- Email: [email protected]
General Semantic Orientation in Dentist-Patient Relations
D.D.S.
P A TIEN T
IN EFFEC TIV E COMMUNICATIONS
General Sem antic Orientation in Dentist-Patient Relations
Symbols, both verbal and nonverbal, in fluence a patient’s attitude toward and acceptance of dental treatment. Dentistpatient communication can be improved if the dentist knows and applies the prin ciples of general semantics in his practice.
The aim o f this paper is to introduce some o f the principles of general seman tics to dentists and to illustrate how the application o f this discipline will help to improve dental-patient communica tions. A dentist with excellent technical abil ity, a pleasing personality and an attrac tive office in a favorable location does not always enjoy a successful practice. His success seems to depend on an addi tional factor: the ability to understand people and to motivate them into accept ing the type o f treatment most beneficial to them. In other words, he must be able
to communicate clearly with his patients, otherwise his technical skills may go for naught. The more capable he is in the use o f symbols, both verbal and non verbal, the more effective he becomes in his communications. If he communicates poorly, the patient may refuse to accept any o f his recommendations or may ac cept only a small part o f the prescribed treatment. The patient may become con fused or afraid; he even may grow so angry that he makes a quick exit from the office. What is the reason for ineffective com munication in dental-patient relations? This may be due in part to the profes sional education of dentists. In past decades, the dental curriculum in most dental schools was confined al most exclusively to the technical and me chanical subjects. Liberal arts courses such as language arts, philosophy and psy chology were conspicuous by their ab sence. Today, in some of the more pro-
T W O
W A Y
D.D.S. E F F E C TIV E
CO M M U N ICATIO N S
Howard H. Jan, D.D.S., Oakland, Calif.
gressive dental schools, the deans are lucky to be able to squeeze in one or two courses in psychology. Because most den tists are graduated from schools with meager training in psychology and prob ably are without the slightest idea of general semantics, their communicative ability needs considerable growth and de velopment. G E N E R A L S E M A N T IC S
General semantics is a, study of human responses to symbols and symbol systems, including language. It is the study o f the entire communicative process. This edu cational discipline was originated by Al fred Korzybski (1879-1950), PolishAmerican scholar and engineer, who said the purpose was to train people in “ proper evaluation.” 1 An understanding o f some of the prin ciples of general semantics will help the dentist to improve his communications
with and evaluation o f his patients. First, he should be aware that his words or symbols will evoke certain responses in his patients. W ill these responses be favor able or unfavorable? I f the responses are unfavorable, there will be some interfer ence in the communication process. Next, one learns in general semantics that effective communication is a twoway process. In the dental situation, the dentist and the patient are both speakers and listeners. Both are givers and receiv ers of words and symbols. Whenever either party ignores this and uses a “ one way street” approach, communications break down. For example, if the dentist acts as a transmitter o f words and ideas and regards the patient as a mere receiv ing set of these words, there is a great risk that the latter will shut o ff his reception, especially when he does not like or under stand the message he hears. T o communi cate effectively, both the dentist and pa tient must take turns acting as transmitter
112/426 • THE JO U R N A L OF THE A M ERICAN DENTAL A SSOCIATION
and receiver. Both must take time and effort to listen as well as to speak to achieve better understanding. Each must question the other frequently to sense his reaction, feeling and meaning. M A P A N D T E R R IT O R Y C O N C E P T
According to Hayakawa,2 we all live in two worlds. First, we live in a world of happenings about us, which we know at first hand by actually having seen, felt or heard the events passing before our senses. This he calls the extensional world. Then there is the verbal world, one that we know through words; a world which we know from parents, friends, schools, news papers, books, conversations, radio and television. For example, our knowledge of the Battle o f Gettysburg comes to us only in words. W e know of its existence only from reports. It is through reports and reports o f reports that we receive most knowledge. In addition, we receive inferences from reports and inferences from other infer ences. In this manner through our living we have accumulated a considerable amount o f secondhand and thirdhand in formation about morals, histories, people and dentistry. T h e verbal world should bear the same relationship to the extensional world, as the m ap does to the territory it is sup posed to represent. If one’ s verbal world or m ap corresponds fairly closely to the extensional world or territory, he has less chance o f being disturbed or hurt by what he finds, because his verbal world has alerted him to what to expect. If, how ever, one’ s verbal world is built on false knowledge and superstition, one con stantly will be running into confusion because it bears little if any resemblance to the extensional world. O n e can acquire false maps or misevaluations in many ways. He can identify his map with those given to him by par ents, friends, teachers and schools without questioning its accuracy. For example, when a dentist uses the
