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. 2025 Jan 8;45(1):e13087. doi: 10.1111/scd.13087

The effects of compassionate care on oral health outcomes: A scoping review

Mariana Sarmet Smiderle Mendes 1, Camila Lopes Ferreira 2, Maria Aparecida Neves Jardini 1, Christopher Andrew Childs 3, Leonardo Marchini 4,✉
PMCID: PMC11707586  PMID: 39775913

Abstract

Purpose

To access and synthesize the existing literature about the effects of compassionate care on oral health outcomes.

Methods

A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines to identify articles from six electronic databases: MEDLINE via the PubMed interface, Embase, Age‐Line, Scopus, CINAHL, and Cochrane.

Results

Among 30 studies reporting on compassion in dental treatment, only two reported on the effects of compassionate care on oral health outcomes. One study is cross‐sectional and evaluated oral health outcomes in children, while the other is a cohort study evaluating oral health outcomes in older adults. Each study used different tools to assess oral health outcomes. However, both studies used the Jefferson Scale of Physician Empathy (JSPE) to assess empathy among dental students, dentists, or dental hygienists.

Conclusion

The retrieved studies used different methodologies and had discrepant results. More clinical studies investigating the effects of compassionate care on the outcomes of dental treatment are necessary.

Keywords: compassionate care, dental care, dentist‐patient relations, empathy, oral health

1. INTRODUCTION

The central nervous system allows people to share feelings with others through mirror neurons, which are complex neural circuits in the brain that respond to observed actions. They were first recognized in 1992 in Parma, Italy. 1 These neurons activate when observing others' intentional actions, causing the observer to experience similar sensations. This mechanism allows people to feel what others are feeling, such as physical or emotional pain or happiness and is generally known as empathy. 2

Compassion, in turn, is the emotional response to another's pain or suffering, accompanied by a genuine desire to help. 3 Therefore, compassionate behavior can influence the feelings and attitudes of others. In healthcare, when providers treat patients with compassion, it can lead to improved clinical outcomes. 3

In medicine, studies have shown that compassionate care can relieve psychological pain, depression, and anxiety, increase motivation and life purpose. 4 and can also positively impact physiological outcomes, such as reducing the risk of heart attack. 5 and the common cold. 6 Compassion can also improve diabetes control, 7 speed up the wound healing process 8 and enhance overall quality of life and survival. 9 It is believed that similar results might be achievable in dentistry if dental providers are specifically trained to offer compassion to their patients. 10

The dentist who makes the patient feel at ease, allows them to tell their story, actively listens, demonstrates interest, positivity, and care, understands concerns, clearly explains instructions, helps the patient practice self‐care, and develops an action plan for their oral conditions in collaboration with the patient, makes the patient feel better and that they are receiving compassionate care. 11 Additionally, effective communication between the dentist and the patient seems to enhance patient compliance with treatment, whereas poor communication reduces it. 10 However, there has been little research about compassionate care's impact on tangible oral health outcomes as it has been shown for medical outcomes.

Therefore, this scoping review aims to access and synthesize the existing research findings about the effects of compassionate care on the oral health outcomes of dental treatments.

2. METHODS

This review was performed following the PRISMA Extension for Systematic Reviews (PRISMA 2020) 12 (Figure 1). However, as this is a scoping review, its purpose differs from that of systematic reviews. The purpose of a scoping review is to broadly map the available literature on a topic without necessarily assessing the quality of the included studies. Therefore, a risk of bias assessment table was not created, as these studies would not align with many of the criteria commonly used in such tables {Tricco, 2018, PRISMA Extension for Scoping Reviews (PRISMA‐ScR): Checklist and Explanation}. 13 , 14

FIGURE 1.

FIGURE 1

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PRISMA 2020 flow diagram for new systematic reviews.

A literature search was performed by a health sciences librarian on the following electronic databases: MEDLINE via PubMed interface, EMBASE, Cumulative Index of Nursing & Allied Health Literature (CINAHL), Cochrane, AgeLine, and Scopus from May 29, 2024 to June 5, 2024, starting with PubMed and progressing in order as listed. The search terms were developed by the primary investigator and the health sciences librarian, who combined the terms to create a comprehensive search strategy. The search utilized in PubMed can be viewed in full in the supplementary material. The original search strategy was then adapted by the health sciences librarian for the other databases listed which can also be fully viewed in supplementary material. The English and Portuguese language and human studies filters were used in PubMed, EMBASE, & CINAHL. The human studies filter was not available in Scopus. None of the filters were available in AgeLine or Cochrane.

