communication skills

Question 1

What is dental anxiety?

Answer 1

General state of apprehension, prepared for something negative to happen

Question 2

What is dental phobia?

Answer 2

Severe anxiety which results in avoidance or endurance of a situation w significant discomfort

Question 3

What are dental anxiety stats?

Answer 3

36%- moderate anxiety
12%- extreme anxiety
45%- fear of dentist is barrier to care
30%- tooth drill= v anxious
28%- LA= v anxious

Question 4

What is the dental anxiety scale?

Answer 4

Extreme- freq cancels, shows up late, resist tx, no referrals (30-50Hz)

Moderate- not proactive, needs more time, talks through tx, resists, low referrals (20-30Hz)

Low- easier, proactive, open to plan, tongue battle, gagging, tense jaw, fair referral (13-20Hz)

Cognitively aware- relaxed, quiet, proactive, trusting, excellent referral (8-12Hz)

Question 5

How does anxiety affect society/NHS?

Answer 5

1. Cost of sedation and GA
2. missed appts

Question 6

How does anxiety affect the dental team?

Answer 6

1. Higher levels of stress
2. Dentist absorbs pts anxiety
3. Dissatisfied about Q of tx
4. Missed appts

Question 7

What are causes of dental anxiety?

Answer 7

1. LEARNING (classical conditioning/observational/vicarious)

2. UNCERTAINTY (fear of unknown/lack of control)

3. PERSONALITY (neuroticism, negative attributes of dentist)

Question 8

What is the social learning theory (Bandura 1986)?

Answer 8

Behaviour learned from environmental through observational learning

Eg. Witness parents, remember, reproduce

Question 9

What are dental pain stats?

Answer 9

77%- some pain
11.6%- LA fails

Question 10

What are the 3 As of anxiety?

Answer 10

ASK how anxious
ACKNOWLEDGE what you heard
ADDRESS the fears by offering solutions

Question 11

What are main skills from the Calgary Cambridge framework?

Answer 11

1. Establish supportive environment and initial rapport
2. Demonstrate respect and interest
3. Listen attentively and use silence effectively
4. Actively encourage (supportive words, non verbal)
5. Open exploratory questions
6. Actively determine pts perspective
7. Adjust language as appropriate
8. Explore tx options and negotiate mutually acceptable plan

Question 12

What is CBT?

Answer 12

Focuses on present not past
Helps identify problems
Positive management strategies
Thoughts, feelings, physical sensations and actions interconnected
Break cycle

Question 13

What is the evidence base for CBT?

Answer 13

2018 systematic review
More effective than other techniques in reducing anxiety
Low quality evidence

Question 14

What are behavioural management techniques?

Answer 14

1. REDUCE UNCERTAINTY (provide info)

2. ENHANCE CONTROL (stop signals)

3. DISTRACT (music, game, eye mask)

Question 15

Can you use IS and GA as a technique?

Answer 15

Doesn’t reduce anxiety
Higher cost to NHS

Question 16

What are key features of the children’s CBT guide?

Answer 16

1. CHALLENGE UNHELPFUL THOUGHTS

2. ENHANCE CONTROL

3. REFLECT AND PLAN REWARD

Question 17

What is bad news?

Answer 17

Any news that drastically and negatively alters the patients view of their future

Question 18

Why is it difficult to give bad news?

Answer 18

1. Not knowing how to
2. Fear of upsetting pts life
3. Not knowing or
4. Fear of implications for pt
5. Fear of pts reaction
6. Uncertainty of what next (answering Qs)
7. Feeling responsible and fearing blame

Question 19

How should you give bad news?

Answer 19

1. PREPARE (info, setting, time) is pt expecting? Should anyone be there? What do they know?

2. DISCUSS NEWS (give info, check understanding, identify main concerns, elicit pts resources and decide on way forward)

3. REVIEW SITUATION

Question 20

How should you deliver bad news according to Calgary?

Answer 20

1. Find out what they know
2. Find out what they want to know (active listening, understand perspective)
3. Give information (minimum jargon, introduce incrementally, pay close attention to response)

Question 21

What is empathy?

Answer 21

Experience of understanding another persons condition from their perspective, place yourself in their shoes

Question 22

What is shared decision making?

Answer 22

1. Share own thinking as appropriate
2. Involve pt
3. Explore management options
4. Ascertain lvl of involvement pt wishes
5. Negotiate mutually acceptable plan
6. Check w pt

Question 23

What are stats for uncooperative behaviour?

Answer 23

20-25% children disruptive
Correlated w age and type of procedure

Question 24

What are different signs of distress?

Answer 24

VERBAL- crying, moaning, complaining, screaming

BEHAVIOURAL- flinching, blocking, thrashing, turning away

Question 25

What is behavioural management?

Answer 25

Means by which the dental team effectively and efficiently perform dental tx and thereby instils a positive dental attitude

Question 26

What are babies able to do at 6 months?

