The phenomenological approach in dentistry - a narrative review

Figures & data

Table 1. Results of articles selected categorized based on topics in dentistry and their summary.

Topic	Author, Year	Methodology and Data Collection Method	Sample Size and Sampling Frame	Main Results
Chronic Orofacial Pain	Hazaveh and Hovey, (2018)	Transcribed verbatim in-depth interviews analysed using the interpretive phenomenological approach	Six participants with chronic orofacial pain who were undergoing treatment at pain clinic and hospital in Canada	Participants experienced various types of loss as a result of chronic pain, revealed disbelief among families and communities in the pain reported, and dissatisfaction with their journey through the health care system
	Lovette et al., (2022)	Participants responded to an open-ended question as part of an online survey about the challenges faced when living with chronic orofacial pain and responses were mapped into themes using the hybrid thematic analysis approach based on tenets of phenomenology	260 participants with diagnosed chronic orofacial pain recruited from members of the Facial Pain Association	Three themes (biomedical, psychological, social) and 15 subthemes were identified in this study
Dealing with Dental Anxiety	Schneider et al., (2018)	Semi-structured interviews that investigated dental imagery and anxiety in the participants were audio-recorded and transcribed verbatim and later analysed using phenomenological thematic analysis	18 participants were recruited from a non-clinical sample of students with varying levels of dental anxiety and treatment experiences	Vivid sensory images were common but varied. Intense and intrusive fear-provoking dental imagery focusing on unpleasant sensations associated with negative past experiences was common in participants with higher anxiety while images that were less distressing and centred around positive appointment outcomes were predominant in participants with lower anxiety ratings
	Murray et al., (2019)	Semi-structured interviews with open-ended, non-directive questions were audio-recorded and transcribed verbatim and analysed with interpretive phenomenological analysis	Six dentists from a pool of specialist dental professionals at a London dental school who predominantly treat dentally anxious patients	Four superordinate themes were revealed: Negotiating identities, Control, Perceptions of dentistry and being a dentist and Stress related to treating dentally anxious patients
Dental Education	Reeson et al., (2013)	Reflective diaries and transcripts of focus group meetings and thematic content analysis were done to identify the themes	Six focus group meetings were held over two years with a mixed group of undergraduate dental students and trainee dental technicians	The key overarching elements arising from both the domains and themes were subsumed under the headings: Apprehension and awkwardness; The growth of the dental team; Worries about patient care
	Koch et al., (2014)	Thematic in-depth interviews were conducted with specific reference to experience of successful clinical and organization change. Then phenomenological human scientific analysis was done	Four purposively selected participants based on occupation (dentist, dental assistant, receptionist, clinic manager) in a Swedish endodontic practice	Four domains were identified: 1) disclosed motivation, 2) allowance for individual learning processes, 3) continuous professional collaboration, and 4) a facilitating educator
	Greviana et al., (2020)	In-depth interviews and focus group discussions were audio-recorded and transcribed verbatim and then analysed using the thematic analysis approach to identify emerging themes and subthemes	Six in-depth interviews and four focus group discussions consisting of seven to 10 undergraduate students in a public school of dentistry in Indonesia	Trainees had low utilization of self-reflective e-portfolios. Five external and internal factors were identified
	Gallagher et al., (2021)	Semi-structured interviews were recorded and transcribed for framework analysis using the interpretive phenomenological approach to develop theories	Twenty dentists from a range of backgrounds working in England were recruited using purposive snowball sampling	Dentists shared concerns about their physical, psychological, and emotional health. Issues relating to professional regulation and health systems, workplace and job specification, issues relating to professional careers, relationships, and personal life, highlighted ethical concerns and feeling driven to deliver, being demoralized by a survival culture, and all leading to a perceived lack of control and reduced professional fulfilment.
Oral Health Perception	Abedi et al., (2013)	Semi-structured interviews and analysed with the conventional content analysis method	60 students from six primary, secondary and high schools in Jooy-bar town, Iran	There were two major clusters extracted. The themes from the perception part included: 1) ways that led to tooth decay, 2) methods to prevent it, 3) definition of tooth decay, 4) role of diet in oral and tooth health, and 5) milk and permanent tooth. Whereas the behaviour part covers 6) measures in taking care of healthy teeth and 7) measures in facing decayed tooth
