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Table of Contents   
ORIGINAL RESEARCH  
Year : 2020  |  Volume : 31  |  Issue : 5  |  Page : 678-684
Efficacy and feasibility of usage of hand signals during dental procedure among students in a Dental Institute in Maduravoyal, Chennai: A cross-sectional study


1 Department of Pediatric and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha University, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
2 Department of Public Health Dentistry, Priyadharshini Dental College and Hospital, Chennai, Tamil Nadu, India
3 SK Dental Clinic, Private Dental Practitioner, Chennai, Tamil Nadu, India

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Date of Submission11-Jan-2019
Date of Decision22-Oct-2019
Date of Acceptance11-Feb-2020
Date of Web Publication08-Jan-2021
 

   Abstract 


Objective: To assess the efficacy of the usage of hand signals during a dental procedure among students in a dental institute. Methods: 268 students and their allotted patients from a dental institute were taught about hand signals (DentiSign) that can be used for communication during dental procedures. During the first dental visit, a pretested questionnaire was provided to students, before and after the treatment procedure, to assess the change in fear and anxiety in their patients. This protocol was followed for the second consecutive visit. The questionnaires were collected and subjected to statistical analysis. McNemar's test was used to analyze the responses for the questionnaire before and after treatment during the first and second visits. Results: By the end of the first visit, 45.75% students felt that using hand signals can make patients feel comfortable and 35.68% students felt that the practitioner will be able to understand patients' fear and anxiety, which were statistically significant. By the end of second visit, the response increased significantly to 92.17% and 94.66%, respectively. A reduction in treatment time was also perceived by the students but was not statistically significant. Conclusion: Use of hand signals during dental treatment can be an option in reducing anxiety and fear for the patients. They can also help in effective communication during the treatment procedure and may help in reducing treatment time.

Keywords: Anxiety, DentiSign, fear, hand signal

How to cite this article:
Vignesh R, Priyadarshni I, Sukanya T. Efficacy and feasibility of usage of hand signals during dental procedure among students in a Dental Institute in Maduravoyal, Chennai: A cross-sectional study. Indian J Dent Res 2020;31:678-84

How to cite this URL:
Vignesh R, Priyadarshni I, Sukanya T. Efficacy and feasibility of usage of hand signals during dental procedure among students in a Dental Institute in Maduravoyal, Chennai: A cross-sectional study. Indian J Dent Res [serial online] 2020 [cited 2021 Jan 21];31:678-84. Available from: https://www.ijdr.in/text.asp?2020/31/5/678/306450



   Introduction Top


Effective doctor-patient communication is a central clinical function, and is the heart and art of medicine and a central component in the delivery of health care. Good doctor-patient communication has the potential to help regulate patients' emotions, facilitate comprehension of medical information, and allow for better identification of patients' needs, perceptions, and expectations.[1]

Most of the dental schools do not place much emphasis on communication skill during student training and evaluation.[2] Thus the dentists graduate without appreciating how well the information is being received, understood, and applied during communication.[3] In general, a clear gap in communication between dentists and patients leads to frustration on both sides. Thus, it is suggested that dentists should be trained to enhance their communicative and informative skills.[4]

The treatment is obviously exercised in the mouth, which is not only needed for verbal expressions but also in an area of the body that is extremely sensitive and highly charged with emotional significance. While performing the treatment in the mouth, the dentist focuses on the success of completing his/her immediately pressing work and not on maintaining verbal interactions with the patients except for information-gathering purposes that will affect the immediate treatment procedures.[5]

Studies on communication between dentist and patient are commonly based on interactions during the consultation period.[5],[6] However, there is no data regarding communication during the treatment procedure, which is the crucial point of communication breakage. Thus, the present study was done as an attempt to assess the efficacy of the usage of hand signals during a dental procedure among students in a dental institute in north Chennai. The objective was to assess the efficacy.


   Materials and Methods Top


A cross-sectional study was conducted among the dental students in a dental institute in Maduravoyal, Chennai. The study population included students attending the clinical postings during their undergraduate course in a dental institute in Maduravoyal, Chennai, who were willing to participate in the study. Using SPSS Software Version 17©, keeping the power of the study at 95% and alpha error at 5%, using G-power analysis from the pilot study, the sample size was decided. The final sample size required for the main study was 250 students.

