Communication in the Dental Office: Part III—Written Communication

GLOSSARY

Letterhead—paper or electronic stationery that includes the company name, address, phone and facsimile numbers, and may also include a logo.

Parallel structure—using the same pattern of words to show that two or more ideas have the same level of importance, usually joined with conjunctions such as “and” or “or.”

PDA—personal digital assistant; type of palm-size computer used as a phone, calendar, and personal organizer.

Salutation—the part of a letter containing the greeting.

Signpost—words signaling the order in which ideas are presented or sentences explaining the transition from one section of writing to another.

Thesaurus—a book listing words in groups of synonyms, antonyms, and related concepts.

THE RIGHT TIME TO CHOOSE THE WRITTEN WORD

Certain types of information are best communicated through a written letter. It is appropriate to use a formal letter when:

 • communicating with someone you have never met or do not know well.

 • documentation is necessary for proof.

 • information may have legal ramifications.

 • introducing bad news or sensitive information, offering to open dialogue.

 • trying to develop good will in the form of thanks, congratulations, sympathy, or apology.

 • following-up verbal communication to ensure message accuracy.

If needing to send a message quickly or contact someone known well, it may be best to place a telephone call, send an impromptu e-mail, or even make a personal visit. It is important to remember that tone and auditory cues don’t always come across as intended once written down. Sarcasm and degrees of happiness and disappointment are hard to read without facial expression signals and tone of voice.

CHARACTERISTICS OF EFFECTIVE WRITTEN CORRESPONDENCE

Today’s dental professional will find that written communication in all of its forms is just as important today as it has been in the past. In addition to letters, reports, and memoranda, the dental team will also compose written materials in electronic mail (e-mail) and text messaging formats. Regardless of the form, effective written correspondence promotes good public relations for the office. The cost of ineffective communication could include the loss of patients, profit declination, and overall patient dissatisfaction.

Professional writing is less formal in tone than that of a research essay or thesis, but more formal than a casual note. Dental professionals need to create professional correspondence that is effortless to read, visually appealing, and positively promotes the dental office. Along with the written words on the page, the letter’s design and format tells the reader about the office’s attention to detail, and level of professionalism.

Before starting the letter, it is important to establish the goal or purpose of the communication. Is the letter making a request, offering a response, or taking action? The audience must be considered and a reaction must be anticipated.

Types of letters that an office may create are:

 • Welcome letter to the practice

 • Acknowledgement of referral

 • Congratulations

 • Missed appointment

 • Collection letter

 • Letter to a colleague

 • Letter to an insurance company

To promote good business practices, the personalized letter should sound like people having a conversation using terms that both can understand. To create a positive response from the reader, the writer should adhere to the following guidelines:

 • First, a professional letter should convey all the necessary information in a concise manner. The letter should not exceed one page in length unless absolutely necessary.

 • Second, the document must be error-free, visually pleasant, and contain structure signposts that easily lead the reader through the document.

 • Third, letters should be typed and printed on clean, 8 ½ X 11” bond paper, and preferably on office letterhead. Handwritten letters are not acceptable.

 • Finally, addresses for mailing purposes must be typed directly onto the envelopes or onto a fixed mailing label.

Written communications from the dental office will vary depending on who is meant to receive the letter. A letter to a specialist regarding a professional diagnosis will include dental terminology and abbreviations common to dental professionals. A letter to a dental supplier requesting a replacement for a damaged piece of equipment may be formal and include dates of purchase or warranty details. An e-mail or letter to a patient may be less formal as in a welcome letter, and should use layperson’s terminology to gain understanding and necessary consent.

Use the following suggestions in creating written correspondence for the office:

 • Follow standard formats for letters. See Figure 1.a. through Figure 1.d. for a variety of formats.

 • Use words that are positive, accurate, appropriate, and familiar. A thesaurus offers word options and expands the writer’s vocabulary. A computer’s grammar and spell checker catches most errors, but not all. Proofreading must be completed to verify accuracy.

 • Use technical terminology sparingly unless communicating with a dental professional.