	Gibson et al., (2019)	In-depth, open-ended interviews about their lives, sense of self and their body, oral health and quality of life were audio-recorded, transcribed, and analysed with phenomenological theory where relevant	15 men and 28 women aged 65–91 years with different education levels conveniently sampled from social and lunch groups, residential homes, local newsletters targeted at white British in cities of Edinburg, Scotland and Sheffield, England	Participants conceived of oral care as a life course project that entailed an active plan to keep the teeth in later life. This involved accessing the social world of dentistry, holding appropriate values, understanding the associated personality types, social practices, goals and outcomes. The life course project embraces ideas on appropriate ageing including how oral health is to be managed at different stages in the life course
	Tynan et al., (2020)	Transcripts of focus group discussions and in-depth interviews were analysed with thematic analysis	27 members of a small, rural indigenous Aboriginal and Torres Strait Islander community in Queensland, Australia participated in three focus groups and 12 in-depth interviews	The community held oral health as a high priority. Factors influencing the importance include the perceived severity of symptoms of oral disease such as toothache; lack of access to finance and transport; the social impact of oral diseases including impact on personal appearance and self-esteem; oral health beliefs and awareness; occurrence of multiple health concerns; and family responsibilities.
	Mohanty et al., (2021)	One-to-one in-depth interview was undertaken, and summative content analysis was conducted	44 schoolteachers in a senior secondary government school in Delhi, India selected through convenient sampling	Every participant in the study felt that “oral health is an integral part of overall health” and the prime reasons quoted were “Awareness/affects general health” followed by “Bad oral health affects academic performance”. The perceived barriers to dental service delivery were “lack of awareness” followed by “financial barriers”
Evaluate Barriers to Oral Health Access	Dickson, (2015)	Phenomenological approach to explore the lived experiences of parents about dental behaviours conducted using face-to-face, semi-structured interviews	Eight parents with one to three children of one month to three years in Northern Ireland not yet registered with a dentist recruited with purposive sampling	Inconsistencies in advice across professions, concerning the appropriate age of registration, were found to result in children being denied early access to dentists. Childhood dental fears and anxiety with lasting impact on some mothers may influence their decision
	Franzon et al., (2018)	In-depth, semi-structured interviews to collect and analyse the phenomenological data about dentistry as a free market within the context of a welfare state	Purposive and maximum variation sampling to select three senior leading policymakers in Sweden	The analysis reported that dentistry was experienced as a complex business relationship between buyers and sellers that transcended the traditional dentist and patient roles. Two inherently conflicting views were found: the belief in the individual’s ability to make a free choice versus the understanding that all individuals in a society do not have the ability or the means necessary to make a free choice
	Ghotane et al., (2019)	Semi-structured interviews were conducted, audio-recorded, transcribed verbatim and analysed with the interpretive phenomenological approach to explore views of key players in dentistry and healthcare in the country and externally	Purposive sampling of 21 informants from different sectors in Sierra Leone whose involvement was within healthcare and related policy	The study had a clear consensus that a high level of oral health needs was unmet. Challenges of dental care delivery revolved around five themes: 1) patients’ predisposition for traditional remedies; 2) practical hindrances; 3) professional isolation and weak governance; 4) pressing local crises and 5) lack of political will. While typology of dental professionals included: 1) loyalty; 2) resilience; 3) embracing opportunity; 4) striving to serve the population
	Mittal et al., (2019)	Semi-structured individual interviews transcribed verbatim and analysed thematically using a phenomenological approach	25 participants over 64 years of age who were eligible for subsidized dental care plans were recruited from a public teaching hospital and a public primary care clinic in Singapore	Themes emerged in four major areas: 1) general awareness of oral health, 2) life course perspective of oral health, 3) barriers to visiting the dentist, and 4) shaping dental service adoption behaviours by financial aid. Besides, trust, convenience, fear, anxiety, previous negative experiences, and lack of knowledge influenced dental visit decisions
	Feng et al., (2020)	Personal interviews and focus groups were audio-recorded, transcribed verbatim and coded thematically	Ten members and 12 staff (in a focus group) of the Positive Living Society of British Columbia (PLSBC) were interviewed	The program helped members receive dental services. Members who had past traumatic experiences were appreciative of the services delivered safely and stigma-free, and they valued the opportunity to educate dental professionals to reduce HIV-related stigma. However, some members continued to face barriers to care at referral clinics for dental needs that could not be treated in the program