A total of 5358 citations were retrieved from all six databases: 1175 in PubMed, 1485 in EMBASE, 266 in Cochrane, 745 in CINHAL, 213 in AgeLine, and 1474 in Scopus. After duplicates were removed, 2907 citations remained. The resulting 2907 references were added to an Excel spreadsheet, which was screened by two examiners independently. During this initial screening, the examiners included references reporting qualitative, quantitative, and mixed‐methods studies, review articles in English and Portuguese languages, without date restrictions, which specifically targeted studies that analyzed the effect of compassionate care provision in oral healthcare outcomes, according to the PICO question: What are the effects of compassionate care in the outcomes of dental treatment? (Table 1) This initial screening was performed by reading titles and, when necessary, abstracts.

TABLE 1.

Table of the PICO question.

PICO question
P Dental patients (without restriction by age, sex, and demographics)
I Compassionate care training for dental providers
C No specific compassionate care training for dental providers
O Oral health outcomes (DMFT, periodontal indexes, plaque levels, etc.)
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Finally, the two independent examiners’ lists of selected references were compared and discrepancies were discussed with a third researcher until consensus was achieved. From a total of 30 references reporting about compassionate care in dentistry, only two references investigated the effect of providing compassionate care on oral health outcomes and have been included in the analysis.

3. RESULTS

Of the thirty full‐text articles evaluated, 27 reported on compassion in dental treatment without correlating it to oral health outcomes. 11 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 (see Supplementary Material) and one study showed no dental results. The remaining two studies included in this review (see Table 2) were in Turkey 41 and Japan, 42 both from 2021.

TABLE 2.

Studies included in this review.

Title Effect of self‐efficacy and empathy characteristics of post‐graduate residents on local anesthesia administration performances: Pilot study The effect of multimodal comprehensive care methodology training on oral healthcare professionals’ empathy for patients with dementia
Author, year, country Kuscu et al., 2021; Turkey Kobayahi et al., 2021; Japan
Number and type of participants 10 female pediatric dentistry post‐graduate; 91 children 45 dentists/dental hygienists and 71 care‐resistant patients
Type of study Cross‐sectional study Prospective study with 1 month of follow‐up
Patient pool average age (range) Mean = 8 ± 2.31 (5–13years) 6% 42 ; 38% (75–84 years); 56% (over 85 years)
Description of the study Assessment of the self‐efficacy and empathy of post‐graduate residents on oral pain and anxiety scores of children during local anesthesia administrations. Evaluation of the oral health status of dementia patients before and after empathy training.
Oral health outcome Pain on local anesthesia administration and Anxiety Comprehensive Care
Oral health assessment tool VAS, CFSS‐DS; FIS; VPT; OHAT
Empathy training There was no training. 7‐h multimodal comprehensive care training programme
Empathy Scale GSS; JSPE‐S JSPE‐HP
Results of the study There was no correlation between Empathy and Pain on local anesthesia administration (p = .693). However, there was a positive correlation between Empathy and Anxiety (CFSS—p = .003; FIS—p = .049; VPT—p = .007). Empathy improved tongue appearance (p = .04), natural teeth condition (presence of cavities) (p = .02), and oral hygiene (p = .01).
Additional notes The explanation for the positive correlation between empathy and anxiety scores is that empathetic students can establish successful communication with anxious children, identifying the need to treat them using local anesthesia.
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Abbreviations: CFSS‐DS, Children's Fear Survey Schedule; FIS, Facial Image Scale; JSPE‐HP, Jefferson Scale of Physician Empathy‐Health Professionals Version; JSPE‐S, Jefferson Scale of Physician Empathy Student Version; GSS, General self‐efficacy scale—Turkish version; OHAT, Oral Health Assessment Tool; VAS, Visual Analog Scale; VPT, Venham Picture Test.

The Turkish study is cross‐sectional and evaluated oral health outcomes in children, 41 while the Japanese study is a cohort study evaluating oral health outcomes in older adults. 42 The Turkish study 41 evaluated pain on local anesthesia administration and Anxiety using the Visual Analog Scale (VAS), Children's Fear Survey Schedule (CFSS‐DS), Facial Image Scale (FIS), Venham Picture Test (VPT), and the other study 42 used the Oral Health Assessment Tool (OHAT) 43 to evaluate comprehensive care. However, both studies used the Jefferson Scale of Physician Empathy (JSPE) to assess empathy among dental students, dentists, or dental hygienists. Each study used a different version of the JSPE: The Student Version for evaluating pediatric dentistry postgraduates, 41 and the Health Professionals Version for evaluating dentists and dental hygienists. 42

Regarding empathy training, the cross‐sectional study 41 had no training while the cohort study had a 7‐h French Multimodal Comprehensive Care Training Program called “the Humanitude” care methodology. 42 , 44

The Japanese study 42 showed that Empathy improved the tongue appearance, natural teeth condition (presence of cavities), and oral hygiene scores of the OHAT, and the Turkish one 41 showed no correlation between Empathy and Pain on local anesthesia administration and a positive correlation between Empathy and Anxiety.

Both studies were conducted in different cultural contexts, with varying sample age profiles and distinct dental providers. Additionally, each study employed a different study design, namely cross‐sectional and cohort.