All the students attending their clinical postings who gave consent to participate were randomly included in the study until the required sample size was met. 270 students were recruited out of which 2 of the students' patients did not return back on the date of appointment. The final sample size obtained to complete the study was 268.

Out-patients of the institute were initially screened and those who had shown Frankl's positive behavior rating were taken in the study. The protocols of the study were explained and those patients who were willing to participate were recruited after signing the consent form. Patients within the age group of 20–30 years who required two or more restorative therapy, root canal therapy, and ultrasonic scaling which required a minimum of two appointments were included and patients with chronic pain, abscess, medically compromised, those showing Frankl's Negative or Definitely Positive rating scale, and those who were not willing were excluded from the study.

Two separate self-administered, pretested questionnaires were given to the students. It included five close-ended questions which were based on the usage of hand signals and their perception in reducing patient's fear, anxiety, and treatment time. During the first visit, pre-procedure questionnaire was provided for students to fill and then both the students and the patients were taught a set of hand signals by the chief examiner. The hand signals which were used in this study was an eight-sign method created by Raymond Cadden which goes by the name DentiSign [Figure 1].[7] The hand signals included are “stop,” “pain,” “I am OK,” “hurts a little,” “hurts a lot,” “I want to talk,” “suction my mouth,” and “I want to scratch my face.” The dental procedure, which was planned for that visit of the patient, was done. It included either restorative or root canal therapy involving only one quadrant or ultrasonic scaling of only one arch in the first visit. A post-procedure questionnaire was provided to assess the efficacy of hand signals in reducing the fear, anxiety of patients, and time taken for the treatment. During the second visit, the same protocol was followed with the remaining treatment that was required for the patient. The students and the patients were taught the hand signals again during the start of the second visit. The questionnaires were collected and data were tabulated. The data table was subjected to statistical analysis.
Figure 1: Hand signs used in the current study (DentiSign© created by Raymond Cadden)

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Statistical analysis

McNemar's test was used to analyze the responses for the questionnaire before and after treatment during first and second visits. A “P” value <0.05 was considered statistically significant.


   Results Top


Demographic details

A total of 268 students were recruited for the study. The study population consisted of 33.1% (n = 89) males and 66.9% (n = 179) females. The total number of patients recruited were 270 among which two patients did not report back for the second visit and they were excluded from the study and their data were excluded from statistical analysis. Thus, the total patients included in the study was 268 among which 128 were females and 140 were males.

Response of students prior to treatment during the first visit: [Table 1]
Table 1: Students' response to questionnaire during 1st visit

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A total of 62.3% (n = 167) students inform their patients to raise their hand in-between to stop the dental procedure. About 72.4% (n = 194) students do not advise to use any other hand signals during the dental procedure. When questioned on the expectation of comfort of patients with the usage of hand signals, 20.9% (n = 56) of students responded that it could help. Among all the students, only 15.3% (n = 41) of students felt that the usage of hand signals could help in understanding patient's fear and anxiety. Only about 16% (n = 43) of students felt that the usage of hand signals could help in reduction of treatment time on dental chair.

Response of students after treatment during the first visit: [Table 1]

A total of 49.6% (n = 133) students felt that the usage of hand signals helped in making patients comfortable. About 39.6% (n = 106) students felt that they could understand patient's fear and anxiety with the hand signals. Among the students, only 6.3% (n = 17) felt a reduction in treatment time, 25% (n = 67) students preferred to use hand signals in everyday practice, and 2.2% (n = 6) students thought of inclusion of some other hand signals.

Response of students prior to treatment during the second visit: [Table 2]
Table 2: Students' response to questionnaire during 2nd visit

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Among the students, 82.1% (n = 220) preferred to inform their patient to raise their hand when required, 67.5% (n = 181) advise to use other hand signals to interrupt the procedure, 66.8% (n = 179) felt that patients' were comfortable with their usage, 48.9% (n = 131) felt that they could understand their patient's fear easier, and still only 18.7% (n = 50) felt that it could help in reducing treatment time.

