What should people expect from person-centred dental visits? The Montreal-Toulouse Wheel of expectations.

There is a dearth of tools designed to inform people about what to expect from person-centred dental encounters and to guide them during the care process. This is why we propose the Montreal-Toulouse Wheel of patients' expectations for dental visits, which describes what people could expect during person-centred clinical encounters. The Wheel comprises four core expectations: 1) be understood; 2) be respected; 3) have power; and 4) be given enough time. It also includes three expectations that are more specific to the process of care: 5) be informed and understand; 6) share decisions with the dentist and even co-construct the treatment plan; and 7) be comfortable during clinical procedures and the whole care process. We also propose a Q-List to help patients reflect on their relationship with dental professionals and engage them in person-centred dental care. This Q-List describes the seven expectations of the Wheel and provides open-ended questions that we invite patients to reflect upon. We also hope that dental professionals and educators will find the Wheel and the Q-List useful to develop person-centredness and promote inclusive and equitable dentistry.

Is the dental profession ready for person-centred care?

Introduction In the last decades, health professions have progressively moved towards person-centredness. Dentistry, however, lags behind the other health professions and remains deeply anchored in a biomedical vision.Aims Our objective was thus to better understand how dentists perceived person-centred care (PCC) and identify the challenges they may face in implementing it.Methods We conducted qualitative descriptive research in the province of Quebec, Canada; it was based on in-depth interviews with 11 general dental practitioners working in private clinics.Results Thematic analyses reveal that dentists had little interest in understanding the life and stories of their patients. Furthermore, their openness to share decision-making was limited to procedures that they considered of relatively low value and less for procedures they considered of higher value, such as indirect restorations.Discussion We argue that dentists' reluctance to understanding and shared decision-making is rooted in the old-established identity of dentistry as an art. Dentists indeed considered the dental craft as sacred - an art form with unbreakable axioms that defined quality of care.Conclusion It is time for the dental profession to reflect on its ideological foundations and reconsider its identity. This reflection is crucial to respond to the needs of a changing society that is losing its confidence in the profession.

Towards a biopsychosocial approach in dentistry: the Montreal-Toulouse Model.

The biomedical model has been severely criticised in the last decades and its dominance challenged. This is why the concept of person-centred dentistry has penetrated the professional discourse and become a growing concern for our profession. Furthermore, dentists have been urged to take patients' environment more into account and to tackle the social determinants of their health, illness and access to care. Unfortunately, dentists still poorly comprehend person-centredness and social dentistry, and face difficulties to implement biopsychosocial approaches. To respond to these issues, we propose the Montreal-Toulouse Biopsychosocial Model for dentistry, which encompasses patient-centredness and social dentistry. Our model presents three types of tasks (understanding, decision-making and intervening) that dentists should take in each of three overlapping levels (individual, community and society). We also propose a 'Q-List', an original tool designed to help dental professionals adopting this model and reflecting upon their actions. This Q-List includes key questions to elicit dentists' reflexiveness and to support their biopsychosocial practice of dentistry. We invite dental professionals to adopt biopsychosocial approaches and use the Montreal-Toulouse Model as a guide. We also encourage them to use our Q-List and adapt it to their context of practice.

Effect of a Person-Centered Course on the Empathic Ability of Dental Students.

Person-centered or patient-centered care (PCC) focuses on the individual's needs and concerns. Although PCC is widely acknowledged as a core value of modern medicine, there has been a lack of research on how dental curricula could engage future dentists in PCC approaches. The aim of this study was to assess the impact of a PCC course on empathy in dental students. A controlled study was conducted with fourth-year dental students in four dental faculties in France in 2014-15. The test group (n=63) received 20 hours of PCC training including arts-based approaches, narrative dentistry activities, and workshops on communication based on the Calgary-Cambridge guide. There was no change in the curriculum of the control group (n=217). Pretest and posttest measures with the Toronto Empathy Questionnaire (TEQ) and Jefferson Scale of Physician Empathy (JSPE) were compared for the two groups. The comparisons showed no significant differences on the TEQ or JSPE (p=0.25 and p=0.08, respectively). However, there was a higher proportion of students with more than an eight-point decrease in TEQ values in the control group (p=0.02). The stabilization of empathic ability in the test group may have counteracted the tendency for natural erosion of empathy among students during their clinical activities. These results suggest that PCC training constitutes a promising approach to developing dental students' empathic ability, but there is a need to assess the effects of such training over longer periods.

What about narrative dentistry?

BACKGROUND AND OVERVIEW: Narrative medicine strives toward a humanized form of medicine in which empathy and the ability to listen are developed with the same emphasis as scientific rigor. We hypothesize that the adoption of narrative medicine in dentistry would be an excellent method to cultivate the philosophy behind the emerging clinical concept of patient-centered dentistry. CONCLUSIONS: Reading literary works, reflective writing, and creative writing would sensitize practitioners to the daily lives of people, human uniqueness, and alterity. Narrative dentistry could lead to more empathic and self-aware practices, and improve dental professionals' observational abilities by making them more perceptive and more attentive to image, metaphor, and meaning. PRACTICAL IMPLICATIONS: The introduction of narrative dentistry would enrich the clinical clerkship of dentists by bringing the often-missing humanities to the dental professional, academic, and scientific environment.