From Volume 9, Issue 1, January 2016 | Pages 28-32
A questionnaire was used to determine child orthodontic patient preferences for the dress code of their orthodontist. Participants were asked the importance of how their orthodontist dressed and to select the most appropriate dress code from a range of outfits. Two hundred participants completed the questionnaire (age range 10–17 years). Almost two-thirds of respondents (64.5%) placed some importance on the dress code of their orthodontist.
When we encounter somebody new, we form an opinion about his or her character and personality within the first few seconds.1 This perception is primarily based on appearance (dress), body language, speech and engagement.2 Therefore, patients' perceptions of the professionalism of the service and quality of care received by dentists could be affected by their dress code.
Since the ‘bare below the elbow’ directive from the Department of Health in 20073 much discussion has taken place on the appropriate attire for healthcare workers.4 The directive was in response to the unacceptable incidence of MRSA and Clostridium difficile infections throughout NHS hospitals. The policy was aimed at improving hand hygiene to reduce the spread of hospital-acquired infections.
Although the measure seemed sensible, it was not proven or evidence based.5,6 However, there is available evidence suggesting unsecured ties as a means of pathogenic transfer.7 The dress code, now extended to other healthcare settings such as dental practices, is considered best practice, with short sleeves being advocated.
In the medical setting, patient preference for various grades of medical staff attire has been found to be malleable to Department of Health guidelines.8 Hospital in-patients perceived ties and white coats to be almost universally unnecessary, instead, having a preference for surgical scrubs for doctors on the ward.4
A study of civilian and military patient populations found that patients did not have a preference for a dentist's clothing but considered the wearing of name badges to be important.9 However, McKenna et al found that dental hospital patients have strong opinions on how dental professionals dress.10 All patients placed some importance on a dental professional's attire, with formal clinical attire including a white coat being preferred for dental consultants and specialists while traditional white tunics were preferred for dentists.10
In a paediatric dental department, children preferred dental students in casual attire and both children and parents ranked formal white in favour of a paediatric coat.11
We expect to see professional athletes in tracksuits and shorts, barristers in antiquated wigs and gowns, the military in their uniforms and the clergy in their traditional attire.6 So, do patients still expect to see orthodontic practitioners in formal dress or white coats?
Orthodontics, while still considered ‘wet fingered’ should not involve the same degree of oral cavity fluids to which an oral surgeon or periodontist might be exposed. There appears to be virtually no published data on the preference of child patients on the dress code of orthodontists. Therefore, this study investigated child orthodontic patients attending for appointments in primary care and assessed their perceptions towards the attire of their orthodontist.
A questionnaire previously used in a dental hospital setting was modified for use in a primary care setting.10 The questionnaire consisted of closed ended questions and was used to yield information on patient demographics and their attitudes towards the attire of their orthodontist.
Participants were asked the importance of how their orthodontist dressed using a modified Likert scale. Cross-infection control measures were included (whether the orthodontist should wear a mask and/or glasses) and participants were asked if the orthodontist should wear a name badge. Finally, participants were shown photographs of a male and female orthodontist in a range of clinical outfits (Figure 1). The photographs were shown in colour with a consistent background. The male and female orthodontist wore black trousers with the following upper body attire:
Participants were asked which photograph was most appropriate for their orthodontist to wear and to select the photograph that best portrayed cleanliness, authority, trustworthiness, approachability and professionalism. New patients were excluded from the study in view of the fact that they may not be familiar with the practical aspects of orthodontics from a patient's perspective. Adult patients were also excluded.
A sample size calculation was not performed due to a lack of previous comparative studies on which to base this. Instead, a descriptive study using survey methodology was conducted using consecutive patients attending for a follow-up appointment. The questionnaire was provided to patients aged under 18 to complete voluntarily before their appointment. The consent form reassured participants that their access to orthodontic treatment would not be affected by either their agreement or refusal to take part in the study.
Participants were asked to sign the consent form and detach it from the questionnaire to ensure that the responses in the questionnaire were anonymous and confidential. The consent form was then returned to the reception desk. The participant completed the questionnaire and a box was provided on the reception desk where the questionnaire could be deposited.