 • Use active verbs to convey your ideal message. This reduces the excessive use of “is,” “are,” “was,” “were,” “I,” or “we.” For example, instead of writing: “This tooth shade is an improvement over the previous choice” change the wording to say, “This tooth shade improves the previous choice.”

 • Tighten the writing. Avoid flowery language and long words. Eliminate words that say nothing and combine similar sentences to remove unnecessary, redundant words.

 • Vary the sentence length and sentence structure.

 • Use “you-oriented” pronouns and avoid the “I” orientation.

 • Use parallel structure and like patterns to combine thoughts and actions.

 • Be complete and include all the necessary data for the reader to make a decision and take action.

 • Maintain confidentiality, only releasing necessary information that is relative and for which the patient has given permission to release.

 • Be courteous to the reader. Use good manners and avoid derogatory statements.

 • Avoid ink smudges and tears or wrinkles in the paper.

NECESSARY BUSINESS EQUIPMENT

The computer is used in almost every dental office to create professional business letters and public relations documents. The computer is a versatile piece of equipment and allows dental team members to handle form letters, interoffice memos, and public relations items such as office newsletters or procedure promotions. Once letters and forms have been created, they are to be saved into the computer’s memory or backed up into a memory file for office record keeping. Basic typing skills, also known as keyboarding, are useful when creating letters. It is important when using form letters to be sure all areas that are personalized get changed from letter to letter. Examples include: dateline, inside address, salutation, and personal references throughout the letter.

A printer or copier is used to print the letters once they have been completed. Letters are also printed in duplicate so the office can retain a hard copy as a record. The printer must be sturdy and able to withstand constant use. Printer ink must be maintained in the inventory control list so the office never runs out. Depending on the type of letter, the person printing the document will choose to print on plain, colored, or letterhead paper.

PARTS OF A BUSINESS LETTER

Most business letters contain the parts listed below and can be identified in the illustrations Figure 1.a. through 1.d.

 • Heading (return address if not on letterhead, and date line)

  o Include the full name of the recipient, do not abbreviate any information

 • such as Street (not St.) and Avenue (not Ave.)

  o Use the month, day, and year format

 • Inside address (recipient’s address)

 • Salutation

  o Use the recipient’s full name whenever possible; end with a colon (:)

 • Body

  o Introduction

  o Purpose and supporting information of letter

  o Closing paragraph

 • Complimentary close

  o Examples would be: “Sincerely,” or “Best Regards’”

 • Keyboarded signature

  o Name should be signed exactly as keyboarded

  o Use title and credentials appropriately

 • Reference initials

  o These initials refer to the person who typed the letter

 • Special notations such as attention line or enclosures.

  o Often noted as enc: or cc:

  o Alerts the recipient that other important documents are included

Standard letter formats, known as templates, are available in most word processing programs. A “letter wizard” will prompt the writer to click into the sections and add information while maintaining the letter format. Format styles include:

 • Block letter format

  o All text is flush with the left margin

  o Paragraphs are double-spaced

  o Standard margins are set at 1 inch

 • Semi-block letter format

  o Similar to block letter; first line of every paragraph is indented

 • Alternative block letter format

  o The body of the letter and sender/receiver addresses are left justified

  o The date and closing are tabbed to the center and typed at that point

 • Simplified letter format

  o Same as the block with one exception – the salutation is eliminated

  o This format is helpful when you do not know the name or gender of the recipient

PUNCTUATION IN BUSINESS/PROFESSIONAL CORRESPONDENCE

When used properly, punctuation provides flow, pause, and emphasis to the words and thoughts in the message. The incorrect placement or omission of punctuation can alter the meaning of the message. A classic example of this is: woman, without her man, is nothing. With different punctuation it reads: woman: without her, man is nothing. Placement of the punctuation changed the emphasis from the man to the woman.

