Direct Interaction based on Tell-Show-Do Techniques

“It is by having hands that man is the most intelligent of animals.” (Anaxagoras)

The tell-show-do technique was developed as a means of helping apprehensive children receive dental care. However, it works just as well with many nervous (or even terrified) adults.

As the name suggests, it involves:

  1. Tell: the dentist explaining to you what they’d like to do
  2. Show: showing you what is involved (e. g. showing the equipment and demonstrating it on a finger)
  3. Do: performing the procedure

Other ingredients…

Underpinning the technique are rapport and control.

Rapport is established before everything else, and also, the tell-show-do technique itself is a great way of establishing rapport, as it is very much an interactive and communicative approach.

To put you into the driving seat and hand control over to you, your dentist asks your permission before each new step. You may also want to agree on a stop signal and practice this together, until you are confident that you are in control and can stop at any time.

Tell-show-do is used in conjunction with non-threatening, everyday language.

Tell-Show-Do is a great technique for anyone who fears loss of control – one of the most common dental fears!

Why and how does Tell-Show-Do work?

The tell-show-do technique can be viewed as a rapid form of desensitisation, where anxiety is reduced by a gradual acclimatisation to the object which causes fear. In contrast to systematic desensitisation, the tell and show phases are not repeated.

A crucial factor which explains why tell-show-do works so well may be the tactile interaction with the environment. Touch and interaction are central to the tell-show-do technique, providing a sense of control which cannot be obtained by “just looking”. In fact, tell-show-do can work well even if a person chooses to keep their eyes closed:

“When I get treatment, or even just a check-up, I have my eyes tightly shut through the whole thing but I am told exactly what is about to happen and always asked if I would like to feel it on my hand first – which I usually do. So without having to see the “scrapey thing”, I can feel it pulled along the back of my hand or have a puff of air blown onto it so there is no surprise when I feel exactly the same sensation a moment later on my gums/teeth. Sometimes being told is just not enough.”

A better term for the technique might be Direct Interaction, as it is the direct interaction with your dentist and with the environment which fosters a sense of control and predictability, and reduces or removes the fear factor.

Also, the very fact that the dentist is taking time to explain things and acknowledge any anxieties or fears their patient has, the more relaxed they will become.

In the following article, dentist Fraser Hendrie explains the direct interaction / tell-show-do technique and gives some examples of how it can be used to tackle dental fears.

Tell-Show-Do – It’s not just for Children!

by Fraser Hendrie BDS MFGDP

A dentist named Harold Addleston coined the phrase Tell-Show-Do more than 40 years ago. Tell-Show-Do is a technique used by dentists to help children work through their fears and curiosities in a new situation, be it a simple dental examination or something more detailed. The theory behind this is simply that children are great little lie detectors and will be more anxious if they sense they are being deceived. So we should be honest and upfront with them, describing things in a truthful yet non threatening way. In time, this rigorously honest approach with them helps them to grow in trust and confidence.

While Tell-Show-Do is an oversimplification of things on many levels, a version of this technique is very helpful for adult patients who suffer from dental fear. The variant that I favour most for adults is more Explain-Ask-Show-Do.

In the past, dentists got a reputation for “doing things to their patients” with the old medical approach of “we know best.” A more modern and enlightened approach is one of mutual co-operation. So Tell-Show-Do in my practice has actually been Explain-Ask–Show–Do for a long time.

This works on the basis that we do not have your agreement to do anything at all until you specifically agree to it. The aim here is to put you as the patient back in control of the situation. So at each key stage we explain what we would like to happen / suggest a next step in your care, we answer any questions that you may have and then, once you are in possession of all of the information that you need, we ask your permission to proceed. The exact stages where we Ask if it is ok to do something will vary from person to person, depending on what we discussed during our initial chat about your fears and phobias.

So if, for example, you are someone who has a phobia about sharp metal objects in your mouth I would want to avoid using a probe or anything like it initially. I might ask if it is ok for me just to look around your mouth with a mirror. I would then Show you the mirror and explain that this was all I would like to use today. I would demonstrate that the mirror was all that I was holding / had within reach. To further show that this is all that we were going to use, I would also keep my hands in plain view the whole time. I would then keep exactly to my promise and use just the mirror for a preliminary look around. This is the Do part of the process.