Data were analysed using the Statistical Package for Social Sciences (Version 20). Descriptive statistical tests were performed and frequency distributions were computed.
Participants were recruited over a one-month period until 100 female and 100 male respondents completed the questionnaire. Six potential participants declined to take part in the study but did not give reasons why. The mean age for females and males was 14 years (range for females 11–17 years and males 10–17 years). Half of each gender was shown the pictures of the female orthodontist and the other half, the male orthodontist.
The responses to the question ‘How important is it to you how your orthodontist dresses?’ are shown in Table 1. Almost two-thirds of respondents (n = 129, 64.5%) placed some importance on the dress code of their orthodontist. For the remaining results, the number of responses was equivalent to the percentage since there were 100 female and 100 male respondents.
| Gender | Not Important (%) | Quite Important (%) | Important (%) | Very Important (%) |
|---|---|---|---|---|
| All Respondents | 35.5 | 35.5 | 21 | 8 |
| Females | 41 | 31 | 22 | 6 |
| Males | 30 | 40 | 20 | 10 |
Opinion on the wearing of a name badge and the use of facemasks and safety glasses by the orthodontist are shown in Table 2. More than half of respondents felt orthodontists should wear a name badge (females 78% and males 61%) and, similarly, more than half had a preference for a facemask to be worn by the orthodontist during treatment (females 61% and males 52%). When asked about the orthodontist wearing safety glasses during treatment, the preferences were less clear (females yes 35%, no 31% and males yes 26%, no 41%).
| Gender | Should orthodontists wear name badges? | ||
| Yes (%) | No (%) | Not Sure (%) | |
| All Respondents | 69.5 | 13.5 | 17 |
| Females | 78 | 11 | 11 |
| Males | 61 | 16 | 23 |
| Gender | Should orthodontists wear a facemask when treating you? | ||
| Yes (%) | No (%) | Not Sure (%) | |
| All Respondents | 56.5 | 23.5 | 20 |
| Females | 61 | 23 | 16 |
| Males | 52 | 24 | 24 |
| Gender | Should orthodontists wear safety glasses when treating you? | ||
| Yes (%) | No (%) | Not Sure (%) | |
| All Respondents | 30.5 | 36 | 33.5 |
| Females | 35 | 31 | 34 |
| Males | 26 | 41 | 33 |
When asked which outfit was considered most appropriate for an orthodontist to wear, the responses are shown in Figure 2 according to respondent's gender and orthodontist's gender. Both female (40%) and male (50%) respondents preferred the female orthodontist to wear a white tunic (photograph 1). Similarly, both female (44%) and male (36%) respondents had a preference for the male orthodontist to wear the same attire, the white tunic shown in photograph 1. The long-sleeved white coat (photograph 6) was the second most preferred outfit for all groups.
The preferences for photographs that best portrayed cleanliness, authority, trustworthiness, approachability and professionalism are shown in Table 3.
| Female Respondents | Female Orthodontist | |||||
| Photo. 1 (%) | Photo. 2 (%) | Photo. 3 (%) | Photo. 4 (%) | Photo. 5 (%) | Photo. 6 (%) | |
| Cleanliness | 48 | 8 | 8 | 2 | 0 | 34 |
| Authority | 26 | 12 | 18 | 2 | 4 | 38 |
| Trustworthiness | 30 | 6 | 34 | 4 | 4 | 22 |
| Approachability | 16 | 4 | 40 | 0 | 22 | 18 |
| Professionalism | 54 | 2 | 12 | 2 | 0 | 30 |
| Male Respondents | Female Orthodontist | |||||
| Photo. 1 (%) | Photo. 2 (%) | Photo. 3 (%) | Photo. 4 (%) | Photo. 5 (%) | Photo. 6 (%) | |
| Cleanliness | 56 | 6 | 4 | 2 | 0 | 32 |
| Authority | 38 | 12 | 6 | 6 | 6 | 32 |
| Trustworthiness | 36 | 4 | 6 | 8 | 8 | 38 |
| Approachability | 36 | 6 | 12 | 4 | 10 | 32 |
| Professionalism | 42 | 8 | 6 | 0 | 8 | 36 |
The white tunic best demonstrated cleanliness by both female and male respondents (48% and 56%, respectively). The white tunic best demonstrated cleanliness by both female and male respondents (48% and 56% respectively).