map “ denture,” he may be identifying it with a beautiful masterpiece for which he earned an “ A ” in dental school. The patient, however, may identify the same map “ denture” with his father’s un pleasant experience with tooth extraction and subsequent inability to eat com on the cob with his wobbly plates. Each has his own frame o f reference; each has his own picture of the same word. As long as this happens, neither is really talking about the same thing, and neither is really communicating. In such a situation, if the dentist wants to reach an understanding with his pa tient regarding dentures, he should try to discover his patient’s attitude by asking such questions as: “ H ow do you feel about wearing dentures? D o you think you will be happy with them? D o you know anyone who has worn dentures and what were his reactions?” This inquiring approach affords the patient an opportunity to voice his ideas, wishes, wants, viewpoints, feelings and prejudices. I f the dentist has been listen ing attentively, not only to the words, but also to the voice for intonations and em phasis, and has been observing the pa tient’ s facial expressions, hand motions and so forth, he would have a more nearly accurate evaluation o f the patient’ s atti tude toward dentures. In this connection, no matter what opinions the patient expresses, the dentist must be careful not to criticize or reject them too quickly, otherwise he may block further communication. When one’ s ideas or thoughts are challenged or criticized, one usually becomes defensive and may become deaf to other points o f view. Another common misevaluation that leads to false map making is what general semanticists refer to as “ allness.” There are two variations of this con cept. T h e first one is when one assumes that the map is all the territory. The sec ond is that all maps are the same. In some dental situations, the patient may assume that the dentist is almighty, all powerful, knows all and can do all. Such
JA N . . .VOLUME 68, MARCH 1964 • 113/427
a patient may say, “ Y ou’ re the dentist; you know all about my problems. I don’ t have to tell you anything. Just go ahead and treat me.” The patient’s assumption of “ allness” in the dentist places all responsibility of treatment on him. If the result should be unsatisfactory, the patient blames the dentist alone. This is completely unjusti fied, since no one person can know all about anything. When a dentist evaluates a problem, he can know only a small part of the problem. His treatment is subjected to many factors, some of which are be yond his control. T o prevent misunderstanding, the den tist must explain frankly to the patient, before treatment is started, what is in volved, what can be accomplished with good patient cooperation and the limita tions of the treatment. The patient must understand that successful treatment de pends not only on the dentist’ s ability, but also on the patient’ s cooperation and his physiological responses. For example, most orthodontists ex plain to their patients before starting treat ment that good-looking, well-arranged teeth are the result o f three factors: (1) the diagnostic and technical ability o f the orthodontist, (2) the faithful cooperation of the patient in wearing elastic bands and other paraphernalia and (3) the favorable growth and the development of the patient’ s teeth, their bony support and the oral facial muscles. Sometimes patients assume that all dental entities or events with the same labels are identical. For example, they may assume that all dentists are the same, all dentures are alike, all fillings are the same, all extractions are painful, all mal occlusions need the same treatment and so forth. This assumption that all maps are the same may cause the following questions in the dental office: “ H ow come my den ture is going to cost $300, when you made one for my neighbor for only $200?” “ Why is it necessary to extract four bicus pids in my daughter’ s orthodontic treat
ment when this was not done in her brother’ s treatment?” Indexing and Dating • T o answer the pa tient’s questions, the general semanticist recommends the use o f a device called indexing and dating. This simple technic consists o f adding an index number or date to the terms; thus, denture-1, denture-2, denture-3. T h e term tells us that each belongs in the same class, and the index number reminds us that each is different from the others. For example, denture-1 is not denture-2; bleeding gingiva-1 is not bleeding gingiva-2, and malocclusion-1 is not malocclusion-2. Denture-1 looks artificial like “ store teeth,” whereas denture-2 looks almost real with teeth reflecting color, sex, age and personality. Periodontosis-1 is differ ent from periodontosis-2. The first patient may have bleeding gingiva with diabetes, whereas the second patient may have lit tle bleeding and no diabetes. Malocclu sion-sister is different from malocclusionbrother. Sister has severe protruding upper incisors, whereas brother has no protrusion but spacing between the in cisors. M outh-1957 is different from mouth-1964, which explains why a den ture constructed for conditions in mouth1957 no longer fits the condition in mouth-1964. Some other misevaluations or false maps are projections, two-valued orienta tions and confusion o f inferences with facts. These semantic confusions can be illustrated in the problem of thumbsucking. Projections • Many thumbsucking chil dren have involved dentist, orthodontist, pediatrician, psychiatrist and parents with their problem. Each o f these interested parties seemed to project his own special interest on to the problem. Each is look ing at thumbsucking through his own color of glasses, tinted by his own experi ence and needs. Many parents feel so embarrassed that their child sucks his thumb in front of