Two common styles of punctuation in the salutation and closing are used in business letters: open punctuation and mixed or standard punctuation. Open punctuation omits all punctuation (except periods after abbreviations) in the salutation and complimentary close lines. Mixed or standard punctuation requires a colon after the salutation and a comma after the complimentary close. Either style of punctuation may be used with any of the basic letter styles. Again, refer to Figure 1.a. through Figure 1.d. for examples of punctuation.

Correct punctuation is based on certain accepted rules and principles rather than by the choice of the writer. Punctuation is important so that the reader can correctly interpret the writer’s thoughts. The summary of rules given in this chapter will be helpful in using correct punctuation. The common use of periods, commas, colons, and other types of punctuation is explained in Table 1.

Capitalization

In addition to understanding the rules for punctuation, it is necessary to review the rules for capitalizing various initials and words. A capital letter is used in the first word of:

 • every sentence.

 • a salutation and all nouns used in the salutation.

 • a complete direct quotation.

 • a complimentary close.

Telephone Numbers/Social Security Numbers

There are several ways of entering telephone numbers in a document. The parentheses method around the area code, such as (734) 555-7800, is commonly used, but does not work well in text material when the telephone number as a whole has to be enclosed in parentheses. One suggested reason not to use the parentheses is because of the growing use of the mandatory area code where there is a shortage of numbers. In these areas, the use of the parentheses with the telephone number might suggest you would not need to use the area code. Three other methods of entering telephone numbers are 707-555-3998, 707 555 3998, and 707.555.3998. The latter system seems to be gaining popularity as it uses periods or dots to separate the elements. This is because these periods resemble the dots in e-mail addresses.

The same is true for Social Security numbers with the exemption of the comment about the parentheses. Common ways of entering SS#s would be 111-00-0000, 111.00.0000 or 111 00 000.

LETTER PREPARATION

Many people are uncomfortable with letter writing and often put it off as long as possible. A professional dental team member will ensure that communications take place in a timely manner. It is not a difficult task if the following steps are followed in an organized manner.

1. Collect the information

Determine who will receive the letter, the subject of the letter, what the receiver knows about the subject you are writing and by whom the letter is being written, and the subject of the letter. Be certain permission has been granted for personal information, and if enclosures are to be included. Provide deadline dates if needed and, in case of a referral, how the patient will contact the office. If it is a letter of inquiry, the nature of the inquiry, product names if available, quantity or specifications of the product, and date needed.

2. Make an outline

This will provide organization and a framework for the letter and ensure that all important points are expressed.

3. Develop the letter

The outline will aid in this step. The first paragraph gets the reader's attention and is important as it sets the mood for the rest of the letter. Each paragraph should have two or more sentences and each paragraph should have one main idea.

In this step, it is very important to follow HIPAA regulations. Consent must be given to disclose and discuss confidential information. A patient’s social security number or other protected health information (PHI) should not be included in case the letter is not delivered as intended.

4. Select a format style

This style may be chosen from the formats shown in Figure 1.a. through Figure 1.d., or from a template selected from the word processing program on the computer.

5. Review and revise the letter

Prior to the final printing of the letter, use the computer’s spell-check and grammar-check functions. While all errors may not be found, it can be used to catch several errors.

As a beginning writer, the letter should always be reviewed by a third party to ensure the content is complete and accurate. After careful review, revisions can be made to the letter as necessary.

6. Produce the letter

To create a professional image the letter should be produced on quality stationery that has the office letterhead printed on it. This lends credibility to the letter and creates a positive and professional look for the office.

7. Proof the printed letter

Even though the letter has been reviewed prior to this time, it should be proofread once it is printed to ensure the formatting is correct and the final document is accurate. Revise if necessary and DO NOT send out an incorrect document. It is also necessary to verify even printing throughout the letter. If the ink in the printing cartridge is low, streaks or faded images may occur.

8. Distribute the letter

Print the exact address used for the recipient onto the outside of the envelope. Have the letter signed. Professional letters will either be tri-folded (3.875 X 8.875) or not at all and placed into a larger mailing envelope (8.75 X 11.25.) Place the correct postage on the envelope and send via U.S. Postal Service.

