We track everything in this profession.

Walk into almost any dental practice and you will find metrics: production, collections, case acceptance, reappointment rates, schedule utilization, hygiene department performance, new-patient
numbers, and cancellations. The metrics we currently use provide valuable insight into what happened. We can access hygiene production, fluoride acceptance percentages, and schedule performance with just a few clicks. Practice management software can generate a report on almost any operational metric in seconds.

Metrics matter because they help us evaluate performance, identify trends, and determine whether patients are receiving the care they need. What they often tell us less about is why outcomes occur.

What I cannot tell you from a production report is whether my patient in operatory two left feeling confident about the next step in their care. I cannot tell you whether they understood the condition we discussed, whether they felt comfortable asking questions, or whether they left with a clear understanding of why treatment was recommended.

Patients who understand their condition and feel confident about the next step in their care may be better positioned to engage in treatment, participate in preventive care, and follow through with recommendations. Yet these factors are rarely captured in the metrics most practices review. Communication measures can serve as leading indicators, helping us to understand the conditions that shape outcomes before they appear in production reports or performance dashboards.

The numbers we’re good at

Dental practices have become increasingly sophisticated in the way we measure performance, and that is not a bad thing. Production, collections, treatment acceptance, retention, and reappointment rates all provide valuable information. The challenge is that outcomes rarely occur in isolation. When treatment acceptance declines, we often look at financial concerns, scheduling barriers, or insurance limitations. Those factors are certainly relevant. However, patient understanding may also play a role.

Health literacy research has consistently demonstrated that many adults struggle to obtain, process, and apply health information when making health-care decisions.¹ Dentistry is no exception. Patients are frequently asked to make decisions about conditions they cannot see, symptoms they may not feel, and risks that may not become apparent until much later.

A patient who says “I need to think about it” may be weighing financial considerations. They may also be trying to process information they do not fully understand.² We measure the outcome. We do not always examine the conditions that may have contributed to it.

Patient understanding: The foundation of informed decisions

Patients who understand their diagnosis, risk factors, and treatment options are better positioned to participate in decisions about their care. Understanding is also foundational to informed consent and shared decision-making.

In dentistry, we routinely ask patients to make decisions about periodontal disease, restorative treatment, oral-systemic health connections, and preventive interventions. Many of these conditions develop gradually and may not cause immediate discomfort. As a result, patients rely heavily on the information and explanations provided by the dental team.

Understanding is not the same as agreement. A patient may fully understand a recommendation and still choose a different path. The goal is not treatment acceptance at all costs; the goal is informed decision-making.

This matters because health-care decisions are increasingly expected to be shared decisions. Patients bring their own experiences, values, priorities, and concerns into the conversation. Understanding creates the foundation upon which those decisions can be made. Without it, treatment acceptance and treatment refusal become more difficult to interpret.

While we routinely measure whether treatment was accepted, we rarely evaluate whether the information provided was clear, meaningful, and actionable to the patient receiving it.

From information to understanding

Dental professionals share information every day. We explain diagnoses, discuss risk factors, review treatment options, and provide preventive recommendations. Yet delivering information and creating understanding are not necessarily the same thing.

Consider a patient diagnosed with periodontal disease. The clinical findings may be explained accurately, the treatment recommendation may be evidence-based, and informed consent may be obtained appropriately. Yet the patient may still leave uncertain about the severity of the condition, the purpose of treatment, or the consequences of delaying care.

The information was delivered. Whether it was understood is a separate question.

This distinction is particularly important in dentistry because many oral diseases develop gradually and may not produce symptoms that patients can easily recognize. Patients are often asked to make decisions based on clinical findings that require explanation and context.

For years, I have said that I never wanted to sell dentistry. The truth is that all of us are influencing decisions every day. I still wanted patients to trust me and move forward with recommended care, because that was most important to get them back to optimal health. What changed was my understanding of how that trust is earned. The more clearly I could explain the disease process, clinical findings, risks of delaying treatment, and available options, the more confident I became in having honest conversations without feeling like I was “selling” dentistry. I became adept at providing the best options for care.

Trust and health behaviors

Closely connected to communication is trust.