Response of students after treatment during the 2nd visit: [Table 2]

About 82.1% (n = 220) of students felt that patients were comfortable with hand signals, 81% (n = 217) of students felt easier to understand patients' fear and anxiety, 42.5% (n = 114) of students felt reduction in treatment time, and 70.9% (n = 190) preferred using hand signals in everyday clinical practice. There were no other suggestions to include any hand signals apart from the signals taught to them.

Comparison of response of students between 1st and 2nd visit prior to treatment: [Table 3]
Table 3: Comparison of students' response to questions before treatment between 1st and 2nd visit

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A total of 65.34% (n = 66) out of 101 students preferred to inform patient to raise their hand to interrupt the procedure, 61.34% (n = 119) out of 194 students preferred to use other hand signals for interruption, 69.34% (n = 147) out of 212 students felt that patients would feel comfortable with the usage, 49.34% (n = 112) out of 227 students felt that the usage of hand signals made them to understand patients' fear and anxiety, and only 15.56% (n = 35) out of 225 students could feel a reduction in treatment time by the start of the second visit. All the results showed statistically significant values (P < 0.001).

Comparison of response of students between 1st and 2nd visit after treatment: [Table 4]
Table 4: Comparison of students' response to questions after treatment between 1st and 2nd visit

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About 66.67% (n = 90) out of 135 students felt that hand signals made patients comfortable, 71.60% (n = 116) out of 162 students felt that using hand signals helped them in understanding patients' fear and anxiety, 41.03% (n = 103) out of 251 students felt a reduction in treatment time, and 63.18% (n = 127) out of 201 students preferred its usage in everyday practice. All these results showed statistically significant values (P = 0.001). There were not much of suggestions from the students by the end of second visit.

Comparison of response before and after treatment at both the visits: [Table 5] and [Table 6]
Table 5: Comparison of students' response before and after treatment of 1st visit

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Table 6: Comparison of students' response before and after treatment of 2nd visit

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By the end of the first visit, 97 (45.75%) out of 212 students and 81 (35.68%) out of 227 students felt that using hand signals can make patient feel comfortable and the practitioner to understand patients' fear and anxiety, respectively, and these results showed statistically significant values (P = 0.013) and (P = 0.004), respectively. In addition, only about 12 (5.33%) out of 225 students experienced a reduction in treatment time.

By the finish of the second visit, out of 179 and 131 students who assumed to provide comfort and to understand patients' fear and anxiety by using hand signals, 165 (92.17%) and 124 (94.66%) students felt that it did, respectively, with a statistically significant result (P = 0.001). In addition, about 97 (44.50%) out of 218 students experienced a reduction in treatment time with the usage of hand signals.


   Discussion Top


Fear of dental treatment and anxiety about dental procedures are prevalent and have an impact on the quality of life and the quality of dental treatment performed—both in terms of limiting attendance for treatment and in the nature of the dental treatment likely to be performed.[6] Studies performed by Kress and Shulman,[8] Buller and Buller,[9] and Roter et al.[10] have shown that the communicative behavior of their health care provider is a major factor associated with patient satisfaction.[11] To achieve effective patient-dentist communication, dentists use several linguistic strategies, with the aim of reducing fear and enhancing confidence and cooperation. The frequency of certain linguistic techniques used during treatment and their effectiveness in achieving patient cooperation has been examined.[12] But such techniques enhance mainly on the dental practitioner to speak to the patient during the treatment procedure. But the concept of receiving information from the patient during treatment expressing their discomfort and fear is often missed.

In the current study, a significant number of students do not ask their patients to raise their hand or any hand signal for disrupting during the procedure. This could be due to the insufficient knowledge among the students who need to be taught about effective communication methods to understand patients' discomfort. These strategies are essential to understand patients' fear and anxiety and to provide them support to develop trust toward the dentist.

A dentist is commonly busy with his/her job of providing effective oral health care. During this process, they tend to concentrate more into the oral cavity than to their surroundings and thereby fail to notice minor movements done by patients to show their discomfort. This can be overcome with the usage of hand signals through which a patient can effectively communicate with simple hand movements that can denote their discomfort easily. Such hand signals can be easily noticed by the dentist and thereby understanding patients' fear and anxiety making them comfortable for dental treatment.