Dental Diseases	Cheng et al., (2013)	Individual, in-depth, semi-structured interviews were audio-recorded, transcribed verbatim and data analysed based on phenomenological method	Nine men diagnosed with oral cancer within one year were recruited using purposive sampling from oral cancer outpatient clinics in a hospital in Taiwan	Five themes emerged from the interview data: 1) the psychological journey in facing oral cancer, 2) the question of how patients can control their disease as well as the sequelae of cancer treatment, 3) the continuous disturbance and turmoil resulting from the disease, 4) the appreciation of the support from family and friends, and 5) the ability to learn to actively face the future
	Hamlet &Harcourt, (2015)	Individual semi-structured interviews (five via telephone and one face-to-face) were conducted and the transcripts were analysed using the interpretative phenomenological analysis	Six older adults aged 57–82 years with cleft lip and palate (CL/P)	The analysis resulted in five themes: 1) cleft across the lifespan, 2) keeping up appearances, 3) being one of a kind, 4) resilience and protection, and 5) cleft in an ever-changing society. CL/P had ongoing impacts, particularly in some aspects of participants’ lives. Participants seemed at ease living with CL/P as an older adult and considered it an important aspect of their identity, yet they still felt isolated at times. They felt that health and dental care could be more considerate of the needs of older people with cleft
	Bitencourt et al., (2019)	Individual, semi-structured, household interviews were carried out and data were interpreted by the phenomenological content analysis	Intentional sampling of 66 adult and elderly participants who had tooth loss identified through the patient dental records of oral health service in Primary Health Care of Porto Alegre, Rio Grande do Sul, Brazil	The study found that losing teeth was a subjective experience with heterogeneous narratives and highlighted the important social aspect of the mouth. The number of missing teeth and the understanding of how people perceived themselves without their teeth determined how much tooth loss affected their lives. Wearing prostheses adds significance to individuals’ perceptions of their body
	Safour & Hovey, (2019)	Face-to-face, open-ended, semi-structured interviews about experiences with TMD-related changes in diet and digestion were recorded and transcribed. Interpretive phenomenology was used to arrange and analyse the narrative data collected	Six adults with chronic temporomandibular joint disorders (TMD) confirmed by specialists and had self-reported changes in dietary habits were recruited through referrals from specialists	The authors were able to identify three common themes: 1) constipation and bloating, 2) loss of chewing function and 3) weight change, which had physiologic and psychologic complications and were largely unaddressed by their doctors
	Imani et al., (2021)	In-depth, open-ended questions, and semi-structured interviews to evaluate parent’s experience during orthodontic treatment of their children with CL/P and analysed with descriptive phenomenology	Purposive sampling of parents of children younger than 15 years with CL/P who presented to private orthodontic clinics in Kermanshah, Iran seeking orthodontic treatment	Qualitative analysis of the interviews yielded three main themes including fatigue (exhaustion, helplessness, and incompetence), self-reliance (mutual support and empathy), and the need for social support (counselling services and citizenship rights)
	Bitencourt et al., (2021)	Semi-structured interviews and phenomenological content analysis were used to interpret the data	52 caregivers of children with early loss of deciduous teeth intentionally sampled using health record analysis from an outpatient service of a public university in the south of Brazil	According to caregivers in the study, premature loss of deciduous teeth brings functional limitations with chewing and speaking, impairments of social interaction with other children, repercussions on the child’s image, and changes in families’ daily lives. On the other hand, early tooth loss by extraction due to pain was perceived as “commonplace” in children’s lives by the caregivers
Dental Treatment	Östergård et al., (2016)	Interviews were transcribed verbatim and the descriptive phenomenological method was chosen for the collection and analysis of the data	One woman and two men aged 64–77 years who according to their dental records, had received periodontal treatment and made improvements in self-care were selected from a private general dental clinic in the southern part of Sweden	The results described the patient-centred perspective held together by eight constituents: 1) change is increased successively, 2) a changed view on self-care at the start of change, 3) improved self-care includes understanding and automatic routine, 4) motivating challenges and feedback are perceived as strengthening, 5) having good thoughts and being satisfied with one’s own capacity, 6) experiencing trust and participation along with an expert, 7) negative experiences and limitations precedes the change, and 8) relating yourself to past time, present time, future and other people
	Liddle et al., (2018)	Two semi-structured interviews were carried out one week before and six to eight weeks after surgery to explore the experience of changing appearance associated with orthognathic surgery. Principles of the interpretative phenomenological analysis were used to guide data collection and analysis	Purposive sampling of five female and two male British participants aged 18–25 years scheduled for bimaxillary osteotomy recruited from a National Health Service (NHS) dental hospital	The following themes were identified: the overall journey of treatment being a rite of passage; the treatment’s role in raising awareness about anomalies in appearance; the initial shock at the changes that followed surgery; the uncertainty about treatment; the impact of actual negative reactions of others; and the role of significant others in the decision-making process.