4. DISCUSSION

Empathy is defined as the emotional experience of another's feelings, while compassion is the emotional response to another's pain or suffering, involving an authentic desire to help. Empathy, when accompanied by action, can lead to compassion. 3 However, to search for articles related to compassion, the most appropriate MeSH term is “Empathy”. In other words, in terms of behavior, empathy and compassion are different, but in general, in the most current studies on this topic, compassion and empathy have been used interchangeably.

According to the findings of this review, there has been discussion about the importance of empathy in dentistry. 16 , 22 , 24 , 25 , 30 , as well as the importance of compassion training in different formats. 17 , 29 , 34 , 35 , 40 However, this review found only two studies. 41 , 42 developed in 2021 that reported on the effects of dental students, dentists, and oral hygienists’ empathy scores on the oral health outcomes of their patients. Both studies have used the JSPE for assessing empathy among dental providers. The JSPE has been translated into 59 languages and is a well‐established scale in the literature for measuring empathy, originally developed for physicians but widely used across all healthcare professionals, including dental providers for offering versions for students and health professionals, enhancing evaluation accuracy for these respective groups. Its strong presence in research enables better comparisons between studies and significantly increases result reliability. It is recommended that future research should also be conducted using JSPE to facilitate comparison and meta‐analyses.

The results, measured using the OHAT scale, indicated that the provider's empathy improved oral hygiene and reduced tooth cavities, with statistical significance. This was evidenced by lower scores in the “tongue” and “oral hygiene” categories, reflecting better oral hygiene, and in the “natural teeth” category, indicating a reduction in tooth cavities following compassion training. 45 It also found a positive correlation between the patient's anxiety and the dentist's empathy. 42 While this may initially seem contradictory, the authors explained that, because the study was cross‐sectional and the questionnaire was administered only once before treatment, dentists caring for more anxious patients had to adopt a more empathetic approach. It is suggested that an empathetic approach helps reduce patients' fear, build trust, and ultimately facilitate the procedure. It is noticeable that dental literature is scarce on this topic as compared to the same topic in medicine, in which there is abundant evidence that compassionate care improves health outcomes, and providers' well‐being, and elevates the healthcare system overall. 3 , 5 , 8 , 41 This scarcity of studies on the effects of compassionate care on oral health outcomes can be because dentistry is often seen as a field focused more on technical skills and procedures rather than compassion and emotional care. Besides, dental appointments are often focused on specific technical issues, and due to the nature of the care, the patient is often unable to speak, which can limit the opportunities for interactions between the patient and the dentist. 6 , 10 Additionally, some dental schools do not emphasize the importance of empathetic communication and compassion as much as medical and nursing curricula. 15 , 46 This can lead to less awareness about how a compassionate approach affects oral health outcomes.

However, it is necessary to consider that compassion might have a significant impact on dental treatment adherence, patient experience, 19 and consequently, clinical outcomes. However, new clinical cohort studies are needed to investigate how oral health outcomes in patients of different ages and conditions are impacted by training their dental providers in compassionate care.

It is important to note some limitations of this review. Despite being thorough, it identified only two relevant articles. The authors conducted an extensive search of available literature databases, but it did not include grey literature nor screening of references of included papers. It is important to recognize that no review can encompass all relevant materials in the literature. Researchers with access to different databases might uncover additional articles and abstracts that contribute to this topic. Moreover, the authors acknowledge that their search strategy could be improved and expanded by other researchers with different viewpoints on the subject.

This review found interesting results but did not establish the relationship between compassion and oral health outcomes. However, the positive results of one of the studies. 11 seem promising and could serve as a model for future investigations.

5. CONCLUSION

Several studies have been discussing compassionate care in dentistry, but there is little research‐based evidence to show that compassionate care can improve oral health outcomes. This scoping review found only two studies assessing the effects of compassionate care on oral health outcomes. These studies used different methodologies and had discrepant results. Therefore, it is important to develop more clinical studies to evaluate the effects of compassionate care on oral health outcomes.

AUTHOR CONTRIBUTIONS

All authors have contributed to the conception and design of the article. Mariana Sarmet Smiderle Mendes, Camila Lopes Ferreira, Christopher Andrew Childs and Leonardo Marchini have contributed to the acquisition, analysis, and interpretation of data. Mariana Sarmet Smiderle Mendes, Christopher Andrew Childs, and Leonardo Marchini have drafted the manuscript. All authors have approved the final version of the manuscript.

Supporting information

Supporting information

SCD-45-0-s001.docx (22.6KB, docx)

ACKNOWLEDGMENTS

The publication of this article was funded by Capes.

Mendes MSS, Ferreira CL, Jardini MAN, Childs CA, Marchini L. The effects of compassionate care on oral health outcomes: A scoping review. Spec Care Dentist. 2025;45:e13087. 10.1111/scd.13087

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supporting information

SCD-45-0-s001.docx (22.6KB, docx)

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