9. Store a copy of the finished document

Place a copy of the document in the appropriate file or save to the correct record.

Preparing An Envelope

Envelopes can be printed for mailing through the word processing procedure. Refer to the HELP tab for software information if unfamiliar with this step. The envelope should include the correct address including the zip code. If possible, use the specific 5-digit zip code plus the 4-digit extension. If the zip code is not known it can be found by visiting the United States Postal Service website at www.USPS.com.

Fold the letter or document so that the date and inside address are visible upon opening the letter. The reader should not be forced to turn the paper around to begin reading the document.

The letters discussed in this course will not be placed into envelopes that have windows. Envelopes with windows are used for formatted letters such as billing statements.

ELECTRONIC MAIL

Because electronic mail, better known as e-mail, is so widely used for communicating today, the dental staff may find themselves sending more e-mail now than in the past. Many professionals find themselves writing e-mails to their colleagues more than they use the telephone. Dental practices will find that the use of e-mail can reduce some office printing and mailing expenses. Patients may prefer to receive recall/recare notices and appointment confirmations via e-mail. Always ask the patient’s preference.

The way professionals communicate over e-mail is a reflection of the dental practice’s professional mission. Interoffice e-mails can be short and informal, but should not be overly used as external office correspondence. Every mailed correspondence that leaves the offices portrays an image that should be perceived as professional.

The dentist employer should expect dental team members to understand proper etiquette for business e-mails. Following the suggestions below will help ensure e-mail communication is effective and efficient.

• Addressee: Be certain to use a salutation with the person’s name in the greeting. Use a colon after the salutation if a business matter or a comma may be used for a casual conversation.

• Mechanics: Double-check all grammar and spelling prior to sending. Also avoid using all capital letters. Such a style can be perceived as yelling. An occasional capitalization is acceptable to make a point or list a title.

• Formatting: Use short paragraphs and bullet points so it is easy for the recipient to scan and read. Thoughts should be summarized in a concise manner.

• Audience awareness: Do not use office jargon or technical terms in the message unless they are understood by the recipient. Avoid using abbreviations.

• Promptness: Respond to electronic communications in a timely manner. An accepted time is usually within one or two business days when possible. If an e-mail has been received and it requires a lengthy response, send a message to the sender that it has been received and provide a date when a full response is expected. A receipt memo should be drafted to immediately respond if the person is to be away from the office for an extended length of time. This automated message lets the original writer know that a full response will be delayed but answered when the person returns to the office.

• Completeness: Be sure to address all questions or action items mentioned in each e-mail communication.

• Personalization: Personalize each communication when appropriate. First names are suitable if that is how you would communicate in person. The use of a template in e-mails is acceptable for frequently asked questions/comments or educational materials.

• Video/Image Attachments: When possible, provide links to video or images, rather than sending them in an e-mail. Use a zip file or an online service like YouSendIt.com to send large attachments. This will help ensure that the message is not blocked by firewalls or SPAM filters.

• Priority: Avoid using the high priority feature unless the e-mail has content that truly warrants it.

• Personal contact: If a complex issue cannot be described easily or concisely via e-mail, send a short e-mail with a description of the issue along with a time for a follow-up call or in-person meeting.

• Signature: Create a standard e-mail signature that offers additional contact information, such as a phone number, website, mailing address, fax or other office information.

• Jokes/chain messages: Jokes and other personal communications that are not relevant to the dental practice should not be sent through the office e-mail system. These should be sent via each team member’s personal mailing address so as not to be associated with the office’s image.

• Check and Re-check:

1. Review the message before sending to ensure you have sent to correct recipients.

2. Use BC, blind copy, when sending to multiple recipients to retain privacy.

3. Are the facts accurate?

4. Does the message sound polite?

5. Do you have the appropriate salutation and signature?

6. Is the message clear and succinct?

7. Does the message avoid inflammatory remarks?

8. Are confidential matters handled properly?

• Verify the e-mail address: Before hitting the send button, it is important to verify all addresses included in the mailing.

