Dentist’s Appearance: Does It Matter?

— Dentistry is a client dependent field. Other than the dentist’s skills, the dentist’s appearance has been observed to affect the patient’s perception of the clinician. This research was conducted to assess patient’s perception of the dentist’s appearance based on the dentist’s attire, gender and age. A total number of 492 Malay respondents were involved in this study. A set of questionnaires was randomly distributed via google forms. This questionnaire consisted of three sections, including socio-demographic details of the respondents, patient’s perception towards dentist’s attire and patient’s perception towards dentist’s gender and age. The result showed that respondents consisted of 78% female and 22% male. The highest percentage of participants was in the age group of 18-30 (85.6%), while the lowest percentage of respondents came from the age group of 49-60 (5.3%). The majority of respondents (51%) preferred a dentist who wears a white coat followed by a dentist in scrub (38.2%) and a dentist dressed in formal attires (9.3%). Only 1.4% of respondents selected a dentist who wears casual attire. Participants also prefer dentist in the age group of 41-60 years old, while participants had no preference toward dentist’s gender. A final open-ended question showed respondents also preferred to see dentists with acceptable dental appearance, good behaviour and established qualification. In conclusion, a dentist’s appearance is important to secure a promising interpretation of the patient towards the dentist.


I. INTRODUCTION
Healthcare services are moving toward advanced development in treatment and prevention to achieve a gold standard of healthcare. Physicians need to build up a rapport, gain trusts and provide quality service to patients. This can be achieved by conveying a good impression of the service. Physician's attire is a way to protect a clinician from surrounding microorganisms. It is also regarded as important by patients since the way a clinician dresses up would highlight the confidence in patients towards the clinician.
Previous studies emphasise the importance of appearance and its effect on impressions and interpersonal relationships (Bersheid et al., 1982). The appearance had been shown to affect a patient's perception of a physician's ability (Brosky et al., 2003). Factors such as age and gender can influence patients' perception of their dentist (Kanzler et al., 2002). Approximately 70% of participants in a study considered that a physician's attire could influence their confidence in the physicians (Yamada et al., 2010). Despite this, other reports claimed that patient's satisfaction is not affected by the way clinicians dress (Druss RG, 1998, Hennessy N et al., 1993. Other factors such as clinician's age, gender, and how they speak have been observed to influence patients' trust and confidence (Shah R et al., 2006, Ambady N et al., 2002.
Worldwide, clinicians wear a white coat, but recently, their dress became more varied. Although a white coat is still the most favourite dress of clinicians, doctors are now observed to appear with less formal attires or casual wears. Some reports said that patients preferred clinicians with white coats (Yamada et al., 2010, Gerardi et al., 2009, Rehman et al., 2005, Cha et al., 2004. Nevertheless, there were other studies observed that patients do not actually mind what their doctors wear (Shelton et al., 2010, Boon et al., 1994 or prefer they wear semi-formal or formal clothes rather than white coats (McKinstry et al., 1991, Lill et al., 2005. In order to achieve a good doctor-patient relationship, it is crucial to demonstrate the importance of the physician's attire as well as to find out the factors that might influence the patient's responses. Based on a study conducted in Southern Nigeria, dentists' attire plays significant roles in patient's perception, affecting the dentist-patient relationship (Eigbobo et al., 2019). Thus, clinicians would focus more on their clothing to provide a better service to patients.
Guidelines related to professional dental attires are varied according to the different opinions among the clinicians, including the patient's acceptance or preference in the specific country. The dental attires commonly worn in the government-based hospitals or clinics in Malaysia include white coat, scrub, disposable surgical gown, or formal attire. There have been observations that young, private practitioners have appeared to be wearing a casual dress while treating patients.
As there is a lack of information regarding patients' perception of dentist's appearance in Malaysia, this study was conducted to observe dental patients' preference toward their dentist's attire, gender, and age.
The general objective of this study is to assess patient's perception of the dentist's appearance. The specific objective is to assess the patient's perception of the dentist's attire and investigate the relationship between the patient's perception of the dentist's sex and age.

A. Study Design
This was a cross-sectional observational study using self-administered questionnaires. Approval from the Universiti Sains Islam Malaysia ethical committee was obtained prior to the study (ethics number: PPPI/TB/FPG/14219).

B. Study Setting
Participants of the study were selected randomly by spreading the questionnaire via google forms in social media platforms, including team members' personal accounts of Whatsapp, Facebook, and Twitter over two months. By doing a random distribution of questionnaires, a wider age range of participants would be obtained. The questionnaires are filled in without the participants being affected by the presence of clinicians.

C. Participants
Informed consent was included in the questionnaire. Participants who declined to give their consent would not be able to proceed with the questionnaire, so they were excluded from the study.
The inclusion criteria for the participants were as follows: • Participants should be in the age range of 18-60 years old. • Malaysian citizen. • Able to read and understand Bahasa Melayu and English languages.
The exclusion criteria were as follows: • Participants who are younger than 18 years old and older than 60 years old. • Non-Malaysian citizen.
• Do not understand Bahasa Melayu and English languages.

D. Sample Size
The sample size was computed through the website www.openepi.com. This module calculates the sample size for determining the frequency of a factor in a population. The sample size was provided for confidence levels from 90% to 99.99%. The sample size needed for this study was 385 participants. A total of 513 questionnaires were recorded, although some responses needed to be excluded, including 18 respondents belonging to ethnicities other than Malay. Three respondents had withdrawn their consents. An initial plan to compare results based on different ethnicities was cancelled as there were insufficient numbers of participants from ethnicities other than Malays. A total of final 492 Malay respondents were collected and analysed.

