Dental professionals’ role perceptions in relation to periodontal (gum) disease explanations

A thematic discourse analysis approach

Authors

  • Marion C. Bowman University of Leeds
  • Isobel Sale University of Leeds
  • Ruth Payne University of Leeds
  • Karen Vinall-Collier University of Leeds
  • Aradhna Tugnait University of Leeds

DOI:

https://doi.org/10.1558/cam.20929

Keywords:

behaviour change, dental communication, dental hygienists / dental therapists, dentists, periodontal (gum) disease, thematic discourse analysis

Abstract

Objective: To use a discourse analysis approach to identify salient features in the lived experiences of dental professionals in relation to explaining periodontal (gum) disease to patients.

Methods: Interview data from 13 UK-trained and three internationally-trained dental professionals was examined using thematic discourse analysis. The first stage (discourse analysis) focused on the identification of language patterns in the interview data. This stage forms the focus of this paper.

Findings: Six discourse categories (Clinician, Mentor, Educator, Collaborator, Rapport Builder, Professional) were identified that related to the participants’ perceived professional roles. The categories were associated with differing worldviews and language use patterns, but with some overlap. All interviewees used a variety of discourse categories in their accounts, but a few relied predominantly on one category, e.g., Clinician or Mentor.

Conclusions: The local discourse categories identified in this study reflect broader discourses in healthcare relating to the roles of providers and patients, which have evolved through time.

Practice implications: Practising dental professionals are faced with a diverse range of patients who have different communication preferences. A suite of discourse categories can act as a ‘toolbox’ that dental professionals can flexibly draw on when needing to adopt a role that could predispose a particular patient to positive oral health behaviour change.

Author Biographies

  • Marion C. Bowman, University of Leeds

    Marion C. Bowman works in the Dental School at the University of Leeds in a non-clinical teaching role. She is currently completing a PhD in dental communication. Her research interest is in using discourse, conversation or linguistic analysis to study written or spoken health communication in Dentistry and Healthcare more generally.

  • Isobel Sale, University of Leeds

    Isobel Sale is completing a Masters in English Literature at the University of Leeds. During her undergraduate study in linguistics she undertook a conversation analysis of online forums discussing female urinary incontinence as part of the Q-step internship scheme. She has a passion for using her linguistics background to destigmatise health conditions in this way.

  • Ruth Payne, University of Leeds

    Ruth Payne is an Associate Professor in Student Education in the School of Languages, Cultures and Societies at the University of Leeds. Her research interests include classroom language, inclusive assessment, student induction and transition and student belonging.

  • Karen Vinall-Collier, University of Leeds

    Karen Vinall-Collier is a Lecturer in Behavioural Sciences and PhD supervisor in Dental Public Health within the Faculty of Medicine and Health, University of Leeds. Her research interests include using qualitative and evidence synthesis methodologies to explore communication in the medical/dental consultation and identify facilitators and barriers to health-related behaviour change.

  • Aradhna Tugnait, University of Leeds

    Aradhna Tugnait is an Associate Professor in Restorative Dentistry and Honorary Specialty Dentist. Her research interests are in systemic disease and periodontal disease and in Dental Education Research and Scholarship, both clinical and applied. She is a Lecturer and PhD supervisor and has co-written two textbooks on periodontology.

References

Ahmed, Hafeez (2017) Oral health: What is gum disease? British Dental Journal 222 (5): 323. https://doi.org/10.1038/sj.bdj.2017.196

Alexander, Karyn, Bianca Brijnath and Danielle Mazza (2014) Barriers and enablers to delivery of the Health Kids Check: An analysis informed by the Theoretical Domains Framework and COM-B model. Implementation Science 9: Article 60. https://doi.org/10.1186/1748-5908-9-60

Alrawiai, Sumaiah, Koula Asimakopoulou and Sasha Scambler (2019) Dentists’ perceptions of a practical model of patient-centred care: Providing information and choice in a dental consultation. Psychology, Health and Medicine 24 (9): 1090–1099. https://doi.org/10.1080/13548506.2019.1595682

Apelian, Nareg, Jean-Noel Vergnes and Christophe Bedos (2020) Is the dental profession ready for person-centred care? British Dental Journal 229 (2): 133–137. https://doi.org/10.1038/s41415-020-1650-3

Asimakopoulou, Koula, Matthew Nolan, Claire McCarthy and Jonathan Newton (2019) The effect of risk communication on periodontal treatment outcomes: A randomized controlled trial. Journal of Periodontology 90 (9): 948–956. https://doi.org/10.1002/JPER.18-0385

