Nonverbal Communication in the Operatory

Persons experiencing difficulty with speech or language, or those with sensory impairments, may utilize one or more types of nonverbal communication. These may be formal or informal. One example of nonverbal communication frequently encountered is sign language, which represents a formal language system. There are other forms of non-verbal communication, however, that are not based on formal language. Some are common experience and include gestures (pointing to a fluoride flavor to indicate one's choice, raising one's hand to ask for assistance, nodding or blinking one's eyes to indicate "yes"), vocalizations (e.g., the use of a specific sound to indicate refusal), and the written word (text). In addition, some individuals may use picture symbols, photos, electronic communication boards, manipulation of objects, or leading a person by the hand in order to signify meaning. Use of nonverbal cues is not limited, of course, to persons with disabilities. Children frequently employ non-verbal communication before language development, or when intimidated by a strange setting; and adults use nonverbal cues, as well, to supplement their intended meanings.

When patients with significant disabilities communicate with you by whatever means, it is important to recognize and honor that communication. For example, if a young lady who is nonverbal makes the sign for 'finished" to indicate wanting to be done while you are cleaning her teeth, you might need to note that you are "almost done, just four more teeth and you will be finished!" Remember that a person who does not use words is still your patient, and will still attempt to communicate with you. Always be sensitive to those communications.

Also recognize ways in which you can express your message to individuals who may be nonverbal and/or have intellectual disabilities. Many patients who are nonverbal will, of course, understand what you are saying. For other patients with significant disabilities, the objects associated with visiting the dentist can be used to prepare the patient for the dentist's examination. For example, one parent reported that the dental hygienist was very helpful in preparing her daughter for the dentist's examination by pairing specific objects with her conversation with her daughter. Simple things like saying we are getting ready for the dentist, and then turning on the overhead examination light, showing her the mirror, and placing the apron and chain around her neck alerted the young lady to what was coming next, so that she was very ready to cooperate when the dentist entered the room.

In the dental operatory setting, clinicians and patients should, if possible, negotiate a means of conveying information about the patient's comfort level to the dentist. For example, a dentist may ask a patient to raise his or her hand to indicate pain. On occasion, a patient may not be able to directly communicate his or her discomfort. Under these circumstances, it is critical that the dentist stay carefully attuned to nonverbal signs of pain, such as grimacing, flinching, skin pallor, sudden changes in muscle tone, moaning, or cries.

By maintaining awareness of the purpose and forms of nonverbal communication and its importance for patients, dentists can provide thorough, sensitive treatment for individuals with disabilities.


LaChapelle, D.L., Hadjistavropoulos, T., & Craig, K.D. (1999). Pain measurement in persons with intellectual disabilities. Clinical Journal of Pain, 15, 13-23.

Venkatagiri, H.S. (2002). Clinical implications of an augmentative and alternative communication taxonomy. Augmentative and Augmentative Communication, 18 (1), 1-24.

Zwakhalen, S.M., van Dongen, K.A.J., Hamers, J.P.H., & Abu-Saad, H.H. (2004). Pain assessment in intellectually disabled people: Non-verbal indicators. Issues and Innovations in Nursing Practice, 45, 236-245.