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The dental care environment can be a significant source of stress and anxiety for both patients and dentists. Anxiety often leads patients to avoid dental practices altogether or to only seek treatment when they are in pain.
The ability to monitor and manage these stress levels could therefore offer significant benefits for patients and dentists alike.
The AngsT project launched earlier this year at the University of Plymouth, aims to improve dentists’ perception of stress by identifying verbal and non-verbal cues that offer insights into a patient’s mental state.
During treatment, patient anxiety can manifest through physical reactions, such as hand or foot movements, which can, in turn, cause frustration, irritation, and anger in dentists. This poses challenges for dentists in terms of effectively responding to these reactions and can contribute to increased stress and burnout.
While the importance of patient-directed empathy in creating a calm clinical atmosphere has long been recognised, the focus in dentistry has primarily been on verbal communication.
As previous studies have demonstrated, non-verbal cues or ‘tells’, including facial expressions, eye gaze, tone of voice, non-verbal sounds, changes in posture, and other micro-movements, can convey more accurate information about the mental states of both patients and dentists than the words they use.
It is evident that overlooking or misinterpreting these behavioural cues, failing to consider environmental factors that may exacerbate the situation, or inadvertently communicating their own anxieties can negatively impact the emotional dynamics of dental treatment.
AngsT is a collaborative project involving researchers in dentistry, medical simulation, and art and media technology at the University of Plymouth.
The project was initiated in response to a collection of video recordings of dental treatments used for a previous dentistry research project employing video ethnography. Our team, which had previously collaborated on medical simulation projects, was intrigued by what insights could be gleaned from this footage regarding the development of simulated experiences for dental training.
We were particularly interested in understanding the manifestations of patient anxiety and identifying cues that could help predict the level of anxiety experienced by individuals. The MPS Foundation has provided us with funding for the next stage of our project, enabling data collection.
During our initial public engagement sessions with patients and dentists, a clear divide emerged between patients who were comfortable with being recorded and those who were not. Dentists responded much more positively to the idea of video recordings, with some expressing a desire for ongoing video documentation to serve as evidence in potential future complaints. Dentists were also optimistic about the potential of these videos to provide educational material for young and inexperienced dentists, helping them develop skills that may not be as easily acquired through trial and error in practice.
We initially received a small seed grant from the SHAP(E)ing Health Collaboration Fund 2020/2021 at the Plymouth Institute of Health and Care Research, which we used to analyse videos captured during a separate research project. The videos revealed various ways in which patients communicate their anxiety, ranging from hand positioning to attempts at distracting the dentist through humour and storytelling, as well as changes in breathing.
The analysis also highlighted the impact of the treatment environment on interactions. Our initial study had limitations, as we only had one camera positioned at a single angle during video capture, which limited our ability to observe different non-verbal cues.
Nonetheless, the results were promising enough to attract funding from the MPS Foundation, enabling us to further explore how to recognise and train other dentists in identifying anxiety-related tells.
The AngsT project will begin with a pilot study using video recordings of dental treatment, which will be used to analyse patients’ emotional experiences during dental visits.
A methodology for filming in the dental clinic will be refined and documented, and used to produce a toolkit for reflexive training of dental clinicians that can be used beyond dental practice.
This will enable the researchers to design and pilot a training model that will enhance the ability of junior dentists, clinical staff, and patients themselves to be sensitive to the emergence of anxiety in the dental clinic.
The ultimate aim is to reduce anxiety, and thereby improve the provision and take-up of dental care, and the wellbeing of dentists.
Mona Nasser is a Professor in Clinical Epidemiology and Oral Health Research at the Dental School, Faculty of Health, University of Plymouth. She is the principal investigator on the AngsT project.
Further information on the project can be found at thempsfoundation.org