An important aspect of the communication between dentists and patients is based upon an understanding and respect of different cultural backgrounds. Research has demonstrated that there exists a disparity in the perceptions of oral health status across distinct ethnic groups (Newton et al. 2003), and that people in general have a preference for health care providers that share their ethnicity (Noonan 2003). Distinct cultures tend to have very different values, with some placing more emphasis on their oral health than others, and some displaying a better understanding of the consequences of poor health. The "cultural deprivation" theory states that certain social groups will be less likely to seek healthcare as often as others due to poor health (Petersen 1990). For example, African-Americans tend to have less frequent visits to dentists and therefore often report more problems and higher levels of dissatisfaction with their oral health. On the other hand, Chinese and Indian groups are more concerned about their health, and habitually report higher levels of impact on their teeth than do other groups, including Caucasians. For example, Chinese patients have a much greater tendency to report limitations of or impact upon their ability to chew or speak that result from dental treatment (65% and 38%, respectively) than do Black Caribbean patients (19% and 17%, respectively) (Newton et al. 2003). There also exist interesting differences between how health and disease are viewed in Asian societies as opposed to Caucasian societies. While Asians learn about and practice healthcare at home, only seeking professional aid when home remedies fail, Caucasians, on average regularly seek out professional care and learn from their physicians. Furthermore, there are not any private dentists in several parts of Asia, including Japan and certain regions of China. Instead, polyclinics are found at or near the workplace or residences and provide services to the general populace (Kawamura et al. 2001). It is important that dentists comprehend and appreciate their patients' needs, and do their best to accommodate each patient's demands fairly, since people have different values and priorities. Doing so may engender feelings of trust in dentists whose patients might not necessarily possess the same cultural backgrounds. By appealing to each patient's individual beliefs and values, dentists may be more successful in encouraging continuity in pursuing treatments and in fostering better oral health.

Involvement in Decision-Making

Ever since the implementation of the Patient Bill of Rights, patients have been encouraged to participate more in their treatment plans in order to gain a better understanding of their therapy and to increase the satisfaction they experience upon its completion. While some research has shown that certain patients do not desire more involvement in the decision-making process, many others have demonstrated that they do. They want to learn more about their treatment plans and want an active role in the process (Chapple et al. 2003; Schouten et al. 2003). Also, even though some patients may want a more active role, their desires for information and participation is not reflected in their overt behavior. Amongst the factors that might dissuade patients from adopting a greater role include knowledge of dentistry and trust. Certain patients' lack of knowledge regarding their dental care causes them to relegate the decision-making process to their dentists. However, the patients who express more confidence and trust in their dentists' abilities are also less likely to assume an involved role in the decision-making process (Schouten et al. 2003). Indeed, the dentists' communicative behavior was negatively correlated with the number of questions the patients asked during emergency consultations

(Schouten et al. 2003). This indicates that the more adept the dentist is at communicating with patients, the less information the patients tend to seek during consultations. On the other hand, those who felt less trustful of their dentists tend to take a more active role. This again shows the influence of trust on arguably the most important aspect of the dentist-patient relationship: both parties' participation in the decision-making process.