Humanizing clinical dentistry through a person-centred model

Nareg Apelian, Jean-Noel Vergnes, Christophe Bedos

Abstract


The clinical approach in dentistry stems from a biomedical model of health that is anchored in positivism. This biomedical model was never explicitly developed or reflected on, but rather implicitly acquired as a product of historical circumstance. A reductionist understanding of health served dentistry well in the past, when health afflictions were mostly acute. Today, however, in the age of chronic illnesses, the current clinical approach is no longer adequate: patients and dentists are both dissatisfied, and there are problems with dental education and dental public health.

 

After a thorough review of the literature, highlighting the current state of the profession, we propose an alternative clinical model upon which updated approaches can be based. We call this model "Person-Centred Dentistry". Our proposed model is rooted on the notion of sharing of power between the dentist and the patient: a sharing of power in the relationship and epistemology. This leads to an expanded understanding of the person and the illness; a co-authoring of treatment plans; and interventions that focus not only on eliminating disease but also on patient needs.

 


Full Text:

PDF

References


Adams T. Dentistry and medical dominance. Soc Sci Med 1982. 1999 Feb;48(3):407–20.

Shortt SE. Physicians, science, and status: issues in the professionalization of Anglo-American medicine in the nineteenth century. Med Hist. 1983 Jan;27(1):51–68.

Butler C. The dental profession. Dom Dent J II. 18–26.

Bremner M. The story of dentistry. 3rd edn (1st 1939). Brooklyn, NY: Dental Items of Interest Co.;

Gullett DW. A history of dentistry in Canada. Published for the Canadian Dental Association, by University of Toronto Press; 1971.

Leong FTL. Encyclopedia of counseling - Positivist paradigm. Los Angeles: SAGE Publications; 2008.

Clarke JK. On the Bacterial Factor in the AEtiology of Dental Caries. Br J Exp Pathol. 1924 Jun;5(3):141–7.

Khatami S, Macentee MI. Evolution of clinical reasoning in dental education. J Dent Educ. 2011 Mar;75(3):321–8.

Nurse P. Reductionism: The ends of understanding. Nature. 1997 juin;387(6634):657–657.

Engel GL. The biopsychosocial model and the education of health professionals. Ann N Y Acad Sci. 1978 Jun 21;310:169–87.

Bunton R, Nettleton S, Burrows R. The Sociology of Health Promotion: Critical Analyses of Consumption, Lifestyle, and Risk. Routledge; 1995.

Ghaemi SN. The rise and fall of the biopsychosocial model. Br J Psychiatry J Ment Sci. 2009 Jul;195(1):3–4.

Balint E. The possibilities of patient-centered medicine. J R Coll Gen Pract. 1969 May;17(82):269–76.

Stewart M. Patient-centered Medicine: Transforming the Clinical Method. Radcliffe Publishing; 2003.

Doherty W, Baird M. Family-Centered Medical Care: A Clinical Casebook [Internet]. New York: Guilford Press; 1987 [cited 2013 Aug 19]. Available from: http://www.alibris.com/Family-Centered-Medical-Care-A-Clinical-Casebook-Doherty-Baird/book/18024801

Sheiham A, Croog SH. The psychosocial impact of dental diseases on individuals and communities. J Behav Med. 1981 Sep;4(3):257–72.

Gift HC, Atchison KA. Oral health, health, and health-related quality of life. Med Care. 1995 Nov;33(11 Suppl):NS57–77.

Locker D, Allen F. What do measures of “oral health-related quality of life” measure? Community Dent Oral Epidemiol. 2007 Dec;35(6):401–11.

Zabell S. R. A. Fisher on the History of Inverse Probability. Stat Sci. 1989 Aug;4(3):247–56.

Guyatt G, Cairns J, Churchill D, et al. Evidence-based medicine: A new approach to teaching the practice of medicine. JAMA. 1992 Nov 4;268(17):2420–5.

Gordon H. Guyatt MD Ms, Jason W. Busse DC Ms. The Philosophy of Evidence-Based Medicine. In: MSc VMMM, editor. Evid-Based Endocrinol [Internet]. Humana Press; 2006 [cited 2013 Aug 19]. p. 25–33. Available from: http://link.springer.com/chapter/10.1007/978-1-59745-008-9_3

Djulbegovic B, Guyatt GH, Ashcroft RE. Epistemologic inquiries in evidence-based medicine. Cancer Control J Moffitt Cancer Cent. 2009 Apr;16(2):158–68.