Now, different dentists will handle this approach at different levels. A thorough discussion with you beforehand should help your dentist get a pretty good idea where the “stress points” are going to come for you in the visit. Your stress levels will vary within the visit from moment to moment. Some dentists will intuitively be better at sensing this than others. It is fair to say however that none of us get this right 100% of the time, so please don’t be afraid to ask questions or let us know how you are doing.

The overall aim is to gradually help your to decrease your stress levels and increase your confidence.

So coming back to our example, at a first visit we may not even get to using a probe, if that is your fear or phobia. What we may do instead (if you agree) is have a conversation about it, and describe and reframe for you how and why it will be used. Very often, explaining the most up-to-date information about what we do and the equipment we use to provide care can help to re-frame and thus reduce your fear too. By this, I mean it may help to balance what your mind tells you happens with this object and bring it closer to what will actually happen. The ultimate aim being over time to bring your internal dialogue or imagery about your dental fears  closer to the current reality of modern dental care delivered by a caring dental team.

In this example, I would Explain that probes are no longer used to vigorously “test” teeth for decay as they were years ago – generally they only lift away any little bits of plaque or trapped food or are used to touch the gum and assess its health. Further on I may even Ask if you would like to hold a probe and feel that the tip of it is specially rounded to make it safe and comfortable (Show) . Assuming this all goes well we may then get to the stage where we simply use the probe to lightly touch the teeth once or twice. (Do)

There is no one magic solution to using this technique. As a dentist, I am trying to balance your fears and phobias against your desire to make progress while respecting where you are currently at both physically and emotionally. It is a balancing act that with practice (on both parts) you become better at as the balance is different for every single person.

Successful easing of dental fears comes when you form a partnership to tackle your fears with your dentist. With trust, time and honesty many patients successfully eliminate their fear altogether.

I firmly believe that as dentists, we need to earn this trust through care, honesty and doing what we say we will. In terms of honesty I do not mean telling patients how dreadful their dental situation is or how bad things are because these are opinions rather than facts. What I mean is simply keeping our promises and doing what we say we will. You can help us to help you by telling us as much detail about your dental fear as possible in advance, or as it comes to your mind, so that we can tailor that care exactly to you.

This approach can work for a number of scenarios, here is one other example. Your dentist simply needs to work out what you need to know, see and experience to help you move forwards. So for someone who tells me they are terrified of getting a “scale and polish” we might just start with the polish part and look at that…

Getting your teeth polished, it is really no different to using a toothbrush, the paste we use is just a little better at removing stains than regular toothpaste (Explain). It can be likened to polishing the bonnet of a car, or polishing up a piece of furniture in so far as the aim is to allow the naturally glossy appearance to shine through. We can check and if you are ok with it (Ask), the polishing brush can be demonstrated on a finger nail (Show). You can hold it and examine it if you like as it is similar to a regular toothbrush. Assuming this is ok, we can then check and if you feel up to it we can move on and polish an individual tooth.

The approach has thousands of variations and can be varied to suit your fear: the more your dentist knows, the more creative they can be in helping you to find a way past your individual “stress / fear points.” The examples here are just 2 common examples that spring to mind. Most dental professionals who are interested in helping patients with dental fear will be happy to flex what is their usual routine, if it helps to make life easier for you. Ultimately, there are some things in dentistry that we cannot change, but with empathy and in investment of time, I have met only a very few patients who cannot be helped past these hurdles.

For example, we know that a dentist cannot do their job thoroughly unless you are sitting in the dental chair, but if this is where your fear lies, do we really need to do a first examination in the dental chair? An examination in a regular chair may be an initial compromise but if both you and your dentist recognise that this is a compromise and commit towards working to the ideal solution then this means progress is being made.

Explain-Ask-Show-Do is a versatile tool that is limited only by the imagination and creativity of the people using it. While not a panacea for dental fear it is one of the major planks on which we can build a foundation to help overcome it.

Fraser works at Craigentinny Dental Care Edinburgh. Outside work, he is being kept busy by his 2 young children and interest in any sport involving water. Fraser has been helping patients overcome their fears for more than 15 years.