In the present study, by the end of first visit, a significant number of students perceived that their patients felt comfortable and reduction of fear and anxiety and also the treatment time. There is an increase in the number of students by the end of second visit who perceived the same. This could be because of the practice of using hand signals by the end of second visit, thereby they are faster to recognize and the student could react at a faster rate.

Since the students could perceive the effectiveness, the prevalence of informing patients about the usage of hand signals increased by the start of the second visit. Their belief in being effective method of communication to understand fears and reducing treatment time also increased. The majority of students who felt that hand signals could not make a difference changed their mindset by the end of the visit as they could perceive their effectiveness. This was found both by the end of first visit and significantly higher by the end of the second visit.

Therefore, these hand signals, which are easy-to-use system, will benefit the patient by providing a clear unambiguous signal system. It will also benefit the dental team (dentist, nurse, hygienist, therapist) by providing a safe, reproducible, and convenient method of nonverbal communication during operative procedures. Hand signals can be any different signals that are easy to use and easily understood. Creating different hand signals which can help in the development of communication and standardizing them can help in making it a universal protocol in a global point of view.

Limitations of the present study include: 1) The inclusion criteria for the study were minor treatments such as restorative and ultrasonic scaling procedures. Pain perception would also be different for the procedure that was taken under consideration. Using these hand signals during extraction and minor oral surgical procedures can provide variation in the results. 2) The reduction in treatment time was more of a subjective perception rather an actual calculation of time. 3) We were able to follow most of the patients for only two visits as they tend to go department wise to different students for treatment completion. There could be much more favorable results if there was one practitioner to treat all the conditions for a single patient.


   Conclusion Top


Hand signals can provide a unique way in effectively understanding patients' fears and act accordingly to provide better health. Caring for patients not only means treating their chief complaint and relieving them from pain but also to handle and help them overcome their anxiety and fears.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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2.
Richa T, Yashoda R, Puranik MP. Dental students'attitude toward learning communication skills in Bengaluru city, India. J Indian Assoc Public Health Dent 2016;14:327-31.  Back to cited text no. 2
    
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Parker MA. A perspective on doctor-patient communication in the dental office. NC Med J 2007;68:365-7.  Back to cited text no. 3
    
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Al-Mobeeriek A. Dentist-patient communication As perceived by patients in Riyadh, Saudi Arabia. Int J Occup Med Environ Health 2012;25:89-96.  Back to cited text no. 4
    
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Sondell K, Söderfeldt B. Dentist-patient communication: A review of relevant models. Acta Odontol Scand 1997;55:116-26.  Back to cited text no. 5
    
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Newton T, Asimakopoulou K, Daly B, Scambler S, Scott S. The management of dental anxiety: Time for a sense of proportion? Br Dent J 2012;213:271-4.  Back to cited text no. 6
    
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Hand signals may cut dental anxiety [arabianbusiness.com]. Media City Dubai, United Arab Emirates. Available from: http://www.m.arabianbusiness.com/hand-signals-may-cut-dentalanxiety-48504.html. [Last accessed on 2019 Dec 15].  Back to cited text no. 7
    
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Kress G, Shulman JD. Consumer satisfaction with dental care: Where have we been, where are we going? J Am Coll Dent 1997;64:9-15.  Back to cited text no. 8
    
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Buller MK, Buller DB. Physicians' communication style and patient satisfaction. J Health Soc Behav 1987;28:375-88.  Back to cited text no. 9
    
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Roter DL, Hall JA, Katz NR. Relations between physicians' behaviors andd analogue patients' satisfaction, recall, and impressions. Med Care 1987;25:437-51.  Back to cited text no. 10
    
11.
Schouten BC, Eijkman MA, Hoogstraten J. Dentists' and patients' communicative behaviour and their satisfaction with the dental encounter. Community Dent Health 2003;20:11-5.  Back to cited text no. 11
    
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Sarnat H, Arad P, Hanauer D, Shohami E. Communication strategies used during pediatric dental treatment: A pilot study. Pediatr Dent 2001;23:337-42.  Back to cited text no. 12
    

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Correspondence Address:
Dr. R Vignesh
Department of Pediatric and Preventive Dentistry, Saveetha Dental College, Saveetha University, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijdr.IJDR_38_19

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