Richards D, Lawrence A. Evidence based dentistry. Br Dent J. 1995 Oct 7;179(7):270–3.

Straub-Morarend CL, Marshall TA, Holmes DC, Finkelstein MW. Toward defining dentists’ evidence-based practice: influence of decade of dental school graduation and scope of practice on implementation and perceived obstacles. J Dent Educ. 2013 Feb;77(2):137–45.

Higgs J. Clinical Reasoning in the Health Professions. Elsevier Health Sciences; 2008.

Wolkenhauer O, Green S. The search for organizing principles as a cure against reductionism in systems medicine. FEBS J. 2013 Apr 29;

Goldstein BH, Epstein JB. Unconventional dentistry: Part IV. Unconventional dental practices and products. J Can Dent Assoc. 2000 Nov;66(10):564–8.

Nili T, Moti M, Avner C. Dentists’ attitudes toward discussing Internet health information with their patients--does professional self-efficacy matter? J Public Health Dent. 2011;71(2):102–5.

Bryman A. The Debate about Quantitative and Qualitative Research: A Question of Method or Epistemology? Br J Sociol. 1984 Mar;35(1):75.

Kelly MP, Moore TA. The judgement process in evidence-based medicine and health technology assessment. Soc Theory Health. 2012 Feb;10(1):1–19.

Gill J. The Insignificance of Null Hypothesis Significance Testing. Polit Res Q. 1999 Sep 1;52(3):647–74.

Baelum V, Lopez R. Periodontal epidemiology: towards social science or molecular biology? Community Dent Oral Epidemiol. 2004;32(4):239–49.

Straus SE, McAlister FA. Evidence-based medicine: a commentary on common criticisms. Can Med Assoc J. 2000 Oct 3;163(7):837–41.

Dickerson TC. The role of coaching in the business of dentistry. Br Dent J. 2007 Sep 8;203(5):237–8.

Gillette J, Matthews JD, Frantsve-Hawley J, Weyant RJ. The benefits of evidence-based dentistry for the private dental office. Dent Clin North Am. 2009 Jan;53(1):33–45, viii.

Petersen PE. Global policy for improvement of oral health in the 21st century – implications to oral health research of World Health Assembly 2007, World Health Organization. Community Dent Oral Epidemiol. 2009;37(1):1–8.

Newsome PR, Wright GH. A review of patient satisfaction: 2. Dental patient satisfaction: an appraisal of recent literature. Br Dent J. 1999 Feb 27;186(4 Spec No):166–70.

Croutze R. A tale of two realities. J Can Dent Assoc. 2010;76(6):345.

Karydis A, Komboli-Kodovazeniti M, Hatzigeorgiou D, Panis V. Expectations and perceptions of Greek patients regarding the quality of dental health care. Int J Qual Health Care J Int Soc Qual Health Care ISQua. 2001 Oct;13(5):409–16.

Redford M, Gift HC. Dentist-patient interactions in treatment decision-making: a qualitative study. J Dent Educ. 1997 Jan;61(1):16–21.

Chapple H, Shah S, Caress A-L, Kay EJ. Exploring dental patients’ preferred roles in treatment decision-making - a novel approach. Br Dent J. 2003 Mar 22;194(6):321–327; discussion 317.

Wilson TG Jr. Compliance and its role in periodontal therapy. Periodontol 2000. 1996 Oct;12:16–23.

Armfield JM, Enkling N, Wolf CA, Ramseier CA. Dental fear and satisfaction with dental services in Switzerland. J Public Health Dent. 2012 Sep 13;

Milgrom P, Fiset L, Whitney C, Conrad D, Cullen T, O’Hara D. Malpractice claims during 1988-1992: a national survey of dentists. J Am Dent Assoc 1939. 1994 Apr;125(4):462–9.

Shulman JD, Sutherland JN. Reports to the National Practitioner Data Bank involving dentists, 1990-2004. J Am Dent Assoc 1939. 2006 Apr;137(4):523–8.

Singh P, Mizrahi E, Korb S. A five-year review of cases appearing before the General Dental Council’s Professional Conduct Committee. Br Dent J. 2009 Feb 28;206(4):217–23.

Marei HF. Medical litigation in oral surgery practice: lessons learned from 20 lawsuits. J Forensic Leg Med. 2013 May;20(4):223–5.

Goldstein BH. Unconventional dentistry: Part II. Practitioners and patients. J Can Dent Assoc. 2000 Aug;66(7):381–3.