114/428 • THE JO U R N A L OF THE A M ER IC A N DENTAL ASSOCIATION
company that they try to nag, scold or shame the child into stopping. Some psychiatrists, recognizing the child’s need for autoerotic habits to feel secure, tend to permit the child to indulge in the habit. Many pediatricians may try to console the anxious parents by telling them that the habit is harmless. Meanwhile, as the patient continues the habit, the upper in cisors become more protrusive. A great many dentists, having seen so many young mouths deformed by this in fantile habit, may be eager to place me chanical restraints to break the habit. The orthodontist may want to study the child’s occlusion and jaw relationship to observe if there has been any damage from thumbsucking, before making any recommendation s. Each party has a different perception of the same problem of thumbsucking. Each is thinking with his own point of view. Two-Valued Orientation • Often there is a two-valued orientation approach to this problem. Two-valued orientation means the tendency to evaluate things in terms of two values only; for example, black and white, positive and negative, good and bad, love and hate and hot and cold. T he patient has a two-valued orienta tion in mind when he asks the question, “ Is it good or bad to let my child suck his thumb?” It all depends on through whose eyes one is looking. It may be good from the psychiatric point o f view, and it may be bad from the dental point of view. O r patients may ask, “ Does thumb sucking cause teeth to protrude, or doesn’t it?” In answering this question one should keep in mind the many-valued ori entation and explain that protrusion of teeth depends on a multitude of factors, never on a single cause. Confusion of Inference with Fact • H ow does one confuse inference with fact? If, after seeing a great number of thumb
sucking children with protruding incisors, one jumps to the conclusion that thumb sucking causes dental deformities, one makes the mistake o f claiming an infer ence for a fact. An inference is a statement about the unknown made on the basis o f the known. Inferences may be made carelessly or carefully. They may be made on the basis o f a great background of previous experi ence with the subject matter or with no experience at all. Th e statement that thumbsucking causes malocclusion is one not proved by factual evidence, therefore it is an infer ence rather than a fact. It is based on an inaccurate or incomplete map o f the thumbsucking territory. A more complete map will show that whether thumbsuck ing causes malocclusion depends on the manner in which the thumb is sucked, the duration o f each act of sucking, the frequency of the habit, the intensity of forces created by the sucking, the resist ance o f the alveolar process to this pres sure and so forth. P L E A S IN G S Y M B O L S
Since few patients look forward to their dental appointments with happy thoughts and many keep them with fear and ap prehension, a considerate dentist should employ as many pleasing symbols as pos sible to help make the office visits more pleasant. These favorable symbols may be nonverbal as well as verbal. Regarding the verbal ones, one should be aware that some words have affective connotations capable of arousing feelings. The dentist should use words that con vey pleasant feeling and avoid those that express discomfort or pain, in order to create the most agreeable surroundings for his patient. T he following examples are suggested: a tooth is prepared instead o f ground down; a tooth is removed instead o f pulled; dentures instead o f plates; to re store a tooth instead of to fill a tooth; to smooth instead o f to file, and the pro
JA N . . .VOLUME 68, MARCH 1964 • 115/429
posed treatment calls for an investment instead o f a cost. One should avoid the following words that connote harm or pain: cut, drill, chisel, scrape, knife, scale, needle, pliers and cement. Bregstein3 has recommended the fol lowing phrases to motivate dental pa tients: investment in youthfulness; den tures with the new look; the Hollywood look; these teeth will add to the feminine qualities o f your appearance, and econ omy dentistry is not good for your teeth. NONVERBAL
SYM BOLS
Color in a dental office is a nonverbal symbol. Every patient with normal eye sight feels the influence of color. Each color with its various shades and hues has a definite psychological effect on the observer. The color red is a symbol of danger and has a tendency to arouse strong ex citement. It should not be used in the office decor, since most patients already are excited and tense when they arrive at the office. Red would make them even more excited. Instead, shades of green and blue are more suitable. Green, the predominating color in nature, is restful and soothing. It conveys the feeling of coolness, cheerfulness, rest and vitality. Blue conveys an impression o f coolness and restraint. White dental uniforms may frighten young children who have had traumatic experiences with physicians and nurses dressed in white. In place of white, many pedodontists wear uniforms of pastel blue or green.