	Barker et al., (2019)	One-to-one, semi-structured interviews and workshops were conducted, and narratives were analysed using the interpretive phenomenological analysis	Opportunistic sampling of 12 patients who had incurred a nerve injury from dental treatment and were diagnosed by oral surgeons via a series of neurosensory tests	Six key themes were presented: 1) personal impact and change in self-perception, 2) impact on relationships, 3) impact on oral health care, 4) adjustment to the injury over time, 5) change in how they perceived dentists, and 6) changes they would make in the dental care system
	Dawson et al., (2019)	In-depth, one-to-one, face-to-face, semi-structured interviews to collect data and was analysed using the interpretive phenomenology	15 adult patients with head and neck cancer (HNC) 7–14 days after oral reconstruct surgery who received swallow therapy	Two overarching themes were discovered: “I never dreamt” and “They look at you, and they speak to you.” The first theme revolved around there was no way for patients to be adequately prepared for the enormity of the surgery and its consequences; however, the second theme was the way healthcare professionals interacted and communicated with the person was healing and therapeutic
	Kanchan et al., (2019)	In-depth interviews were audio-recorded, transcribed, coded, categorized and analysed to derive themes based on the phenomenology study design	Purposive sampling of 10 female and 6 male (mean age 58.4 years) undergoing radiotherapy for the past two months for oral cancer in an Indian hospital	The analysis of data generated four main categories: pain, nutritional consequence, barriers in communication and support system which showed the multifaceted experience of patients undergoing radiotherapy
	Saltnes et al., (2019)	Semi-structured interviews about quality of life (QoL) were recorded, transcribed, coded and analysed using the phenomenological method of analysis	Convenient sampling of six males and six females aged 21–48 years with oligodontia and experiences with comprehensive dental treatments	The following themes were obtained from the data; “feeling of being different”, “the burden of treatment”, “shared decision making”, “treatment increases self-esteem” and “use of coping strategies”.
	Moi et al., (2020)	Face-to-face interviews were recorded, transcribed verbatim, and analysed using Giorgi’s phenomenological method	A cohort of 21 Caucasian Norwegian adults with a mean age of 40.8 years treated for unilateral CL/P during childhood and adolescence from 1973–1979 were recruited	The study noted these patients were very aware of their bodily differences. The possible adverse reactions from peers early in life negatively affected their social life. Factors like self-confidence, cleverness, being physically fit, and having trusted friends were barriers against teasing and bullying. Nevertheless, reflected images remind them of the objectifying looks from society and often lead to bodily adjustments. The treatment course was not questioned, and they accepted the treatment decisions made by experts and parents. Although problems related to the cleft could persist or return after ordinary treatment, they were typically more hesitant for additional surgery in adulthood
	Gill et al., (2021)	In-depth interviews were audio-recorded, transcribed verbatim and detailed thematic analysis based on phenomenology framework was done	Eight male and two female smokers with an average smoking duration of 28 years registered at a Quit Smoking Clinic at the International Medical University, Malaysia	Three key themes with eight child nodes were extracted: barriers to quitting smoking, reasons for quit attempts, and how to quit. Unsuccessful attempts were related to tobacco addiction and successful attempts were based on the need to improve one’s health and family
Others	Fakheran et al., (2020)	Face-to-face, semi-structured, audio-recorded interviews on the oral health-related quality of life (OHRQoL) were performed and transcribed verbatim. Data was analysed using the interpretative phenomenological analysis approach	27 pregnant women recruited from four healthcare centres located in Isfahan city, Iran	The impact of pregnancy on women’s OHRQoL was condensed into three major themes and six sub-themes which covered daily life, psychological well-being, social life, physical impact, and barriers to utilization of dental care services. New domains like “dentists’ refusal to treat pregnant women”, “negative feelings about pregnancy” and “concerns about foetal health” were found as important factors that could influence the OHRQoL in them
	Iyer et al., (2020)	In-depth, face-to-face qualitative semi-structured interviews were conducted. The data was voice-recorded digitally, transcribed, and then analysed using Giorgi’s phenomenological analysis	Purposive sampling of 12 female dentists of Vadodara, India working with one or more male colleagues or auxiliary	Five themes were identified: 1) Striking work-family balance, 2) Dependence on male authority for instating work discipline, 3) Male dentists’ hostility to the “woman in power” concept, 4) Male dentists’ superiority in technical skills, and 5) privileges for women dentists

