Difficult dental conversations: Discussing gum (periodontal) disease

Periodontitis is a common, chronic condition which is largely preventable. The condition has a significant impact on patients if left to progress. Effective communication between dental professionals and patients about oral health-related behaviour change is key to stabilizing the condition.
Research into dental communication has tended to follow a checklist approach, quantifying observed communicative behaviours without transcribing the interaction. This approach is not able to capture subtle shifts in language use. The aim of this study was to use an in-depth language-based approach to explore what makes a conversation about periodontal disease likely to be successful in terms of a resulting intention towards oral health-related behaviour change.
The qualitative research in this study was undertaken in three stages. Firstly, dental professionals (n=16) were interviewed regarding their lived experience of explaining periodontal disease to patients. A thematic discourse analysis of interview accounts identified six discourse categories related to participants’ perceived professional identity roles.
In the second stage of fieldwork, people with periodontal disease (n=14) were interviewed about their experience of having this condition. A narrative macro-analysis was used in combination with a linguistic micro-analysis of participants’ stance towards periodontitis. The combined analysis identified three categories of orientation towards behaviour change.
The results of the first two stages of fieldwork were used to design periodontal disease roleplay scenarios. The resulting roleplay interactions (n=87) between dental students or tutors and 6 simulated patient (SP) characters were discourse analysed to produce a set of recommendations on the communicative approaches more likely to be successful. Subtle language choices, e.g. word choice, framing and sequencing were found to have a differential impact on success for different SP characters. Being able to be use discourses flexibly in real time was identified as a key skill currently not emphasized in the dental curriculum.