Trust is not simply a relational outcome. Research has associated trust with treatment adherence, continuity of care, patient satisfaction, and engagement in preventive services. In oral health care, trust may also influence what patients are willing to disclose.³

Every clinician has experienced this. The patient who finally admits they have not been using any interproximal cleaners. The patient who shares symptoms they were hesitant to discuss. The patient who feels comfortable asking questions before making a treatment decision. These conversations and the clinician's ability to instill trust have clinical implications. The information patients share influences assessment, diagnosis, treatment planning, and follow-through with care.

Trust is something dental professionals work to build every day. The opportunity may be recognizing it not only as a relational outcome, but also as a factor that influences many of the clinical and operational outcomes practices already value.

Psychological safety and team performance

Communication behaviors that create trust and better outcomes with patients are the same that create high-performing teams. Health care is increasingly recognized as a team-based endeavor, and effective teamwork depends on more than technical competence. It requires the ability to exchange information, clarify expectations, and coordinate care.³

Research has suggested that psychologically safe teams are more likely to learn, adapt, and improve because information flows more freely throughout the organization.

In environments where people feel comfortable asking questions and acknowledging uncertainty, teams have more opportunities to learn from one another.⁴ Small concerns can be addressed before they become larger problems, and ideas for improvement are more likely to surface. While psychological safety may not appear directly on a monthly report, its influence may be reflected in how effectively teams communicate, adapt, and solve problems together.

In dental settings, this may look like the assistant who feels comfortable speaking up about a potential issue, the hygienist who raises a concern about a patient’s condition, or the front office team member who identifies a recurring patient experience challenge.

Closely related is alignment—not agreement, but alignment around priorities, expectations, and what excellent care looks like in practice. Teams that share a common understanding of purpose are often better positioned to provide consistent patient experiences and navigate challenges effectively.

What measurement could actually look like

I am not arguing for another dashboard. Most dental professionals are already managing significant documentation and reporting requirements. The goal is to identify and better understand leading indicators, not just lagging outcomes, so practices can improve performance before problems appear in traditional metrics and not to create more administrative burden. This might involve a small number of intentional questions asked consistently over time.

For patients:

• Did you leave today’s visit understanding your condition?
• Do you feel confident about your next step in care?
• Were your questions answered in a way you could understand?

For teams:

• Do you feel comfortable raising concerns?
• Do you understand the priorities
  of the practice?
• Does the team share a common understanding of what excellent care looks like?

The purpose is not to generate perfect scores but to identify patterns.

Importantly, these measures should not be viewed as replacements for traditional business metrics. Production, retention, and treatment acceptance remain valuable indicators of performance and expanding measurement could provide additional context for understanding them. When viewed together, outcome measures and human-centered measures may offer a more complete picture of practice success.

The story behind the numbers

Every day, dental professionals influence far more than production, treatment acceptance, or patient retention. We influence understanding. We build trust. We create environments where patients feel comfortable asking questions and teams feel comfortable speaking up. Those moments are not separate from clinical care. They are part of it. Those moments rarely appear in a report, yet they influence many of the outcomes we value most. Recognizing their influence may be one of the most important ways we continue to improve patient outcomes and strengthen the future of our profession. 

Editor's note: This article appeared in the August/September 2026 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.

References

1. Lawler HM, Farrell C, Fitzgerald M, Jones D, Cullen J. Oral health literacy education and practice in US dental hygiene programs: a national survey. J Dent Educ. 2023;87(3):287-294. doi:10.1002/jdd.13129
2. Hillen MA, Gutheil CM, Strout TD, Smets EMA, Han PKJ. Tolerance of uncertainty: conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med. 2017;180:62-75. doi:10.1016/j.socscimed.2017.03.024
3. Edmondson AC. Psychological safety and learning behavior in work teams. Admin Sci Q. 1999;44(4):350-383. doi:10.2307/2666999
4. Edmondson AC. The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth. Wiley; 2018.
5. Epstein RM, Street RL Jr. The values and value of patient-centered care. Ann Fam Med. 2011;9(2):100-103. doi:10.1370/afm.1239