Answer 26

Lift head and chest
Sit when held
Reach and grab
Prefer moving objects
Focus eyes
Distress by sudden noise
Laugh and vocalise
Cry loudly
Smile to speech
Wary of strangers
Pleasure to loving attention

Question 27

How should you interact w a 6 month old?

Answer 27

Respond to baby’s needs
Allow baby to touch objects
Allow baby to hold/play
Face to face communication
Make sure no negative associations
Introduce slowly objects that make noise

Question 28

What can babies do at 12 months?

Answer 28

Rise to sit up
Crawl
Point to objects of interest
See we’ll
V good visual memory
Know and respond to own name
Speak 2-6 words
Understand simple instructions
Fluctuating moods

Question 29

How should you interact a 12 month old baby?

Answer 29

Provide interesting varied environment
Use baby’s name
Talk to baby about everyday
Provide simple instructions
Encourage role play
Plenty of reassurance
Use familiar comforting items

Question 30

How can you give a good first impression?

Answer 30

Acknowledge child
Meet w in waiting room
Toys, bricks, balls
Introduce by first name
Position on same level
Be encouraging
Ask about favourites

Question 31

What is a 2 year old able to do?

Answer 31

Run, throw, push, pull
Listen to conversation
Speak over 200 words
Express how feel
Curious

Question 32

How should you interact w a 2 year old?

Answer 32

Provide simple instructions
Explain using toys, picture books, glove puppets
Play let’s pretend
Encourage child to express feelings

Question 33

What is a 5 year old able to do?

Answer 33

Good balance/coordination
Brush own teeth
Increased attention
Fluent speech
Enjoy jokes
Can give full name, age etc
Likes and dislikes
Independent

Question 34

How should you interact with a 5 year old?

Answer 34

Encourage to do simple tasks
Involve them
Explain everything
Ask if any Qs
Engage through humour
Praise and reward

Question 35

What is the role of the parent?

Answer 35

1. Gain child’s attention, improve compliance
2. Avert escape or avoidant behaviour
3. Enhance effective communication
4. Minimise anxiety and achieve positive dental experience

Question 36

What are positive approaches to behaviour management?

Answer 36

1. Effective communication skills
2. Tell-show-do
3. Distraction
4. Behaviour shaping and positive reinforcement
5. Hand signs (stop signals)
6. Written information
7. Pain control methods

Question 37

What is behaviour shaping?

Answer 37

Reinforce- strengthen pattern of behaviour- increase probability of future behaviour

Question 38

What are positive reinforcers?

Answer 38

1. Verbal praise
2. Facial expression
3. Positive voice modulation
4. Parental approval
5. Rewards and treat

Question 39

What are pharmacological pain control methods?

Answer 39

1. Topical
2. LA
3. Conscious sedation
4. GA

Question 40

When might you have language barriers?

Answer 40

Children
Elderly
Disabilities
Non native English

Question 41

What is cultural competence?

Answer 41

Acknowledgement of the importance of culture in peoples lives
Respect for cultural differences

IDEALLY- treat pts as individuals but maintain constant awareness of potential impact of culture (avoid stereotyping)

Question 42

What Calgary skills can be applied to pts w language barriers?

Answer 42

Initiation- check pronunciation/how to greet, check wish for family/interpreter to be present

Gathering info- explore beliefs about tx and perspective to healthcare

Building relationship- aware of differences in non verbal, avoid assuming, show sensitivity to differences

Explanation and planning- work w interpreter, check understanding of info, address concerns freq, give real choices based on situation

Question 43

What makes the perfect dentist?

Answer 43

Confident
Empathetic
Humane
Personal
Frenal
Respectful
Through

Question 44

How should you deal w a difficult pt?

Answer 44

1. Don’t downplay complaint, listen w/o interrupting
2. Express empathy
3. Express that you will do whatever it takes to solve their problem
4. Don’t go on defensive
5. Take control of situation
6. Ask pt what they want
7. Establish plan and sell it
8. Carry out plan and make sure pt is happy w result

Question 45

What is the Calgary Framework?

Answer 45

INITIATE SESSION- greet pt, obtain name, introduce self, role and nature of interview, obtain consent, demonstrate respect and interest

GATHER INFO- encourage pt to tell story, open and closed Qs, leave space for pt to think, verbal/nonverbal, clarify pts statements, periodically summarise, don’t use jargon, establish dates/sequence of events

PHYSICAL EXAM

EXPLAIN/PLAN- give info in chunks and check understanding, find out previous knowledge, ask what else would be helpful, avoid giving advice or premature reassurance

CLOSE SESSION

PROVIDING STRUCTURE* - summarise at end of enquiry, progress to next session w sign posting/transitional statements, logical sequence, attend to timing, keep on task

BUILDING RELATIONSHIP* - non verbal, if multitasking don’t interfere w rapport, appropriate confidence, non judgemental, use empathy, provide support, deal sensitively, involve pt