E. Data Collection
The questionnaire was developed based on the past questionnaires from two previous studies (Hiroshi K, et al., 2014, William V.D.C et al., 2017) and distributed through social media. In this study, we have decided to study patient's preferences towards dentist's attire, so a collection of four photographs (Figures 1 to 4) were used. The photographs showed a dentist wearing a white coat, a formal dress, a casual dress and a scrub. The questionnaire consists of four sections, which were as follows:

1) Section 1: Demographic data of patients / respondents
In Section 1, the respondent's details were recorded, including their age, gender, level of education, marital and employment status and monthly income. This information was summarised to conclude on what factors determine the patient's preference towards a dentist's attire.
2) Section 2: Patient's perception towards dentist's attire In Section 2, the respondents were asked to choose their preferred dentist's attire. Four photographs showing different dentist's clothing styles were put in this section. Facial expression, posture and hairstyle were kept as similar as possible in all photographs. The individual in the photographs was not involved in the survey. This section linked the respondent's assumptions of their dentists with their attires. The photographs given were as follows:  3) Section 3: Patient's perception towards dentist's age and gender. Section 3 discussed the respondents to link their assumptions of their dentists with the dentist's age and gender. They were asked to select their male or female dentist preferences or no preference regarding the dentist's gender. The age group of dentists were divided into three age ranges that were 25-30 years old, 31-40 years old and 41-60 years old.

Section 4 displayed an open-ended question.
Respondents were asked about their opinion related to other factors or criteria of dentists that may help increase the patient's confidence with the dentist.

A. Demographic data of the study population
After approximately two months of distribution of the questionnaires, a total of 492 surveys were collected. The participants were Malay, which was reflective of the biggest population of the region. A total of 77.4% of respondents had a degree higher than SPM. The majority of the participants were young adults (age 18-30 years old), contributing to 85.6%. Female participants were higher than males with 78% and 22%, respectively (Table 1).

B. Patient's perception towards dentist's attire
When the subjects were asked to choose their most preferred dentists' attire by selecting one photograph out of four displayed photographs, more than half of them (51%) selected dentist with a white coat, followed by dentists wearing scrub (38.2%). Less than 2% of subjects had chosen casual attire dentists ( Table 2).

C. Statistical Analysis
Data were analysed using IBM SPSS Version 23. Here, p < 0.05 was considered as significant using descriptive statistics and the Chi-square test. The Chi-square test was done for the correlation of subjects age and dentist's age. The result showed that the age of patients correlated significantly with the age of dentists (p< 0.05). From the result in Table 3, the younger respondents preferred dentist in the age range of 41 to 60 years old, while the middle group and the older respondents chose the junior dentist aged 25 to 30 years old for their dental care. In total, 171 respondents had chosen a senior dentist as the dentist they preferred for their dental care (Table 3). Meanwhile, both male and female respondents had no preferences towards the dentist's gender, with a total of 224 respondents. This result was also statistically significant as the p<0.05 by the Chi-square test (Table 4). Appearance is one of the important factors that affect a patient's perception and confidence towards the dentist. It can be understood that the appearance in terms of attire, age, and gender of the dentist plays an important role in the respondents' preferences. Most of the respondents for this research had chosen a white coat as the most appropriate and suitable attire for a dentist who provides dental care. This result agrees with the previous studies that have similarly observed white coat as the most preferred attire of dentists, followed by scrub (Yamada, 2010;Kalyan, 2013;William, 2017).
Due to a similar report by many previous studies, a white coat becomes a symbol of doctors, creating a sense of confidence in patients . In the present study, only 1% of the respondents preferred dentists in casual attire, which contradicts a previous study that stated a population in New Zealand prefer dentist to wear casual attire (Lill, 2005). British Department of Health has published the guidelines regarding the attire of a dentist. It is stated that long sleeves attire may prevent thorough hand hygiene procedures and are likely to be heavily contaminated during work activities and contact with patients. At the same time, a scrub is more hygienic and suitable for dentists and physicians (Jones, 2018).
Most of the respondents in this study preferred dentists in the age range of 41 to 60 years old. This result supports several previous studies that found more senior and experienced dentists of 41 to 60 years of age were chosen as the preferred dentists by patients, while patients did not display any preferences towards dentist's gender (Furnham, 2009;Ibrahim et al., 2015). Furthermore, older professionals are more preferred because they have better skills and experiences than younger professionals (Swami et al., 2011).
This study has shown that patients do not mind the gender of the dentist who is going to treat them. Nevertheless, in contrast to this, an earlier study reported that a dentist's age and gender to be important because these factors relate to personal manners, technical and explanatory skills (Shah et al., 2006).
Apart from the dentist's dress, respondents of this study have given their opinions related to other important factors that will ensure the establishment of confidence and cooperations of patients towards the dentist who is treating them. The majority of patients felt that the way a dentist describes dental management and how they convey their explanations to patients is similarly important to how the dentists display themselves in their daily professional dress. Patients liked dentists who showed understanding and empathy towards the patient's dental experiences besides giving promising dental treatments.
This present study has demonstrated that dentists' attires play an outstanding role in patients' perception and satisfaction. However, it could not be concluded whether a particular type of dress like a white coat will remain the most appropriate clothes for dentists in the future.

IV. CONCLUSION
This study has observed the importance of dentist's attires towards building up a good rapport and stabilised relationships and confidence of patients towards the dentists who treat them.
A patient's perception is crucial as a good impression can help in building up a good relationship and co-operation between dentist and patient. The study shows that a white coat is seen as the most appropriate style for dentists regardless of the dentist's gender, followed by scrubs, formal and casual attire. From the respondent's answers, it can be concluded that patients in Malaysia have no preferences in the gender of the dentist. At the same time, majority of them wants dentist in the specific age range of 41 to 60 years old.