Dentist Empathic Accuracy Is Associated With Patient-Reported Reassurance

ABSTRACT

Objectives

The aim of this work was to determine dentists’ ability to accurately estimate patients’ anxiety level during dental treatment (ie, “empathic accuracy”) and to determine the strength of the association between empathic accuracy and patient-reported reassurance.

Methods

A cross-sectional study was conducted amongst 177 adult patients who underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling) performed by 10 different dentists from 3 dental offices in the Netherlands. Patients reported their anxiety level during treatment and the extent to which they felt reassured by the dentist using a visual analogue scale (VAS). Simultaneously, the dentists estimated patients’ anxiety level. Empathic accuracy was calculated as an absolute difference between patient-reported anxiety (100-point VAS) and dentist estimation of anxiety (100-point VAS).

Results

Agreement between dentists’ assessment of patients' anxiety and patient-reported anxiety proved good, intraclass correlation coefficient (177) = 0.63; 95% confidence interval [CI], 0.53-0.71. A small to medium-sized positive correlation, r (177) = 0.15; 95% CI, 0.00-0.29, was found between dentists’ empathic accuracy and patient-reported reassurance. A negative correlation was found between empathic accuracy and patients’ anxiety scores, r (177) = −0.23; 95% CI, −0.38 to −0.09.

Conclusions

Given that greater empathic accuracy was associated with higher patient-reported reassurance during treatment, training young dental professionals in empathic accuracy might help patients feel reassured. Importantly, our results also suggest that with elevated levels of patient anxiety it is increasingly challenging for dentists to recognise this emotion, and thus support the patient in an optimal manner.

Key words

Introduction

A wide array of studies have established that dental anxiety is deeply rooted in previous negative dental experiences or, less frequently, in other types of distressing and traumatic life events.1, 2, 3, 4, 5, 6, 7, 8, 9 Risk factors for experiencing pathologic forms of dental anxiety (a spectrum ranging from elevated fear and dental phobia to posttraumatic stress disorder) include having undergone an invasive dental procedure (eg, injections, drillings, and extractions), extreme emotional responses during negative experiences (eg, felt helplessness, nausea, embarrassment, or sense of suffocation), and characteristics related to the dentist (eg, lack of understanding, impoliteness, rudeness, insufficient information provided during treatment, and criticism).1, 2, 3, 4, 5, 6^,10, 11, 12 Creating a pleasant dental experience for the patient, and thereby preventing the development of a pathologic form of fear of the dental treatment, is most likely when the dentist is properly trained and willing to conduct behaviours that affect the internal state of the patient. In other words, it is imperative13, 14, 15, 16 that dentists have the empathic capabilities (we use the term “empathic accuracy”) to accurately estimate their patients’ level of anxiety and, moreover, to respond accordingly. Examples are providing emotional reassurance and a creating a sense of control by the patient.^12,17,18

Regarding the accuracy with which dental professionals estimate their patients’ anxiety levels during treatment, only one cross-sectional study by Höglund et al. that included 1128 adult patients from several Swedish public dental clinics demonstrated that dentists were capable of accurately estimating their patients’ anxiety.19 In line with these findings, research conducted in the field of social psychology suggests that professionals working in health care settings may be able to accurately estimate their patients’ affective state.20, 21 Despite these findings, a substantial proportion of studies indicate that health care professionals, including dentists, have limited capacity to accurately assess the emotional state of their patients, particularly when the affective state is negative.22, 23, 24, 25, 26^,27, 28 In this context, our work aimed to determine the accuracy of dentists’ ability to estimate patients’ anxiety level during dental treatment and to establish the strength of the association between dentists’ empathic accuracy and patients’ reported reassurance.

Materials and methods

Our cross-sectional study included 177 adult patients (62% female, 38% male; age range, 18-88 years; mean age, 45 years; SD, 19 years) who received dental treatments from 10 dentists at 3 dental offices in the Netherlands. Informed consent was obtained from each participant. The medical ethics committee of the Academic Center for Dentistry Amsterdam (ACTA) approved the study protocol. Patients participated in this study between July and October 2022. They underwent different invasive dental procedures (ie, extractions or procedures requiring injections and drilling). Treatments varied in length from 15 minutes to 1.5 hours.

The following exclusion criteria were applied: patients below 18 years of age, pregnant patients, patients with a history of psychiatric or psychological disorders, and those who were prescribed sedative or anxiolytic medication prior to treatment. Patients who did not meet the exclusion criteria received an invitation letter explaining the purpose and procedure of the study. All data were collected using an online survey tool, Qualtrics. Both patients and dentists completed the survey after treatment. Patients were instructed to rate their level of anxiety on a 100-point visual analogue scale (VAS) ranging from 0 (not anxious) to 100 (extremely anxious). Similarly, dentists rated patients’ anxiety level on a 100-point VAS.

In addition, patients completed a 100-point VAS to rate the extent to which they felt reassured by the dentist (0, not at all reassured, to 100, extremely reassured). The average empathic accuracy score was computed as the absolute difference between patients’ self-reported anxiety and dentists’ estimation of anxiety. The internal consistency (Cronbach's α) of the VAS items was high (0.90).

Statistical analyses were performed using the statistical package SPSS version 25.0. Descriptive statistics, including means and standard deviations (SDs), were used to summarize patient and dentist characteristics. The intraclass correlation coefficient (ICC) was used to determine the agreement between patients’ reported anxiety and dentists’ estimation of anxiety. Pearson correlation coefficients were calculated to establish the relationship between empathic accuracy and patient-reported reassurance, as well as between empathic accuracy and patient-reported anxiety.