer to do so for them. Respecting autonomy and assuming the patient has some capacity to participate in this way can improve their satisfaction and adherence to treatment.

Moreover, attentive listening can help the clinician to gauge the patient's ability to understand as well as providing an insight unto their emotional state (both age groups are likely to be anxious) and we should always guard against being patronising.

Whilst it may be tempting to prefer addressing the parent/carer, by doing so we may unintentionally marginalise the patient and we should try our best to avoid this.

Communication tools

Human interaction is a complex business. Communication is not simple and it can arise in a variety of different ways whilst the patient's response will be based mostly on emotion. In other words they are more likely to respond not so much to what we say but, to the way that we say it or the way we handle and approach them. Patience and allowing sufficient time for the appointment are essential if you are to communicate information at the patient's own pace.

Both age groups may have a limited capacity to communicate, the young due to immaturity and the old because of some impairment such as loss of hearing or sight, or because of dementia and its onset which sadly affects approximately 8% of people over 65.

The dentist can communicate in a variety of different ways and each method has the potential to help with these two groups of patients. When speaking, our choice of words, the tone and pace we adopt will be crucial and so are the non-verbal messages we send through facial expression, eye contact and gestures. We may consider using simple visual aids to help communicate with the patient before having a more detailed discussion with the parent/carer.

Patients in return will also communicate with us in a variety of ways;

• Vocally; using speech or sounds such as crying or moaning
• Physiologically; sweating or pallor
• Facial expressions; grimacing or smiling
• Posturally; guarded or withdrawn

We must learn to pick up any clues we are given and to work at an intuitive, empathetic level alongside the logical and technical way in which we will have been trained.

Ageism

Taking a moment to understand that the patients' predicament may also help us to understand, what at face value seems to be, rather awkward or unusual behaviour. For example, an inattentive, restless child may have an underlying learning difficulty; an elderly patient whose attendance seems erratic may have early onset dementia and be prone to forgetfulness.

Unfortunately ageism is common in healthcare and it is important to ask, "Am I acting on inaccurate or inappropriate assumptions or generalisations based on the age of this patient rather than finding out about the individual?"

Treating people as individuals rather than being 'elderly' or 'young' is the key to understanding and success.