What’s in a name?
Perceived effective and ineffective dental terminology when treating paediatric patients: a cross-sectional survey
In paediatric dentistry, Shakespeare’s line is not necessarily the case. The careful choice of wording and the use of descriptive language or euphemisms to explain procedures may be the difference between the acceptance or refusal of treatment by a child. Explaining procedures in a way that a child can understand results in a reduction in their fear.
In its latest handbook, the American Academy of Pediatric Dentistry states that “successful treatment of paediatric dental patients depends on effective communication”. Successful communication should be uncomplicated, specific, minimise jargon, use repetition and be appropriate for the patient’s understanding, as well as using a patient-centred approach. Using child-friendly language, or ‘Childrenese’, to substitute words for more acceptable phrases is an effective way to communicate
with children.
Recent articles have highlighted the importance of awareness around jargon use in a dental setting for the adult patient; however, there is a lack of studies exploring this for paediatric dental patients. The authors are aware of only one large study, which was published more than 40 years ago, highlighting effective terminology used for paediatric patients. Since publication of this study in the 1980s, techniques, materials, pop culture and social boundaries have changed.
What’s in a name? That which we call a rose by any other name would smell as sweet
– William Shakespeare
We conducted a Scotland-wide survey which investigated the word preferences used by paediatric dental team members when treating children. The aim was to provide members of the dental team who have limited experience of paediatric dentistry, those who have recently graduated, or those who wish to improve their communication with children, with a selection of perceived effective and ineffective words when describing common treatments to paediatric patients. A voluntary, anonymous survey was disseminated to NHS dental team members who routinely treat paediatric patients in the community public dental service (PDS) and hospital dental services (HDS) throughout Scotland. There were 209 responses to the survey, which was sent to 1,054 participants: a response rate of 19.8 per cent. The respondents – of whom 41 per cent were dental nurses, 35 per cent were dentists who worked in community, 10 per cent were dental hygienists or therapists, and 4 per cent were paediatric specialists or consultants – worked in 11 different health boards across Scotland.
There is clearly a wide variety of replacement terms in use in paediatric dentistry in Scotland. While options are limited only by the imagination of dental team members, some favourite words are evident; the top word choice in each of the dental terms was selected by between 39 per cent (fluoride varnish) and 96 per cent (aspirator) of respondents. The word choices are unaffected by the gender, years of experience and job role of the dental team members and are generally not affected by the health board region.
When compared with the large-scale US survey of more than 40 years ago, the four overlapping studied terms – drill, rubber dam, extraction and local anaesthetic – share at least some of the same top three word replacements, despite the differences in time and location. Individual creativity is still certainly evident today, however, with respondents using unique choices such as ‘squirt gun’ for local anaesthetic or ‘roller coaster rumbles’ for drill.
While often humorous, this friendly terminology has the additional benefit of being tailored to the child. Person-centred care, of which good communication is integral, has been shown to improve patient outcomes.
The General Dental Council standards state that dentists must communicate effectively with patients and that dentists must give information in a way the patient understands. There is also the added consideration of the triadic communication with the patient, the parent/guardian and the dental professional, which can have added complexity when choosing language that each person understands.
Dental team members reported that ‘local anaesthetic’ had the highest reported ineffective words associated (45.5 per cent), with word choices such as ‘injection’, ‘jag’, ‘jab’, ‘needle’ and ‘sharp scratch’ commonly reported as negatively received by children. Substitution for the dental terms, ‘extraction’ and ‘dental drill’ also had relatively high numbers of perceived ineffective words (32.1 per cent and 27.8 per cent, respectively), with ‘extraction’ and ‘pull’ being received negatively to describe the extraction of a tooth, and words like ‘drill’ and ‘bee’ mentioned as poorly received when describing a dental drill.
It is suggested by the authors that a child might be anticipating pain or discomfort by these descriptions. In addition, more than one-third of respondents reported negatively received words when describing fluoride varnish to children. In this case, ‘banana’ and ‘paint’ caused a negative response. There were divided opinions on the use of ‘banana’ to describe fluoride varnish. It features in the top three most common and effective ways to describe fluoride varnish, but many respondents said that it could be received negatively due to the anticipated taste. It was suggested that many children may not like the taste of bananas – several respondents use the word ‘fruity’ instead as it is less specific.
‘Childsmile varnish’ was also noted as positively received by one respondent, likely due to the fact that many children in Scotland are familiar with the Childsmile fluoride varnish application programme, where the Childsmile team attend nurseries and schools to apply fluoride varnish twice a year. Some respondents suggested that children may also anticipate a bad taste if the words ‘paint’ and ‘nail varnish’ are used for ‘fluoride varnish’ or ‘fissure sealants’.
The use of the euphemism ‘sleep’ when describing a ‘general anaesthetic’ (GA) had mixed opinions from dental team members. This was by far the most common way for respondents to describe a GA (97 per cent). In particular, 43 per cent reported commonly using the term ‘put to sleep’. However, of the 16 per cent of respondents who reported negatively received terms for GA, two-thirds would specifically avoid the phrase ‘put to sleep’.
Proposed reasons for this were that a child may develop a fear of sleeping, or that they may associate this with a pet being euthanised or a family bereavement. It was suggested to avoid the term ‘putting to sleep’ and to instead use ‘going for a short sleep/ snooze’ to describe the hospital appointment. Other words which had negative connotations included being ‘knocked out’ and receiving ‘gas’, potentially due to a perceived threat to the child.
We can conclude that in a sample of Scottish dental team members who treat paediatric dental patients:
There were a wide range and variety of words and phrases used to describe dental terms, treatments and dental instruments.
The child’s age commonly influenced the choice of language. The chosen terminology was not generally influenced by the child’s gender, except in the case of pre-formed metal crowns.
The three preferred replacement terms for each of the 11 dental terms have been identified through this study. These could be used as a guide to direct staff and unify terminology across the Scottish health boards.
‘Local anaesthesia’, ‘fluoride varnish’ and ‘extraction’ had the highest reported proportion of negatively received terminology.
For each treatment and dental instrument included in the questionnaire, there is a wide scope for creativity and there is certainly not one ‘correct’ way to describe each dental term. This is reflected
in the many different alternative words and phrases suggested by the participants. It is hoped that this study provides insight into words that are thought to be effective and ineffective by dental team members who have experience working with children.
This is an edited version of the authors’ paper published by the British Dental Journal.