Sancho FM, Ruiz CN. Risk of suicide amongst dentists: myth or reality? Int Dent J. 2010 Dec;60(6):411–8.

Hawton K, Agerbo E, Simkin S, Platt B, Mellanby RJ. Risk of suicide in medical and related occupational groups: a national study based on Danish case population-based registers. J Affect Disord. 2011 Nov;134(1-3):320–6.

Meltzer H, Griffiths C, Brock A, Rooney C, Jenkins R. Patterns of suicide by occupation in England and Wales: 2001-2005. Br J Psychiatry J Ment Sci. 2008 Jul;193(1):73–6.

Rada RE, Johnson-Leong C. Stress, burnout, anxiety and depression among dentists. J Am Dent Assoc 1939. 2004 Jun;135(6):788–94.

Myers HL, Myers LB. “It”s difficult being a dentist’: stress and health in the general dental practitioner. Br Dent J. 2004 Jul 24;197(2):89–93; discussion 83; quiz 100–101.

Te Brake H, Smits N, Wicherts JM, Gorter RC, Hoogstraten J. Burnout development among dentists: a longitudinal study. Eur J Oral Sci. 2008 Dec;116(6):545–51.

Gorter RC, Freeman R. Burnout and engagement in relation with job demands and resources among dental staff in Northern Ireland. Community Dent Oral Epidemiol. 2011 Feb;39(1):87–95.

Wassersug JD. From “patient” to “customer”. A dangerous trend in healthcare. Postgrad Med. 1986 Apr;79(5):255–7.

Milgrom P, Cullen T, Whitney C, Fiset L, Conrad D, Getz T. Frustrating patient visits. J Public Health Dent. 1996;56(1):6–11.

Burke FJ, Main JR, Freeman R. The practice of dentistry: an assessment of reasons for premature retirement. Br Dent J. 1997 Apr 12;182(7):250–4.

Spallek H, Song M, Polk DE, Bekhuis T, Frantsve-Hawley J, Aravamudhan K. Barriers to implementing evidence-based clinical guidelines: a survey of early adopters. J Evid-Based Dent Pract. 2010 Dec;10(4):195–206.

Carlsen B, Glenton C, Pope C. Thou shalt versus thou shalt not: a meta-synthesis of GPs’ attitudes to clinical practice guidelines. Br J Gen Pract J R Coll Gen Pract. 2007 Dec;57(545):971–8.

Delière M, Yan-Vergnes W, Hamel O, Marchal-Sixou C, Vergnes J-N. Cochrane systematic reviews in orthodontics. Int Orthod Collège Eur Orthod. 2010 Sep;8(3):278–92.

Flanagan D. Evidence-based practice or practice-based evidence? J Oral Implantol. 2013 Apr;39(2):121.

Rabe P, Holmén A, Sjögren P. Attitudes, awareness and perceptions on evidence based dentistry and scientific publications among dental professionals in the county of Halland, Sweden: a questionnaire survey. Swed Dent J. 2007;31(3):113–20.

Iqbal A, Glenny A-M. General dental practitioners’ knowledge of and attitudes towards evidence based practice. Br Dent J. 2002 Nov 23;193(10):587–591; discussion 583.

Bauer J, Spackman S, Chiappelli F, Prolo P, Stevenson R. Evidence-based dentistry: a clinician’s perspective. J Calif Dent Assoc. 2006 Jul;34(7):511–7.

Kao RT. The challenges of transferring evidence-based dentistry into practice. J Evid-Based Dent Pract. 2006 Mar;6(1):125–8.

Lantz MS, Foy PJ. What is the ethical course of action when a third-party payer denies coverage for a treatment I recommend simply because the treatment is not one of the plan’s “evidence-based best practices”? J Am Dent Assoc 1939. 2010 Aug;141(8):1025–6.

Sherman JJ, Cramer A. Measurement of changes in empathy during dental school. J Dent Educ. 2005 Mar;69(3):338–45.

Nunes P, Williams S, Sa B, Stevenson K. A study of empathy decline in students from five health disciplines during their first year of training. Int J Med Educ. 2011 Feb 8;2:12–7.

Brands WG, Bronkhorst EM, Welie JVM. Professional ethics and cynicism amongst Dutch dental students. Eur J Dent Educ Off J Assoc Dent Educ Eur. 2011 Nov;15(4):205–9.