The use of e-mail to communicate with patients and other professionals is not risk-free. Certain legal concerns should be addressed such as compliance with the HIPAA Security Rule. Also, be aware that these e-mails may be used against the dental practice in a legal or malpractice case.

CREATING A WEBSITE AND USING SOCIAL MEDIA

Many offices are taking advantage of their computer literacy and have an informational website or a social media page. This course will provide only basic information of how to design a website or Facebook page and to provide a few cautionary recommendations in creating either of these communication tools.

Prior to creating a website, the person responsible for its creation must make sure to find an appropriate domain name and a reliable web hosting service. A domain name is the primary address of the website, also known as the URL (uniform resource locator). An example of an URL is www.perrydental.com. It is essential to understand that the domain itself (although an important part of the website) does not represent the actual website. Instead, it only serves as a hint as to where the site is currently located.

When choosing a web service the web designer and dental office must be very careful in deciding what services to choose, as this can play a big role in the overall performance of the website (stability, speed, up-time, etc.). Details concerning web support should be obtained to ensure that help via phone support is readily available. The office’s computer technician is likely to have information regarding reputable, local website service providers.

Facebook pages receive a great deal of search engine respect. Large corporations utilize them when developing corporate websites. Many politicians use Facebook pages to get out their messages and gain feedback from the electorate. These social media sites are meant to provide a way to network, communicate, and advertise services for businesses. Having mobile, fast information via phone and tablet, such as an iPad®, Nook®, or Kindle®, allow these sites to become valuable tools for the dental office.

The opportunities with online sites such as Facebook, Twitter, and LinkedIn offer great possibilities to advance and promote a dental office. A Facebook page is a single page that can be created via the Facebook.com domain. This page can be used for anything the office wishes to make public. It could be considered a one-page meeting place, with information about services the office provides, links to educational materials, a message forum box, or anything else desired. Anyone can create a Facebook page as all that is needed is a Facebook account. This page should be created and maintained by someone in the office who is comfortable in using social media.

Here are some suggestions for using an office website or Facebook page.

 • The pages should be limited to professional information for patients and anyone who may be searching for a potential dental office.

 • Entries should be made by only one or two persons in the office, but checked by all employees to maintain its integrity.

 • The general population associated with the application should not be able to post on the office page.

 • Caution should be used when posting photos or personal information of staff or patients. A photo release must be obtained prior to any publication. Even with permission, it may not be wise so generic photos should be used. With a program like Facebook if someone opts out, certain provisions are made to remove photos that are “tagged” to them. Standard model permission forms are available and can be signed by the staff member, patient, or parent when a minor is involved.

 • Personal activities should not be posted on a dental website unless they portray the dental team involved in some supportive, community activity and if permission is obtained from every participant to use the photograph.

 • Pages must be designed with concern for potential litigation and confirm that no derogatory statements are made about any product or person.

 • A final comment regarding full disclosure, with a program such as Facebook, postings are never truly removed or deleted. Users agree to this practice when they agree to the terms of using it and a database holds all information until Facebook chooses to release it.

TEXT MESSAGING

Text messaging is a way to communicate using a mobile phone but it can also be sent via PDA or pager. Text messaging is so popular that it is reported by CTIA – The Wireless Association® Consumer Info that approximately 300,000 texts are sent per minute in the United States. The ability and capacity to send and receive text messages depends on the details of individual mobile phone calling plans.

Text messaging is done through a series of short, typed messages. Terms associated with text messaging include SMS (short message service), texting, and mobile messaging. Texting is best used for messages that are no longer than 160 characters. Each letter, space, and punctuation mark is considered a character. Because of this limitation, popular abbreviations have become standard among those who text. While there are so many, the following are commonly used:

Abbreviation:	Stands for:
idk	I don’t know
lol	Laughing out loud
btw	By the way
thx	Thanks
k	Okay, or I got it
uok	Are you okay?
brb	Be right back
ur	You are

This communication system works effectively when exchanging information with staff members who need to receive short messages when they are away from the office or between sattellite offices. Another appropriate use with a patient is to confirm an appointment or notify them of a delay in the day’s schedule. These short, succinct messages allow for quick notifications and responses in a quiet manner.