Instruments such as drills, needles, chisels and pliers are symbolic o f pain and trauma to most people. They should be kept out o f the patient’s sight as much as possible, so as not to arouse feelings of fear and anxiety. Many dentists place these instruments on the table behind the patient rather than in front which is typi cal and traditional. Some o f the more progressive dentists are even doing away with the standard dental units. They are trying to make dental treatment rooms look as nondental as possible. Patients who enter these rooms do not see any drills, engines, cuspidors or pliers. They only see a reclining lounge chair in restful surroundings. SUM M ARY
Dentists who make a diligent effort to understand and apply the principles of general semantics in their daily contact with patients will find themselves able to serve their patients more effectively. Be cause general semantics helps to improve communications between dentist and pa tients, the latter will have a better under standing of their problems and will be more likely to accept and to appreciate the prescribed dental services. This will enable the dentist to enjoy a more effec tive and successful practice.
400 Thirtieth Street
1. Hayakawa, S. I. (ed.) Language, meaning and maturity. New York, Harper & Bros., 1954, p. 26. 2. Hayakawa, S. 1. Language in thought and action. New York, Harcourt, Brace & Co., 1949, p. 31. 3. Bregstein, S. J . Interviewing, counseling, and man aging dental patients. Englewood Cliffs, N. J., PrenticeHali, Inc., 1957, p. 265.
P A TIEN T
IN EFFEC TIV E COMMUNICATIONS
General Sem antic Orientation in Dentist-Patient Relations
Symbols, both verbal and nonverbal, in fluence a patient’s attitude toward and acceptance of dental treatment. Dentistpatient communication can be improved if the dentist knows and applies the prin ciples of general semantics in his practice.
The aim o f this paper is to introduce some o f the principles of general seman tics to dentists and to illustrate how the application o f this discipline will help to improve dental-patient communica tions. A dentist with excellent technical abil ity, a pleasing personality and an attrac tive office in a favorable location does not always enjoy a successful practice. His success seems to depend on an addi tional factor: the ability to understand people and to motivate them into accept ing the type o f treatment most beneficial to them. In other words, he must be able
to communicate clearly with his patients, otherwise his technical skills may go for naught. The more capable he is in the use o f symbols, both verbal and non verbal, the more effective he becomes in his communications. If he communicates poorly, the patient may refuse to accept any o f his recommendations or may ac cept only a small part o f the prescribed treatment. The patient may become con fused or afraid; he even may grow so angry that he makes a quick exit from the office. What is the reason for ineffective com munication in dental-patient relations? This may be due in part to the profes sional education of dentists. In past decades, the dental curriculum in most dental schools was confined al most exclusively to the technical and me chanical subjects. Liberal arts courses such as language arts, philosophy and psy chology were conspicuous by their ab sence. Today, in some of the more pro-
T W O
W A Y
D.D.S. E F F E C TIV E
CO M M U N ICATIO N S
Howard H. Jan, D.D.S., Oakland, Calif.