Atkins, Lou, Jill Francis, Rafat Islam, Denise O’Connor, Andrea Patey, Noah Ivers, Robbie Foy, Eilidh Duncan et al. (2017) A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science 21: Article 77. https://doi.org/10.1186/s13012-017-0605-9

Barrat, M. Christine (2015) Untitled comment added 2 August to article ‘Periodontal monitoring’. Dental Protection, 27 August 2014. Online: https://web.archive.org/web/20170609200029/https://www.dentalprotection.org/new-zealand/publications-resources/clinical-audit-tools/clinical-audit-tools-display/2014/08/27/periodontal-monitoring

Batchelor, Paul (2014) Is periodontal disease a public health problem? British Dental Journal 217 (8): 405–409. https://doi.org/10.1038/sj.bdj.2014.912

Barnes, Rebecca (2019) Conversation analysis of communication in medical care: Description and beyond. Research on Language and Social Interaction 52 (3): 300–315. https://doi.org/10.1080/08351813.2019.1631056

Boiko, Olga V. (2010) Dentist-patient communica­tion: How do the models correspond? Social Science and Dentistry 1 (2): 57–67.

Boman, Ase, Ina Borup, Lene Povlsen and Elisabeth Dahlborg Lyckhage (2012) Parents’ discursive resources: Analysis of discourses in Swedish, Danish and Norwegian health care guidelines for children with Diabetes type 1. Scandinavian Journal of Caring Sciences 26 (2): 363–371. https://doi.org/10.1111/j.1471-6712.2011.00942.x

Bowman, Marion (2021) A framework for scaffolding academic reflective writing in dentistry. European Journal of Dental Education 25 (1): 35–49. https://doi.org/10.1111/eje.12575

Bowman, Marion, Ruth Payne, Karen Vinall-Collier and Aradhna Tugnait (2022) Conversation, discourse and linguistic analysis in dental communication: Valuable but under-used approaches. British Dental Journal 232 (12): 875–878. https://doi.org/10.1038/s41415-022-4348-x

Braun, Virginia and Victoria Clarke (2006) Using thematic analysis in Psychology. Qualitative Research in Psychology 3 (2): 77–101. https://doi.org/10.1191/1478088706qp063oa

Bridges, Susan M., Colman McGrath, Cythia K. Y. Yiu and Brenda S. S. Cheng (2010) ‘Reassuring’ during clinical examinations. Journal of Asian Pacific Communication. 20 (2): 85–206. https://doi.org/10.1075/japc.20.2.02bri

Cane, James, Denise O’Connor and Susan Michie (2012) Validation of the theoretical domains frame­work for use in behaviour change and implementa­tion research. Implementation Science 7: Article 37. https://doi.org/10.1186/1748-5908-7-37

Carey, Jim A., Anna Madill and Michael Manogue (2010) Communication skills in dental education: A systematic review. European Journal of Dental Education 14: 69-78. https://doi.org/10.1111/j.1600-0579.2009.00586.x

Chapple, Ian L., Fridua Van der Weijden, Christof Doerfer, David Herrera, Lior Shapira, David Polak, Phoebus Madianos, Anna Louropoulou et al. (2015) Primary prevention of periodontitis: Managing gingivitis. Journal of Clinical Periodontology. 42 (16): S71–S76. https://doi.org/10.1111/jcpe.12366

Cheek, Julianne (2004) At the margins? Discourse analysis and qualitative research. Qualitative Health Research 14 (8): 1140–1150. https://doi.org/10.1177/1049732304266820

Cobban, Sandra J., Eunice M. Edgington, Florence Myrick and Louanne Keenan (2009) A discourse on the nature of dental hygiene knowledge and knowing. International Journal of Dental Hygiene 7: 10–16. https://doi.org/10.1111/j.1601-5037.2008.00315.x

Crawford, Tonia, Peter Roger and Sally Candlin (2017) The interactional consequences of ‘empowering discourse’ in intercultural patient education. Patient Education and Counseling 100 (3): 405–500. https://doi.org/10.1016/j.pec.2016.09.017

Croft, Phil, Deborah A. White, Connie M. D. Wiskin and Teresa F. Allan (2005) Evaluation by dental students of a communication skills course using professional role-players in a UK school of dentistry. European Journal of Dental Education 9 (1): 2–9. https://doi.org/10.1111/j.1600-0579.2004.00349.x

Cross, Duncan and Ann Smalldridge (2011) Improv­ing written and verbal communication skills for international medical graduates: A linguistic and medical approach. Medical Teacher 33: e364–e367. https://doi.org/10.3109/0142159X.2011.577469

Dahm, Maria, Lynda Yates, Kathryn Ogden, Kim Rooney and Brooke Sheldon (2015) Enhancing international medical graduates’ communication: The contribution of applied linguistics. Medical Education 49 (8): 828–837. https://doi.org/10.1111/medu.12776

Davis, Karen (2011) Power words in periodontal communication. Online: https://www.rdhmag.com/patient-care/radiology/article/16408614/power-words-in-periodontal-communication

D’Cruz, Len (2010) Risk management in clinical practice. Part 1: Introduction. British Dental Journal 209 (1): 19–23. https://doi.org/10.1038/sj.bdj.2010.579

Dental Defence Union (2014) Probing deeper into periodontics claims. DDU Journal (April): 9–11.