Rodríguez C, Tellier P-P, Bélanger E. Exploring professional identification and reputation of family medicine among medical students: a Canadian case study. Educ Prim Care Off Publ Assoc Course Organ Natl Assoc GP Tutors World Organ Fam Dr. 2012 May;23(3):158–68.

Rowland ML, Naidoo S, AbdulKadir R, Moraru R, Huang B, Pau A. Perceptions of intimidation and bullying in dental schools: a multi-national study. Int Dent J. 2010 Apr;60(2):106–12.

Alzahem AM, van der Molen HT, Alaujan AH, Schmidt HG, Zamakhshary MH. Stress amongst dental students: a systematic review. Eur J Dent Educ. 2011;15(1):8–18.

Newman P, Peile E. Valuing learners’ experience and supporting further growth: educational models to help experienced adult learners in medicine. BMJ. 2002 Jul 27;325(7357):200–2.

Rees CE, Knight LV, Wilkinson CE. Doctors being up there and we being down here: A metaphorical analysis of talk about student/doctor–patient relationships. Soc Sci Med. 2007 août;65(4):725–37.

Coulter A. Paternalism or partnership? BMJ. 1999 Sep 18;319(7212):719–20.

Baergen R, Baergen C. Paternalism, risk and patient choice. J Am Dent Assoc 1939. 1997 Apr;128(4):481–4.

Hinton RJ, Dechow PC, Abdellatif H, Jones DL, McCann AL, Schneiderman ED, et al. Creating an Evidence-Based Dentistry Culture at Baylor College of Dentistry: The Winds of Change. J Dent Educ. 2011 Mar;75(3):279–90.

Chambers DW. Evidence-based dentistry. J Am Coll Dent. 2010;77(4):68–80.

Goldenberg MJ. On evidence and evidence-based medicine: lessons from the philosophy of science. Soc Sci Med 1982. 2006 Jun;62(11):2621–32.

Greabu M. Standards--the common element in providing the safety, quality and performance of the medical practice. J Med Life. 2009 Sep;2(3):313–8.

Azria É. Le soignant et la standardisation des pratiques médicales. Laennec. 2013 Jul 1;Tome 61(3):32–41.

Goldie MP. Global oral health inequities. Int J Dent Hyg. 2011;9(4):239–41.

Petersen PE. Sociobehavioural risk factors in dental caries – international perspectives. Community Dent Oral Epidemiol. 2005;33(4):274–9.

Desprès C. La Couverture maladie universelle, une légitimité contestée : analyse des attitudes de médecins et dentistes à l’égard de ses bénéficiaires. Prat Organ Soins. 2010 Mar 1;Vol. 41(1):33–43.

M.Ed NJM, Ba MAH. Oral Health Access Issues for Children with Special Health Care Needs. In: Hollar D, editor. Handb Child Spec Health Care Needs [Internet]. Springer New York; 2012 [cited 2013 Aug 18]. p. 169–88. Available from: http://link.springer.com/chapter/10.1007/978-1-4614-2335-5_9

Nash DA. A larger sense of purpose: dentistry and society. J Am Coll Dent. 2006;74(2):27–33.

Levesque MC, Bedos C. Social Values, Regulatory Tensions and Professional Practices with Underprivileged Populations: The Case of Quebec’s Oral Healthcare System. Healthc Policy. 2011 Aug;7(1):e101–e115.

Sondell K, Söderfeldt B. Dentist-patient communication: a review of relevant models. Acta Odontol Scand. 1997 Apr;55(2):116–26.

Mead N, Bower P. Patient-centredness: a conceptual framework and review of the empirical literature. Soc Sci Med 1982. 2000 Oct;51(7):1087–110.

Alderson P, Goodey C. Theories of consent. BMJ. 1998 Nov 7;317(7168):1313–5.

Wear D. The medical humanities: toward a renewed praxis. J Med Humanit. 2009 Dec;30(4):209–20.

Bardes CL. Defining “Patient-Centered Medicine.”N Engl J Med. 2012;366(9):782–3.

Chambers DW. How to make moral choices. J Am Coll Dent. 2011;78(4):56–63.

Boetzkes E, Waluchow WJ. Readings in Health Care Ethics. Broadview Press; 2000.

Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978 Feb;88(2):251–8.

Elwyn G, Edwards A, Kinnersley P, Grol R. Shared decision making and the concept of equipoise: the competences of involving patients in healthcare choices. Br J Gen Pract J R Coll Gen Pract. 2000 Nov;50(460):892–9.