gressive dental schools, the deans are lucky to be able to squeeze in one or two courses in psychology. Because most den tists are graduated from schools with meager training in psychology and prob ably are without the slightest idea of general semantics, their communicative ability needs considerable growth and de velopment. G E N E R A L S E M A N T IC S
General semantics is a, study of human responses to symbols and symbol systems, including language. It is the study o f the entire communicative process. This edu cational discipline was originated by Al fred Korzybski (1879-1950), PolishAmerican scholar and engineer, who said the purpose was to train people in “ proper evaluation.” 1 An understanding o f some of the prin ciples of general semantics will help the dentist to improve his communications
with and evaluation o f his patients. First, he should be aware that his words or symbols will evoke certain responses in his patients. W ill these responses be favor able or unfavorable? I f the responses are unfavorable, there will be some interfer ence in the communication process. Next, one learns in general semantics that effective communication is a twoway process. In the dental situation, the dentist and the patient are both speakers and listeners. Both are givers and receiv ers of words and symbols. Whenever either party ignores this and uses a “ one way street” approach, communications break down. For example, if the dentist acts as a transmitter o f words and ideas and regards the patient as a mere receiv ing set of these words, there is a great risk that the latter will shut o ff his reception, especially when he does not like or under stand the message he hears. T o communi cate effectively, both the dentist and pa tient must take turns acting as transmitter
112/426 • THE JO U R N A L OF THE A M ERICAN DENTAL A SSOCIATION
and receiver. Both must take time and effort to listen as well as to speak to achieve better understanding. Each must question the other frequently to sense his reaction, feeling and meaning. M A P A N D T E R R IT O R Y C O N C E P T
According to Hayakawa,2 we all live in two worlds. First, we live in a world of happenings about us, which we know at first hand by actually having seen, felt or heard the events passing before our senses. This he calls the extensional world. Then there is the verbal world, one that we know through words; a world which we know from parents, friends, schools, news papers, books, conversations, radio and television. For example, our knowledge of the Battle o f Gettysburg comes to us only in words. W e know of its existence only from reports. It is through reports and reports o f reports that we receive most knowledge. In addition, we receive inferences from reports and inferences from other infer ences. In this manner through our living we have accumulated a considerable amount o f secondhand and thirdhand in formation about morals, histories, people and dentistry. T h e verbal world should bear the same relationship to the extensional world, as the m ap does to the territory it is sup posed to represent. If one’ s verbal world or m ap corresponds fairly closely to the extensional world or territory, he has less chance o f being disturbed or hurt by what he finds, because his verbal world has alerted him to what to expect. If, how ever, one’ s verbal world is built on false knowledge and superstition, one con stantly will be running into confusion because it bears little if any resemblance to the extensional world. O n e can acquire false maps or misevaluations in many ways. He can identify his map with those given to him by par ents, friends, teachers and schools without questioning its accuracy. For example, when a dentist uses the
map “ denture,” he may be identifying it with a beautiful masterpiece for which he earned an “ A ” in dental school. The patient, however, may identify the same map “ denture” with his father’s un pleasant experience with tooth extraction and subsequent inability to eat com on the cob with his wobbly plates. Each has his own frame o f reference; each has his own picture of the same word. As long as this happens, neither is really talking about the same thing, and neither is really communicating. In such a situation, if the dentist wants to reach an understanding with his pa tient regarding dentures, he should try to discover his patient’s attitude by asking such questions as: “ H ow do you feel about wearing dentures? D o you think you will be happy with them? D o you know anyone who has worn dentures and what were his reactions?” This inquiring approach affords the patient an opportunity to voice his ideas, wishes, wants, viewpoints, feelings and prejudices. I f the dentist has been listen ing attentively, not only to the words, but also to the voice for intonations and em phasis, and has been observing the pa tient’ s facial expressions, hand motions and so forth, he would have a more nearly accurate evaluation o f the patient’ s atti tude toward dentures. In this connection, no matter what opinions the patient expresses, the dentist must be careful not to criticize or reject them too quickly, otherwise he may block further communication. When one’ s ideas or thoughts are challenged or criticized, one usually becomes defensive and may become deaf to other points o f view. Another common misevaluation that leads to false map making is what general semanticists refer to as “ allness.” There are two variations of this con cept. T h e first one is when one assumes that the map is all the territory. The sec ond is that all maps are the same. In some dental situations, the patient may assume that the dentist is almighty, all powerful, knows all and can do all. Such