All text messaging performed on behalf of the dental office must be appropriate in nature, still follow the HIPAA guidelines, protect private health information, and avoid derogatory remarks.

Patients, and parents of minor patients, must sign an approval form that gives their messaging preferences. While messaging is popular, some patients may still prefer a phone call and voice message left to their cell or home phone answering service.

SUMMARY

Written communication is appropriate for many types of business documents including welcome letters, acknowledgment of referrals, collection letters, and letters to colleagues. The professionalism of the office is maintained with appropriate use of terminology, choice of letter format, good grammar, and proper punctuation. Every written message can be used to promote the office in a positive way and conversely in a negative way as legal correspondence.

Dental professionals must take time to properly prepare the information used in written correspondence. Details should be observed during letter construction and mailing. If the office chooses to engage in social media sites, the activity should be monitored, follow HIPAA Security Rules, and remain current. Text messaging can be utilized between staff members at different locations, or with patients when permission is granted.

REFERENCES

Bird DL, Robinson DS. Modern Dental Assisting. 10th ed. 2012. Mosby Elsevier.

Finkbeiner and Finkbeiner, Practice Management for the Dental Team, 7th ed. 2010, Mosby Elsevier.

Learn How to Text Message. CTIA. http://www.ctia.org/consumer_info/index.cfm/AID/10671

Parallel Structure in Professional Writing. Purdue Online Writing Lab. http://owl.english.purdue.edu/owl/resource/644/1/

Punctuation. Purdue Online Writing Lab. http://owl.english.purdue.edu/owl/section/1/6/

The Apostrophe. Purdue Online Writing Lab. http://owl.english.purdue.edu/owl/resource/621/01

Writing the Basic Business Letter. Purdue Online Writing Lab. http://owl.english.purdue.edu/owl/resource/653/01/

Writing Professional Letters. http://www.uwgb.edu/careers/PDF-Files/Professional-Letters-Guide.pdf

ABOUT THE AUTHORS

Betty Ladley Finkbeiner, CDA-Emeritus, BS, MS, is a Faculty Emeritus at Washtenaw Community College in Ann Arbor, Michigan, where she served as chairperson of the dental assisting program for over three decades. Betty began her career as an on-the-job trained dental assistant for the late Joseph S. Ellis, DDS, in Grand Rapids, Michigan, and later became a CDA and an RDA in the state of Michigan. She received bachelors and masters degrees from the School of Education at the University of Michigan. She has served as a consultant and staff representative for the American Dental Association’s (ADA) Commission on Dental Accreditation and as a consultant to the Dental Assisting National Board. She was appointed to the Michigan Board of Dentistry from 1999–2004.

Ms. Finkbeiner has authored articles in professional journals, authored several continuing education classes, and co-authored several textbooks including: Practice Management for the Dental Team; Comprehensive Dental Assisting: A Clinical Approach; Review of Comprehensive Dental Assisting; and a handbook entitled, Four-handed Dentistry: A Handbook of Clinical Application and Ergonomic Concepts. She has co-authored videotape productions including Medical Emergencies for the Dental Team; Four-handed Dentistry, An Ergonomic Concept; and Infection Control for the Dental Team, and lectured to University of Michigan dental school classes and many dental meetings. Currently retired, she continues to write, lecture, and provide consultant services in ergonomic concepts to practicing dentists throughout the country.

Wilhemina Leeuw, MS, CDA, is a clinical assistant professor of dental education at Indiana University Purdue University, Fort Wayne. A DANB Certified Dental Assistant since 1985, she worked in private practice for over 12 years before beginning her teaching career in the dental assisting program at IPFW. She is very active in her local and Indiana state dental assisting organizations. Professor Leeuw’s educational background includes dental assisting in both clinical and office management. She has received her master’s of science degree in organizational leadership and supervision and is also the continuing education coordinator for the American Dental Assistants Association.