Hazaveh, M., & Hovey, R. (2018, July). Patient experience of living with orofacial pain: An interpretive phenomenological study. JDR Clinical & Translational Research, 3(3), 264–271. https://doi.org/10.1177/2380084418763317

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Lovette, B. C., Bannon, S. M., Spyropoulos, D. C., Vranceanu, A. M., & Greenberg, J. (2022, July 29). “I still suffer every second of every day”: A qualitative analysis of the challenges of living with chronic orofacial pain. Journal of Pain Research, 15, 2139–2148. https://doi.org/10.2147/JPR.S372469

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Schneider, A., Andrade, J., Tanja-Dijkstra, K., & Moles, D. R. (2018, August 1). Mental imagery in dentistry: Phenomenology and role in dental anxiety. Journal of Anxiety Disorders, 58, 33–41. https://doi.org/10.1016/j.janxdis.2018.06.009

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Murray, E., Kutzer, Y., & Lusher, J. (2019, March). Dentists’ experiences of dentally anxious patients in a specialist setting: An interpretative phenomenological analysis. Journal of Health Psychology, 24(3), 288–298. https://doi.org/10.1177/1359105316666655

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Reeson, M. G., Walker-Gleaves, C., & Jepson, N. (2013, November 9). Interactions in the dental team: Understanding theoretical complexities and practical challenges. British Dental Journal, 215(9), E16–. https://doi.org/10.1038/sj.bdj.2013.1046

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Koch, M., Englander, M., Tegelberg, Å., & Wolf, E. (2014, August). Successful clinical and organisational change in endodontic practice: A qualitative study. European Journal of Dental Education, 18(3), 121–127. https://doi.org/10.1111/eje.12066

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Greviana, N., Mustika, R., & Soemantri, D. (2020, May). Development of e‐portfolio in undergraduate clinical dentistry: How trainees select and reflect on evidence. European Journal of Dental Education, 24(2), 320–327. https://doi.org/10.1111/eje.12502