JA N . . .VOLUME 68, MARCH 1964 • 113/427
a patient may say, “ Y ou’ re the dentist; you know all about my problems. I don’ t have to tell you anything. Just go ahead and treat me.” The patient’s assumption of “ allness” in the dentist places all responsibility of treatment on him. If the result should be unsatisfactory, the patient blames the dentist alone. This is completely unjusti fied, since no one person can know all about anything. When a dentist evaluates a problem, he can know only a small part of the problem. His treatment is subjected to many factors, some of which are be yond his control. T o prevent misunderstanding, the den tist must explain frankly to the patient, before treatment is started, what is in volved, what can be accomplished with good patient cooperation and the limita tions of the treatment. The patient must understand that successful treatment de pends not only on the dentist’ s ability, but also on the patient’ s cooperation and his physiological responses. For example, most orthodontists ex plain to their patients before starting treat ment that good-looking, well-arranged teeth are the result o f three factors: (1) the diagnostic and technical ability o f the orthodontist, (2) the faithful cooperation of the patient in wearing elastic bands and other paraphernalia and (3) the favorable growth and the development of the patient’ s teeth, their bony support and the oral facial muscles. Sometimes patients assume that all dental entities or events with the same labels are identical. For example, they may assume that all dentists are the same, all dentures are alike, all fillings are the same, all extractions are painful, all mal occlusions need the same treatment and so forth. This assumption that all maps are the same may cause the following questions in the dental office: “ H ow come my den ture is going to cost $300, when you made one for my neighbor for only $200?” “ Why is it necessary to extract four bicus pids in my daughter’ s orthodontic treat
ment when this was not done in her brother’ s treatment?” Indexing and Dating • T o answer the pa tient’s questions, the general semanticist recommends the use o f a device called indexing and dating. This simple technic consists o f adding an index number or date to the terms; thus, denture-1, denture-2, denture-3. T h e term tells us that each belongs in the same class, and the index number reminds us that each is different from the others. For example, denture-1 is not denture-2; bleeding gingiva-1 is not bleeding gingiva-2, and malocclusion-1 is not malocclusion-2. Denture-1 looks artificial like “ store teeth,” whereas denture-2 looks almost real with teeth reflecting color, sex, age and personality. Periodontosis-1 is differ ent from periodontosis-2. The first patient may have bleeding gingiva with diabetes, whereas the second patient may have lit tle bleeding and no diabetes. Malocclu sion-sister is different from malocclusionbrother. Sister has severe protruding upper incisors, whereas brother has no protrusion but spacing between the in cisors. M outh-1957 is different from mouth-1964, which explains why a den ture constructed for conditions in mouth1957 no longer fits the condition in mouth-1964. Some other misevaluations or false maps are projections, two-valued orienta tions and confusion o f inferences with facts. These semantic confusions can be illustrated in the problem of thumbsucking. Projections • Many thumbsucking chil dren have involved dentist, orthodontist, pediatrician, psychiatrist and parents with their problem. Each o f these interested parties seemed to project his own special interest on to the problem. Each is look ing at thumbsucking through his own color of glasses, tinted by his own experi ence and needs. Many parents feel so embarrassed that their child sucks his thumb in front of
114/428 • THE JO U R N A L OF THE A M ER IC A N DENTAL ASSOCIATION
company that they try to nag, scold or shame the child into stopping. Some psychiatrists, recognizing the child’s need for autoerotic habits to feel secure, tend to permit the child to indulge in the habit. Many pediatricians may try to console the anxious parents by telling them that the habit is harmless. Meanwhile, as the patient continues the habit, the upper in cisors become more protrusive. A great many dentists, having seen so many young mouths deformed by this in fantile habit, may be eager to place me chanical restraints to break the habit. The orthodontist may want to study the child’s occlusion and jaw relationship to observe if there has been any damage from thumbsucking, before making any recommendation s. Each party has a different perception of the same problem of thumbsucking. Each is thinking with his own point of view. Two-Valued Orientation • Often there is a two-valued orientation approach to this problem. Two-valued orientation means the tendency to evaluate things in terms of two values only; for example, black and white, positive and negative, good and bad, love and hate and hot and cold. T he patient has a two-valued orienta tion in mind when he asks the question, “ Is it good or bad to let my child suck his thumb?” It all depends on through whose eyes one is looking. It may be good from the psychiatric point o f view, and it may be bad from the dental point of view. O r patients may ask, “ Does thumb sucking cause teeth to protrude, or doesn’t it?” In answering this question one should keep in mind the many-valued ori entation and explain that protrusion of teeth depends on a multitude of factors, never on a single cause. Confusion of Inference with Fact • H ow does one confuse inference with fact? If, after seeing a great number of thumb
