Dental Quality Improvement

Plan Do Study Act (PDSA) cycles lie at the heart of quality improvement. Dental teams are action oriented, and want to get on with things. When you see a problem, it is natural to want to fix it straight away. This attitude works well in normal clinical practice, and is one of the things that interests teams in quality improvement. As with dental interventions, however, diagnosis is important.

In quality improvement work, it is always worth taking a breath to ask yourself:

• Do we understand the problem?
• Do we know what we are trying to fix?
• Do we know what is causing it, or is contributing to it?

We discussed how to get started in quality improvement in dentistry in this previous post for anyone who is looking for ideas.

A team from Harvard have published their story of working to understand a problem. Their paper describes work to understand how dental students communicate caries risk to patients, and to know patients’ communication preferences.

Caries Management by Risk Assessment (CAMBRA) inevitably needs good communication with patients. A patient’s ability to understand is influenced by their oral health literacy. Their communication preferences also play a role. Additionally, any language barriers between patient and clinician can affect understanding. Meshing the approach of the clinician with the needs of the patient is important in obtaining the best outcomes for the patient. The Harvard work is part of a project to improve patient communication by dental students. The team started with a baseline survey to understand the current situation. In turn, this will allow them to develop improvement options to trial using PDSA cycles.

Harvard dental students reported using a variety of approaches in communicating with patients. They included using simple language and explaining only two to three concepts at a time. Speaking slowly was another method. They also used teach-back, where the patient is asked to repeat the information to the clinician, using their own words. See Table 1 for details.

Table 1: Student and Patient Preferences for Communication

Student Reported Use of Communication Methods	Patient Preferences for Communication
Using simple language (100%)	Simple language (54.8%)
Explaining no more than two – three concepts at a time (65.6%)	Using motivational interview methods (47.1%)
Speaking slowly (62.5%)	Use of visual aids, such as x-rays and models (40.4%)
Using teach-back (59.4%)	Speaking slowly (38.5%

Source: Zhang et al., 2025

Patient preferences overlapped with the students. Motivational interviewing methods were described to patients in the study as ‘listen and understand your concerns and worries and work together’. There were some differences in perception. Patients were asked to recall features of communication at their last appointment. While 100% of dental students reported using simple language, only 61.5% of patients recalled this. Most dental students reported explaining caries risk, but many patients remained unclear on the details when questioned. The results are presented in detail in the paper.

This work gave the quality improvement team a good understanding of the issues that might affect communication. The authors concluded that,

‘The inclusion of simple language and motivational interviewing techniques should be key components of caries management communication training. The use of radiographs, dental models, and educational materials such as infographics and pamphlets can also be helpful during caries management discussions with patients. Integrating a learning component on motivational interviewing into the pre-doctoral training can be beneficial.’

This gives the team a good understanding of the issue. It helps them build quality improvement interventions. It also provides a baseline to which future findings can be compared. To ensure a quality improvement approach rather than a research driven approach, the team would also want to consider how to involve students and patients in the next stages of the project.

This was a baseline survey at a university. The survey method and analysis took more time than will be available to many services. The principle is to take stock of a problem. Confirm its existence and seek to understand it better. This approach is good practice in any quality improvement work. The work can be adjusted. It should fit the time available. However, it is always worth taking stock before embarking on a new project.

References

Featherstone J. D. B., Chaffee B. W. (2018) The Evidence for Caries Management by Risk Assessment (CAMBRA®). Advances in Dental Research 29 (1): 9-14. https://doi.org/10.1177/0022034517736500

Featherstone J. D. B., Alston P., Chaffee B. W., Rechmann P. (2019) Caries Management by Risk Assessment (CAMBRA): An Update for Use in Clinical Practice for Patients Aged 6 Through Adult, Journal of the California Dental Association, 47: 1, 25-34. https://doi.org/10.1080/19424396.2019.12220743

Kay E., Vascott D., Hocking A., Nield H. (2016) Motivational interviewing in general dental practice: A review of the evidence. British Dental Journal, 221, 785–791 (2016). https://doi.org/10.1038/sj.bdj.2016.952

Talevski J., Beauchamp A., Wong Shee A., Rasmussen B., Hilbers J. (2021) The Teach-Back Toolkit: A Guide to the Use and Implementation of the Teach-Back Method. teachback.org

Zhang, F., Xie, J.J., Chutinan, S. Riedy, C. A. (2025) Preferred communication techniques by student-providers and patients during caries management in a teaching practice: a quality improvement study. BMC Medical Education 25, 764. https://doi.org/10.1186/s12909-025-07354-w

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