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Gallagher, J. E., Colonio-Salazar, F. B., & White, S. (2021, July 20). Supporting dentists’ health and wellbeing-a qualitative study of coping strategies in’normal times’. British Dental Journal, 1–9. https://doi.org/10.1038/s41415-021-3205-7

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Abedi, G., Rostami, F., & Eftekhari, S. (2013). Phenomenology of students’ perception and behavior on oral and tooth health. International Journal of Collaborative Research on Internal Medicine & Public Health, 5(4).

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Gibson, B. J., Kettle, J. E., Robinson, P. G., Walls, A., & Warren, L. (2019, March). Oral care as a life course project: A qualitative grounded theory study. Gerodontology, 36(1), 8–17. https://doi.org/10.1111/ger.12372

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Tynan, A., Walker, D., Tucker, T., Fisher, B., & Fisher, T. (2020, December). Factors influencing the perceived importance of oral health within a rural aboriginal and torres strait islander community in Australia. BMC Public Health, 20(1), 1–9. https://doi.org/10.1186/s12889-020-08673-x

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Mohanty, V., Jain, S., & Grover, S. (2021, April 1). Oral healthcare-related perception, utilization, and barriers among schoolteachers: A qualitative study. Journal of Indian Society of Pedodontics and Preventive Dentistry, 39(2), 154–158. https://doi.org/10.4103/JISPPD.JISPPD_368_20

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Dickson, C. M. (2015). Every child has the right to smile!–A qualitative study exploring barriers to dental registration in a SureStart area in Northern Ireland. Community Practitioner: The Journal of the Community Practitioners’ & Health Visitors’ Association, 88(8), 36–41.

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Franzon, B., Englander, M., Axtelius, B., & Klinge, B. (2018, January 1). Dentistry as a free market in the context of leading policymaking. International Journal of Qualitative Studies on Health and Well-Being, 13(1), 1484218. https://doi.org/10.1080/17482631.2018.1484218

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Mittal, R., Wong, M. L., Koh, G. C., Ong, D. L., Lee, Y. H., Tan, M. N., & Allen, P. F. (2019, December). Factors affecting dental service utilisation among older Singaporeans eligible for subsidized dental care–a qualitative study. BMC Public Health, 19(1), 1–8. https://doi.org/10.1186/s12889-019-7422-9

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Hamlet, C., & Harcourt, D. (2015). Older adults’ experiences of living with cleft lip and palate: A qualitative study exploring aging and appearance. The Cleft Palate-Craniofacial Journal: Official Publication of the American Cleft Palate-Craniofacial Association, 52(2), e32–e40. https://doi.org/10.1597/13-308

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Safour, W., & Hovey, R. (2019, October 1). A phenomenologic study about the dietary habits and digestive complications for people living with temporomandibular joint disorders. Journal of Oral and Facial Pain and Headache, 33(4), 377–388. https://doi.org/10.11607/ofph.2302

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Saltnes, S. S., Geirdal, A. Ø., Saeves, R., Jensen, J. L., & Nordgarden, H. (2019). Experiences of daily life and oral rehabilitation in oligodontia–a qualitative study. Acta Odontologica Scandinavica, 77(3), 197–204. https://doi.org/10.1080/00016357.2018.1535137

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Fakheran, O., Keyvanara, M., Saied-Moallemi, Z., & Khademi, A. (2020, December). The impact of pregnancy on women’s oral health-related quality of life: A qualitative investigation. BioMed Central Oral Health, 20(1), 1–1. https://doi.org/10.1186/s12903-020-01290-5

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Iyer, R. R., Sethuraman, R., & Wadhwa, M. (2020, September 1). A qualitative research analysis of gender-based parities and disparities at work place experienced by female dentists of Vadodara, India. Indian Journal of Dental Research, 31(5), 694. https://doi.org/10.4103/ijdr.IJDR_586_18

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