sucking children with protruding incisors, one jumps to the conclusion that thumb sucking causes dental deformities, one makes the mistake o f claiming an infer ence for a fact. An inference is a statement about the unknown made on the basis o f the known. Inferences may be made carelessly or carefully. They may be made on the basis o f a great background of previous experi ence with the subject matter or with no experience at all. Th e statement that thumbsucking causes malocclusion is one not proved by factual evidence, therefore it is an infer ence rather than a fact. It is based on an inaccurate or incomplete map o f the thumbsucking territory. A more complete map will show that whether thumbsuck ing causes malocclusion depends on the manner in which the thumb is sucked, the duration o f each act of sucking, the frequency of the habit, the intensity of forces created by the sucking, the resist ance o f the alveolar process to this pres sure and so forth. P L E A S IN G S Y M B O L S
Since few patients look forward to their dental appointments with happy thoughts and many keep them with fear and ap prehension, a considerate dentist should employ as many pleasing symbols as pos sible to help make the office visits more pleasant. These favorable symbols may be nonverbal as well as verbal. Regarding the verbal ones, one should be aware that some words have affective connotations capable of arousing feelings. The dentist should use words that con vey pleasant feeling and avoid those that express discomfort or pain, in order to create the most agreeable surroundings for his patient. T he following examples are suggested: a tooth is prepared instead o f ground down; a tooth is removed instead o f pulled; dentures instead o f plates; to re store a tooth instead of to fill a tooth; to smooth instead o f to file, and the pro
JA N . . .VOLUME 68, MARCH 1964 • 115/429
posed treatment calls for an investment instead o f a cost. One should avoid the following words that connote harm or pain: cut, drill, chisel, scrape, knife, scale, needle, pliers and cement. Bregstein3 has recommended the fol lowing phrases to motivate dental pa tients: investment in youthfulness; den tures with the new look; the Hollywood look; these teeth will add to the feminine qualities o f your appearance, and econ omy dentistry is not good for your teeth. NONVERBAL
SYM BOLS
Color in a dental office is a nonverbal symbol. Every patient with normal eye sight feels the influence of color. Each color with its various shades and hues has a definite psychological effect on the observer. The color red is a symbol of danger and has a tendency to arouse strong ex citement. It should not be used in the office decor, since most patients already are excited and tense when they arrive at the office. Red would make them even more excited. Instead, shades of green and blue are more suitable. Green, the predominating color in nature, is restful and soothing. It conveys the feeling of coolness, cheerfulness, rest and vitality. Blue conveys an impression o f coolness and restraint. White dental uniforms may frighten young children who have had traumatic experiences with physicians and nurses dressed in white. In place of white, many pedodontists wear uniforms of pastel blue or green.
Instruments such as drills, needles, chisels and pliers are symbolic o f pain and trauma to most people. They should be kept out o f the patient’s sight as much as possible, so as not to arouse feelings of fear and anxiety. Many dentists place these instruments on the table behind the patient rather than in front which is typi cal and traditional. Some o f the more progressive dentists are even doing away with the standard dental units. They are trying to make dental treatment rooms look as nondental as possible. Patients who enter these rooms do not see any drills, engines, cuspidors or pliers. They only see a reclining lounge chair in restful surroundings. SUM M ARY
Dentists who make a diligent effort to understand and apply the principles of general semantics in their daily contact with patients will find themselves able to serve their patients more effectively. Be cause general semantics helps to improve communications between dentist and pa tients, the latter will have a better under standing of their problems and will be more likely to accept and to appreciate the prescribed dental services. This will enable the dentist to enjoy a more effec tive and successful practice.
400 Thirtieth Street
1. Hayakawa, S. I. (ed.) Language, meaning and maturity. New York, Harper & Bros., 1954, p. 26. 2. Hayakawa, S. 1. Language in thought and action. New York, Harcourt, Brace & Co., 1949, p. 31. 3. Bregstein, S. J . Interviewing, counseling, and man aging dental patients. Englewood Cliffs, N. J., PrenticeHali, Inc., 1957, p. 265.