Légaré F, Ratté S, Stacey D, Kryworuchko J, Gravel K, Graham ID, et al. Interventions for improving the adoption of shared decision making by healthcare professionals. Cochrane Database Syst Rev. 2010;(5):CD006732.

Bernson JM, Hallberg LR-M, Elfström ML, Hakeberg M. “Making dental care possible: a mutual affair”: a grounded theory relating to adult patients with dental fear and regular dental treatment. Eur J Oral Sci. 2011 Oct;119(5):373–80.

Liddell A, Locker D. Dental visit satisfaction in a group of adults aged 50 years and over. J Behav Med. 1992 Aug;15(4):415–27.

Fiscella K, Meldrum S, Franks P, Shields CG, Duberstein P, McDaniel SH, et al. Patient trust: is it related to patient-centered behavior of primary care physicians? Med Care. 2004 Nov;42(11):1049–55.

Pellegrino ED. Being ill and being healed: some reflections on the grounding of medical morality. Bull N Y Acad Med. 1981;57(1):70–9.

Lévesque M, Hovey R, Bedos C. Advancing patient-centered care through transformative educational leadership: a critical review of health care professional preparation for patient-centered care. J Healthc Leadersh. 2013 Jul;35.

Elwyn G, Frosch D, Rollnick S. Dual equipoise shared decision making: definitions for decision and behaviour support interventions. Implement Sci IS. 2009;4:75.

Politi MC, Clark MA, Ombao H, Dizon D, Elwyn G. Communicating uncertainty can lead to less decision satisfaction: a necessary cost of involving patients in shared decision making? Health Expect Int J Public Particip Health Care Health Policy. 2011 Mar;14(1):84–91.

Bain CA. Treatment planning in general dental practice: case presentation and communicating with the patient. Dent Update. 2004 Mar;31(2):72–6, 78–80, 82.

Petersen PE, Bourgeois D, Ogawa H, Estupinan-Day S, Ndiaye C. The global burden of oral diseases and risks to oral health. Bull World Health Organ. 2005 Sep;83(9):661–9.

Jeske AH. The curse of discovery: pioneers of dental and medical anesthesia. Tex Dent J. 2009 Oct;126(10):973–7.

Arntz A, van Eck M, Heijmans M. Predictions of dental pain: the fear of any expected evil, is worse than the evil itself. Behav Res Ther. 1990;28(1):29–41.

Nash DA. Envisioning an oral healthcare workforce for the future. Community Dent Oral Epidemiol. 2012 Oct;40 Suppl 2:141–7.

Scully C, Porter SR. Referrals in oral medicine. Dent Update. 2007 Aug;34(6):340–2, 345–6, 348–50.

Giddon DB, Swann B, Donoff RB, Hertzman-Miller R. Dentists as oral physicians: the overlooked primary health care resource. J Prim Prev. 2013 Aug;34(4):279–91.

Institute of Medicine. Dental Education at the Crossroads: Challenges and Change [Internet]. 1995 [cited 2013 Aug 19]. Available from: http://www.nap.edu/openbook.php?record_id=4925

Nash DA. Ethics, empathy, and the education of dentists. J Dent Educ. 2010 Jun;74(6):567–78.

Masella RS, Thompson TJ. Dental Education and Evidence-Based Educational Best Practices: Bridging the Great Divide. J Dent Educ. 2004 Dec 1;68(12):1266–71.

Lincoln YS. Naturalistic Inquiry. SAGE; 1985.

Creswell JW, Plano Clark VL. Designing and conducting mixed methods research. Thousand Oaks, Calif.: SAGE Publications; 2007.

Lesaffre E, Feine J, Leroux B, Declerck D, editors. Bedos C, Pluye P, Loignon C and Levine A. Qual Res Stat Methodol Asp Oral Health Res [Internet]. John Wiley & Sons, Ltd; 2009 [cited 2013 Aug 19]. p. i–xvii. Available from: http://onlinelibrary.wiley.com/doi/10.1002/9780470744116.fmatter/summary

Masood M, Thaliath ET, Bower EJ, Newton JT. An appraisal of the quality of published qualitative dental research. Community Dent Oral Epidemiol. 2011 Jun;39(3):193–203.

Webb DJ, Maxwell SRJ. A spoonful of sugar? Tomorrow’s Doctors 2002. Br J Clin Pharmacol. 2002 Oct;54(4):341–3.


Refbacks

  • There are currently no refbacks.


ISSN: 2291-918X