Dental Protection (2016) Dental Protection Horizons Roadshow 2015: How to avoid becoming a statistic. Online: http://www.dentalprotection.org/uk/about/media-centre/press-releases-display/2015/08/28/dental-protection-horizons-roadshow-2015-how-to-avoid-becoming-a-statistic

Francis, Jill, Denise O’Connor and Janet Curran (2012) Theories of behaviour change synthesised into a set of theoretical groupings: Introducing a thematic series on the theoretical domains framework. Implementation Science 7 (35): 7–35. https://doi.org/10.1186/1748-5908-7-35

General Dental Council (2013) Standards for the Dental Team. London: General Dental Council. Online: https://standards.gdc-uk.org/Assets/pdf/Standards%20for%20the%20Dental%20Team.pdf

General Dental Council (2015) Preparing for Practice: Dental Team Learning Outcomes for Registra­tion (revised edition). London: General Dental Council. Online: https://www.gdc-uk.org/docs/default-source/quality-assurance/preparing-for-practice-(revised-2015).pdf

Heritage, John and Douglas W. Maynard (2006) Problems and prospects in the study of physician-patient interaction: 30 years of research. Annual Review of Sociology 32: 351–374. https://doi.org/10.1146/annurev.soc.32.082905.093959

Hodges, Brian D., Ayelet Kuper and Scott Reeves (2008) Discourse analysis. British Medical Journal 337 (7669): 570–572. https://doi.org/10.1136/bmj.a879

Holden, Alexander (2019) Dentistry and oral health in online media sources. Community Dental Health 36 (3): 221–228.

Holloway, Immy and Kathleen Galvin (2017) Qual­itative Research in Nursing and Healthcare (4th edition). Chichester, UK: Wiley Blackwell.

Humphris, Gerry, John Crawford, Kirsty Hill, Angela Gilbert and Ruth Freeman (2013) UK population norms for the modified dental anxiety scale with percentile calculator: Adult dental health survey 2009 results. BMC Oral Health 13 (29): Article PMC3691614. https://doi.org/10.1186/1472-6831-13-29

Jahng, Kristina, Leslie Martin, Carol Golin and Robin DiMatteo (2005) Preferences for medical collaboration: Patient–physician congruence and patient outcomes. Patient Education and Counseling 57 (3): 308–314. https://doi.org/10.1016/j.pec.2004.08.006

Kelly, Aengus (2015) The Ceremonial (Dis)Order of the Clinic: Mapping Engagement in Dental Interactions. Unpublished doctoral dissertation, School of Linguistics, Speech and Communication Sciences University of Dublin, Ireland.

Lupton, Deborah (1992) Discourse analysis: A new methodology for understanding the ideologies of health and illness. Australian Journal of Public Health 16 (2): 145–150. https://doi.org/10.1111/j.1753-6405.1992.tb00043.x

McCrae, Niall and Edward Purssell (2016) Is it really theoretical? A review of sampling in grounded theory studies in nursing journals. Journal of Advanced Nursing 72 (10): 2284–2293. https://doi.org/10.1111/jan.12986

Mishler, Elliot G. (1984) The Discourse of Medicine: Dialectics of Medical Interviews. Norwood, NJ: Ablex.

NHS Information Centre for Health and Social Care (2009) Adult Dental Health Survey 2009 – Summary Report and Thematic Series. Online: https://digital.nhs.uk/data-and-information/publications/statistical/adult-dental-health-survey/adult-dental-health-survey-2009-summary-report-and-thematic-series

Nowak, Marta, Heather Buchanan and Koula Asimakopoulou (2018) ‘You have to treat the person, not the mouth only’: UK dentists’ perceptions of communication in patient consultations. Psychology, Health & Medicine 23 (6): 752–761. https://doi.org/10.1080/13548506.2018.1457167

O’Neill [as O’Neil], Michaela (2016) The role of hygienists and therapists. Dentistry Online, 16 September. Online: https://www.dentistry.co.uk/2016/09/16/the-role-of-dental-hygienists-and-therapists/

Pearce, Mark, Steven J. Agius, Joan E. Macfarlane and Nicholas Taylor (2015) Supporting dental registrants in difficulty. British Dental Journal 218: Article E5. https://doi.org/10.1038/sj.bdj.2015.97

Potter, Jonathan and Margaret Wetherell (1987) Discourse and Social Psychology: Beyond Attitudes and Behaviour. London: Sage.

