Inclusive language in dentistry is essential for delivering high-quality, equitable care that respects and empathizes with patients from diverse backgrounds. It involves using language that avoids exclusion and bias, focusing on person-first terms, and understanding the preferences of individuals and communities. This approach not only promotes health equity and belonging but also strengthens trust and communication between providers and patients and among members of the dental health care team. Education, training, and consistent deliberate practice in inclusive language among health care professionals are crucial for integrating these principles into oral health care.
Key points
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Inclusive language in dentistry is crucial for creating a respectful, empathetic environment that acknowledges and supports patients from diverse backgrounds, promoting health equity and a sense of belonging.
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Inclusive language involves using respectful, accurate, unbiased language, focusing on person-first language, and being aware of the evolving nature of language to reflect individuals’ preferences and community standards.
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Language is embedded in health care systems and can reinforce or challenge biases.
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Education and training in inclusive language for all oral health care providers and staff are essential to integrate the principles of health equity and belonging in practice, improve patient–provider relationships, and enhance health care outcomes.
Introduction
Oral health care providers are entrusted with the care of patients from a vast array of backgrounds, each with their unique needs, experiences, and expectations. Caring for diverse patients, many that have been historically excluded from receiving equitable care, requires us to actively acquire new knowledge that is aligned with inclusive, person-centered care principles. This approach ensures care that is customized to each individual’s identities, beliefs, and needs. Inclusive care stands on the principle that everyone deserves high-quality health care that is respectful, empathetic, and meets their unique needs, regardless of their background or identity.
In health care, including the dental clinic setting, establishing trust is crucial for successful relationships, and adopting person-centered care principles fosters this trust. The role of language is a critical tool in fulfilling the promise of trusting and inclusive care, acting not just as a means to convey information, but also as a way to express respect, empathy, and understanding. Employing inclusive language is vital for creating an environment where patients of all backgrounds feel acknowledged and understood, underscoring the importance of language in effectively delivering inclusive care.
While inclusive language is broadly defined as language that avoids certain words or expressions that might exclude particular groups of people, it is widely accepted that inclusive language must go beyond exclusion. Inclusive language should be “respectful, accurate, unbiased, and consistent with the preferences of the individuals and communities who are discussed.” Using inclusive language in our health care practices and educational settings supports our patients, staff, and students in a manner that reinforces both health equity, which is the state in which everyone has a fair and just opportunity to attain their highest level of health, and belonging, or the sense of security and support when there is a sense of acceptance and inclusion. Adopting inclusive language within the oral health care setting is an essential step toward integrating the principles of health equity and belonging into everything oral health care providers do. Through the use of inclusive language, every individual can feel seen, heard, and valued, all while moving toward a more equitable oral health care system.
Inclusive language should be utilized in all contexts and is equally important in the clinical setting between providers and patients, among providers and staff, and in the educational setting, as a way to support student development and to model best practices. As we move forward in our discussion, it is important to note the distinction between language and communication. Language is the structured system of symbols, words, and rules we use to convey messages, while communication encompasses the broader process of exchanging information, thoughts, and feelings through various means, including language, gestures, and other nonverbal cues. Communication encompasses shared terminology (language) as well as narrative and nonverbal means of representing thoughts, emotions, and ideas. In a clinical setting, the importance of language between providers and patients acts as the cornerstone for building trust and understanding. Inclusive language facilitates clear communication and reduces misunderstandings and misinterpretations that can lead to misdiagnosis, dissatisfaction, or inadequate treatment. By acknowledging each patient’s unique identity, health care providers can create a welcoming and safe environment that encourages patients to share vital information about their health, lifestyle, and concerns, leading to more accurate assessments and personalized care plans.
Among providers and staff, the adoption of inclusive language fosters a culture of respect, acknowledging and valuing diversity while improving an individual’s sense of belonging. Inclusive language in the workplace has additional benefits including reducing discrimination and bias, improving communication and collaboration, and building trust and respect. Benefits such as improving communication and collaboration can improve job efficacy, support retention of clinical staff, reduce adverse clinical events and outcomes, and are among the most important factors in improving clinical effectiveness and job satisfaction.