The white tunic was considered to best portray professionalism by female respondents (54%), authority, approachability and professionalism by male respondents (38%, 36% and 42%, respectively), while the black shirt with rolled sleeves was perceived to demonstrate trustworthiness and approachability by female respondents (34% and 40%, respectively). Female respondents felt authority was best demonstrated with a white coat (38%) while male respondents felt this attire best showed trustworthiness (38%).
The white tunic best demonstrated cleanliness by both female and male respondents (44% and 46%, respectively).
The white tunic was preferred by female respondents to portray trustworthiness (46%) and male respondents to demonstrate trustworthiness and approachability (38% and 28%, respectively). Female and male respondents felt authority was best portrayed with a black shirt and rolled sleeves (42% and 32%, respectively).
The aim of this study was to investigate child orthodontic patients' preference for their orthodontist's attire in primary care. A questionnaire that had previously been used in a dental hospital setting10 was used and modified for use in an orthodontic setting. The benefit of using this questionnaire was that it had already been piloted and assessed for usability and clarity. A range of attire was selected that the child patient may have been exposed to in a healthcare environment.
Almost two-thirds of respondents placed some importance on the dress code of the orthodontist. In a dental hospital, a large majority of patients (95.2%) placed some importance on the dress code of dental professionals.10 This is in contrast to another study carried out partly in an orthodontic setting in which 73.2% of respondents had no preference for the way the clinician was dressed.9 The time lapse between the latter study and the current study is 13 years and an increasing emphasis being placed on the appearance of dental professionals with the passage of time may explain the difference in results.
Most respondents felt that orthodontists should wear a name badge, which is in keeping with the study by McKenna et al who carried out a cross-sectional survey in a dental hospital.10 However, in another study in an orthodontic setting, 60.4% did not care if the clinician wore a name badge.9 This result would be anticipated in a practice setting where the patient would know the orthodontist, however, there is no plausible explanation as to why respondents in the current study felt a name badge should be worn.
More than half of respondents had a preference for a facemask to be worn by the orthodontist during treatment. This is consistent with another study in which 87.6% had such a preference in an orthodontic setting,9 and 72% in a dental hospital setting.10 The wearing of safety glasses by the orthodontist during treatment was less clear in the current study, however, more than half of respondents in other studies preferred their orthodontic clinician,9 and dentist,10 to wear safety glasses. It is possible that patients underestimate the risk orthodontic procedures pose to orthodontic practitioners since the risks are not as apparent as those in ‘wet fingered’ dentistry.
Male and female respondents preferred to see the male and female orthodontist in a white tunic. Similarly, 57% of respondents in a dental hospital preferred to see their dentist in a traditional dental tunic.10 A greater awareness of cross-infection policies that discourage long sleeves and ties may account for these findings.
Nevertheless, the long-sleeved white coat was the second most preferred outfit for all groups. In a dental hospital setting, 78% of respondents had a strong preference for dental consultants or specialists to wear formal clinical attire including a white coat.10 This may be due to patients expecting only to have a consultation in a hospital setting without any operative dentistry. Similarly, in an orthodontic practice, patients may not associate the level of risk to be as high as in a dental practice, which is considered a lot more ‘wet fingered’.
It is possible that if patients were made more aware of possible cross-infection control implications of dress code, responses may have changed. Before being made aware of the bare below the elbows policy, white coats were preferred for junior doctors and the examining doctor, however, after being informed, patients changed their preference for consultant, junior doctor and examining doctor to wear either a short-sleeved shirt with no tie or surgical scrubs.8
Although surgical scrubs were considered acceptable forms of dress for doctors on the wards,4 in the present study the preference for this dress code was very low.
It is hoped that this study will increase the orthodontist's awareness of patients' preferences in order to marry up what is required by law but also preferred by patients.
