Impact of communication between dentists and patients on the patient experience during professional dental cleaning

INTERVENTION: This is a randomized controlled, parallel‐arm clinical trial including si Xcomparison arms in a factorial design and 60 adult participants, with 10 participants per group, undergoing manual or ultrasonic periodontal instrumentation. Randomization will follow a factorial design to evaluate the combined effects of the instrumentation technique and communication stimuli, specifically Enhanced Expectation and Enhanced Empathy, on patient‐reported subjective outcomes. After signing the Informed Consent Form and agreeing to participate in the study, participants will be randomized to one of si Xexperimental conditions. The conditions will be determined by combining two types of periodontal instrumentation, Manual Instrumentation and Ultrasonic Instrumentation, with three levels of communication: Standard Communication, Enhanced Expectation, and Enhanced Empathy. Participants will therefore be allocated to si Xgroups: Group A, consisting of Manual Instrumentation combined with Standard Communication; Group B, consisting of Ultrasonic Instrumentation combined with Standard Communication; Group C, consisting of Manual Instrumentation combined with Enhanced Expectation; Group D, consisting of Ultrasonic Instrumentation combined with Enhanced Expectation; Group E, consisting of Manual Instrumentation combined with Enhanced Empathy; and Group F, consisting of Ultrasonic Instrumentation combined with Enhanced Empathy. Groups A and B will be considered control groups, whereas Groups C, D, E, and F will constitute the intervention groups. This methodological arrangement will allow testing the hypothesis that enhanced communication strategies may favorably modulate patients’ subjective responses to treatment and determining whether this effect differs according to the periodontal instrumentation technique used. Researcher A will be responsible for allocation concealment. After signing the Informed Consent Form, participants will be randomized using a random number generator and identified using sequentially numbered, opaque, sealed envelopes containing the assigned experimental condition. The envelopes will be opened only after participant enrollment, ensuring allocation concealment and reducing the risk of selection bias. On the day of the intervention and data collection, Researcher A will be responsible for marking the patient records according to the assigned condition. Researcher B will perform the communication interventions by communicating expectations regarding the treatment outcome or providing care in an empathetic manner before periodontal instrumentation. Researcher C will be responsible for performing the periodontal instrumentation and will remain blinded to the communication strategy assigned to each participant, having access only to the information required to perform the clinical procedure, specifically the type of periodontal instrumentation to be used, manual or ultrasonic. Researcher D will be responsible for data collection. Blinding of participants, outcome assessors, and data analysts will be implemented to minimize potential biases in CONDITION: Dental Calculus ; Gingivitis and periodontal diseases PRIMARY OUTCOME: It is expected that participants submitted to the Enhanced Expectation and Enhanced Empathy communication strategies will report lower mean pain intensity after supragingival periodontal instrumentation compared with Standard Communication, measured using the Numeric Rating Scale, with scores ranging from 0 to 10, immediately after the procedure SECONDARY OUTCOME: A better overall patient experience is expected after the appointment, assessed using two items adapted from the Consumer Quality Index, concerning the recommendation of the procedure and the recommendation of the professional, with a scale ranging from 0 to 10 A lower expectation of pain or discomfort before periodontal instrumentation is expected, assessed using a Visual Analogue Scale ranging from 0 to 10, adapted from van Vliet et al. and Petersen et al A lower level of anxiety before and after periodontal instrumentation is expected, assessed using the ten‐item Dutch State measure of the State Trait Anxiety Inventory, with a scale ranging from 1 to 4 A lower perceived expectation of discomfort after the procedure is expected, assessed using a single‐item Visual Analogue Scale ranging from 0 to 10 A more favorable assessment of pain in relation to the prior expectation is expected after periodontal instrumentation, assessed using a single‐item Visual Analogue Scale ranging from much worse than expected to much better than expected An improvement in mood before and after periodontal instrumentation is expected, assessed using the Positive and Negative Affect Schedule, consisting of 20 items rated on a scale from 1 to 5 Assessment of the researcher's empathic personality trait using the Interpersonal Reactivity Index, used to validate the empathy interventions Higher patient satisfaction is expected immediately after the procedure, assessed using a single‐item Visual Analogue Scale ranging from 0 to 10 Higher patient‐perceived empathy is expected immediately after periodontal instrumentation, assessed using the Consultation and Relational Empathy Measure, consisting of 10 items rated on a scale from 1 to 5, with a not relevant option Lower fear of periodontal instrumentation is expected before and after the procedure, assessed using a single‐item Visual Analogue Scale ranging from 0 to 10 INCLUSION CRITERIA: Patients undergoing the initial periodontal clinical examination at the Dental School Clinic of the Faculdade Pernambucana de Saúde; adults aged between 18 and 65 years; presence of at least 20 natural teeth; physical status classification I or II according to the American Society of Anesthesiologists; ability to speak, hear, and understand the Portuguese language; and willingness to participate in the study by signing the Informed Consent Form