OBJECTIVES: This thesis adopts a multivariate approach to examine perceptions and practices regarding routine dentist-patient interactions in initial consultations. METHODS: A 16-item Dental Patient Feedback on Consultation skills (DPFC) questionnaire was adapted for use in the dental setting through face, content, and construct validity. A cross-sectional survey (n=389) of patients’ perceptions of their dentist’s clinical performances was conducted in a teaching hospital. Test-retest reliability (n=42) was assessed. Variations in DPFC responses (scale and item level) were examined in relation to socio-demographics and dental attendance patterns in bivariate and regression analyses. Second tier data was collected in the form of 70 audio-visual recordings (~15 hours) which were transcribed and sequentially analyzed to identify internal structures. Corpus-based discourse and sociolinguistic analysis drawing on traditions of Conversation Analysis, was used to identify dental consultation stages and sequential patterns across turn-taking systems. Transcribed recordings from the top quartile of survey results (n=18) were examined to reveal how dentists and their patients co-accomplished ‘successful’ consultations. RESULTS: Face validity of the DPFC questionnaire ranged 81.1-100%. Content Validity Index ranged 0.73-1.00. Variations across DPFC scores regarding global ratings of satisfaction were apparent (p<0.001). Cronbach’s alpha value was 0.94 and Intraclass Coefficient Correlation value was 0.89. Results identified that dental attendance pattern was a factor associated with DPFC (p<0.05); but no significant differences were observed regarding socio-demographics. Corpus-based discourse and sociolinguistic analysis indicated seven specific consultation stages across the 70 recordings. This was divided into two parts by radiographic imaging, namely Part A: Opening, Oral Problem Presentation, Medical History Taking, Oral Examination, Post-examination; and Part B: Diagnosis and Explanation, and Closing. Sequential analysis of Turn-Constructional Units in the Oral Problem Presentation Stage across the 70 recordings indicated patterns for dentists’ soliciting and patients’ presenting. Dentists solicited patient problems through open-ended questions (n=68) and closed-ended questions (n=2). Patients adopted two oral problem presentation types either using talk with gestures (n=61) or without gestures (n=9). Sequential analysis of the top quartile of recordings (n=18) revealed that patients perceived higher satisfaction with clinical communication if dentists re-visited their oral problems in the Diagnosis and Explanation Stage through a stepwise formulation. This presented as re-visiting patients’ oral problems through either repeating patients’ own terms or repairing patients’ prior talk. Finally, a case is analyzed to examine how a patient perceived effective dentist communication despite receiving a less-than-satisfactory admission outcome. CONCLUSIONS: The lack of socio-demographic variations in DPFC indicates similar treatment across groups and standardized communication practices by dentists in this public hospital context. Patients with prior dental visits within one year require greater attention in first encounters, possibly due to their recently unresolved oral problems. To enhance the quality of dentist-patient communication, dentists need to attend to patients’ non-verbal signals during talk when presenting oral problems. In identifying how patients and dentists co-accomplish ‘successful’ communication, a clear topical thread connecting patients’ oral problem presentation with the final dentist explanation stages emerged. Empirical findings suggest re-visiting of patients’ oral problems before delivering diagnosis may enhance patient perceptions of ‘successful’ communication in initial consultations. / published_or_final_version / Dentistry / Doctoral / Doctor of Philosophy

Thesis (PhD Dentistry)--University of Pretoria, 2006. / Includes bibliographical references.

Thesis (PhD(Dentistry))--University of Pretoria, 2006. / Includes bibliographical references.

Thesis (M.D.S.) -- University of Adelaide, Dept. of Dentistry, 1989. / Includes bibliographical references.

Includes bibliographical references.

Thesis (M.S.)--University of Alaska Anchorage, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis supervisor: Steven M. Lily. Includes bibliographic references (p. 235-243).

Thesis supervisors: Michael L. Spector, Deborah V. Dawson. Includes bibliographic references (p. 66-70).

Thesis (M.S.)--University of Alaska Anchorage, 1998. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Banca: Antenor Araújo / Banca: Nemre Adas Saliba / Banca: Jaime Renato Furquim de Castro / Banca: Renato Luis Ference / Banca: Roberto Antonio Nicodemo / Resumo: A Ergonomia, ciência da racionalização do trabalho, busca o total entrosamento do homem e seus instrumentos de trabalho. Em Odontologia, a Ergonomia se faz presente no ato do profissional trabalhar corretamente sentado, em situação de conforto funcional, intervindo em paciente na posição supina, contando com equipamento e instrumental adequadamente concebidos. Atualmente, o equipamento odontológico está devidamente racionalizado; no entanto, determinados instrumentos necessitam ser redesenhados, para melhor se ajustarem àqueles requisitos. O projeto de um instrumento manual deve permitir manejo cômodo, firme e seguro. Devem-se considerar detalhes anatômicos, posição correta do operador quando da intervenção e características específicos de utilização. O instrumento ora em análise - fórceps para molares inferiores - foi concebido dentro desses requisitos, em conjunto com novo sistemática de exodontia via alveolar, consubstanciada em estudos eletromiográficos e biomecânicos. A morfologia do instrumento, que possibilita cinético simples e natural do operador, foi obtida por mudança no paradigma dos instrumentos de ação cruzado convencionais (cuja apreensão ocorre sobre as hastes), desvinculando-se o "cabo" do "braço da hoste". Isto induziu a concepção anatômica de empunhaduras perpendiculares às extremidades das hastes, resultando em instrumento eficiente e eficaz, conforme indicado em sua fase de experimentação / Abstract: Ergonomics, the science of working rationalization, seeks the best relationship between man and his working tools. In Dentistry, ergonomics is present as for the professional working correctly seated, in functional comfort, intervening of supine position patient, by means of suitable equipment and instrument. Nowadays, dental equipment is justly rationalized; however, some instruments should take shape, in order to adapt those requirements. The hand tool design should permit a comfortable, non-slip and safe handling. Thus, anatomical details, the correct position of the operator for its use and specific characteristics of application should be taken into account. The instrument under analysis - forceps - was conceived according to these requirements along with a new alveolar tooth extraction technique, based on electromyographic and biomechanical studies. The morphology of the instrument, which makes possible a simple and natural kinetics of the operator, was obtained by changing the paradigm of the conventional cross-action instruments (whose grip is always on the arms of the tool), divesting the "handle" from the "tool arm". This induced on anatomical conceiving of perpendicular handles to the extremity of the tool arm, resulting an efficient and effective instrument, according to indicated on its experimental phase