Roberts, Celia and Srikant Sarangi (2005) Theme-oriented discourse analysis of medical encounters. Medical Education 39 (6): 632–640. https://doi.org/10.1111/j.1365-2929.2005.02171.x

Roberts, Celia, Val Wass, Roger Jones, Srikant Sarangi and Annie Gillet (2003) A discourse analysis study of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Medical Education 37 (3): 197–201. https://doi.org/10.1046/j.1365-2923.2003.01443.x

Sarangi, Srikant (2010) Reconfiguring self/identity/status/role: The case of professional role perf­orm­ance in healthcare encounters Journal of Applied Linguistics and Professional Practice 7 (1): 75–95. https://doi.org/10.1558/japl.v7i1.75

Sarnat, Haim, Pnina Arad, David Hanauer and Elana Shohami (2001) Communication strategies used during paediatric dental treatment: A pilot study. Paediatric Dentistry 23 (3): 337–341.

Smile Aider (2020) Smile Aider (Stakeholder Meaningful Involvement Engagement Aiding Dental Research). School of Dentistry, University of Leeds website. Online: https://medicinehealth.leeds.ac.uk/dir-record/research-projects/1243/smile-aider-stakeholder-meaningful-involvement-engagement-aiding-dental-research

Swenson, Sara L., Stephanie Buell, Patti Zettler, Martha White, Delaney C. Ruston and Bernard Lo (2004) Patient-centred communication: Do patients really prefer it? Journal General Internal Medicine 19 (11): 1069–1079. https://doi.org/10.1111/j.1525-1497.2004.30384.x

Talja, Sanna (1999) Analyzing qualitative inter­view data: The discourse analytic method. Library and Information Science Research 21 (4): 459–477. https://doi.org/10.1016/S0740-8188(99)00024-9

Taylor, Gary and Jane Ussher (2001) Making sense of S&M: A discourse analytic account. Sexualities 4 (3): 293–314. https://doi.org/10.1177/136346001004003002

Threlfall, Antony G., Carianne M. Hunt, Keith M. Milsom, Martin Tickle and Anthony S. Blinkhorn (2007) Exploring factors that influence general dental practitioners when providing advice to help prevent caries in children. British Dental Journal 202: Article E10. https://doi.org/10.1038/bdj.2007.143

Turner, Daniel (2020) Introducing discourse analysis for qualitative research. Quirkos, 29 September. Online: https://www.quirkos.com/blog/post/discourse-analysis-qualitative-research/

Varela-Centelles, Pablo, Pedro Diz-Iglesias, Ana Estany-Gestal, Juan Seoane-Romero, Rosendo Bugarin-Gonzalez and Juan Seoane (2016) Periodontitis awareness amongst the general public: A critical systematic review to identify gaps in knowledge. Journal of Periodontology 87 (4): 403–415. https://doi.org/10.1902/jop.2015.150458

Walker, Tom W. M., Carla Fleming, Ashwin Kerai, S. Hall, Dylan Rakhra, Jeremy P. Horwood, Andrea E. Waylen and S. J. Thomas (2018) Are dental students well-equipped to deal with difficult communication situations? British Dental Journal 224: 163–168. https://doi.org/10.1038/sj.bdj.2018.44

Waylen, Andrea E., Gregory Makoul and Y. Albeyatti (2015) Patient-clinician communication in a dental setting: A pilot study. British Dental Journal 218: 585–588. https://doi.org/10.1038/sj.bdj.2015.389

Weston, Cynthia, Terry Gandell, Jacinthe Beauchamp, Lynne McAlpine, Carol Wiseman and Cathy Beauchamp (2001) Analyzing interview data: The development of a coding system, Qualitative Sociology 24 (3): 381–400. https://doi.org/10.1023/A:1010690908200

Published

2023-07-06

Issue

Section

Articles

How to Cite

Bowman, M. C., Sale, I., Payne, R., Vinall-Collier, K., & Tugnait, A. (2023). Dental professionals’ role perceptions in relation to periodontal (gum) disease explanations: A thematic discourse analysis approach. Communication and Medicine, 18(3), 223-240. https://doi.org/10.1558/cam.20929