Within the educational setting, language has profound effects and influences learners’ feelings of belonging, resilience, identity, self-efficacy, and achievement. Language acts as a mirror, reflecting the values and norms of the educational setting, and thereby shaping the professional identity of future health care providers. Lapses in shared understanding due to non-inclusive language risk alienating learners, patients, and colleagues create barriers to effective communication and empathy. Modeling inclusive language is paramount for educators, as it equips future health care providers with the necessary skills to engage with patients from diverse backgrounds in a respectful and understanding manner. Through deliberate practice and emphasis on inclusive language, health professions educators can ensure that the next generation of providers is not only clinically competent, but also culturally responsive and inclusive in their practice.
Discussion: inclusive language in the clinical setting
In the health care setting, the adoption of inclusive language is essential for fostering a respectful environment that values each patient’s unique background and needs. Inclusive language is characterized by its nonjudgmental nature, reliance on facts, and the practice of mentioning personal characteristics only when they are medically relevant. This approach avoids stigmatization and ensures that communication does not inadvertently harm or alienate patients. By focusing on facts and relevance, health care providers can create a more welcoming and supportive space for all patients. Using inclusive language in practice requires an understanding of general guidelines, key principles, and community-specific preferences.
General Guidelines
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Use plain language : Plain language is a straightforward way of communicating that avoids complex vocabulary, making information accessible to people of all reading levels and backgrounds. This simplicity ensures that important health information is not obscured by medical jargon, which can often be intimidating or misunderstood by patients. It is equally important to avoid use of expressions or idioms that may not translate well across different cultures or may carry unintended connotations.
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Listen : Listening is a cornerstone of inclusive communication. Providers should actively listen to patients, giving them space to share if something is harmful or uncomfortable for them. This space for open dialogue can reveal when certain terms or phrases may be distressing or inappropriate, allowing for immediate correction and education. Listening is an essential skill for effective communication between individuals of different backgrounds and with diverse life experiences.
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Set aside assumptions : Implicit bias and the use of associated stigmatizing language have far-reaching effects, automatically activating stereotypes that can influence judgments and behaviors in subtle, often unrecognized ways. Health care providers must not presume to know the experiences or needs of their patients based on their appearance, background, or health condition. Setting aside assumptions and being aware of our own biases avoid stereotyping and also open the door for patients to share their unique perspectives and needs in an open way.
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Consider context : Understand historical contexts of language as words are often rooted in oppression. Certain terms that were once widely used may carry a history of derogatory or exclusionary use (such as blacklist or blackmail, which may associate the color black with negative or bad characteristics). Educating oneself about these historical contexts is key to understanding why some terms should be avoided. Inclusive language may also be context dependent, with a word or phrase being appropriate in one context while being considered harmful in another, thus emphasizing the need to understand the preference of individuals and communities.
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Always evolving : Language is not static; it is always evolving. As society becomes more aware of the experiences of individuals and groups, language adapts to reflect this awareness. Health care providers must stay informed about these changes and the reasons behind them to remain respectful and relevant in their interactions with others. Communities and individuals may also change their preferences overtime, and it is important to understand when preferred language shifts.
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Be aware of preferred terms : While there are overarching guidelines that providers can follow, the preference for terms and language is determined by the individual and community. A discussion of current preferences of some communities is discussed later in this article.
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Should be utilized everywhere : Inclusive language is not limited to a single setting and is applicable from the waiting area to the clinical room. Training on the use of inclusive language should occur for all individuals who work in the oral health setting, the principles of which can be utilized in all settings in the health care environment.
Key Principles
Person-first language
The role of person-first language in fostering an inclusive clinical environment is integral to delivering compassionate and respectful care. Person-first language places the individual before any characteristic or diagnosis they might have, humanizing the individual and avoiding reduction to a single aspect of their identity. By emphasizing the person rather than a particular condition, health care providers acknowledge the patient’s value and identity beyond their health challenges.
The importance of person-first language lies in its ability to reshape perceptions. It counteracts the stigma often associated with medical conditions and disabilities, which can be perpetuated through language and avoids using labels or adjectives to define someone. For example, instead of referring to someone as “diabetic,” person-first language would suggest saying “person with diabetes.” This subtle shift changes the focus from the disease to the individual, recognizing that the condition is only one attribute of the person’s complex identity.
Person-first language also extends to discussions about lifestyle or social circumstances. Instead of labeling someone as “homeless,” which defines them solely by their lack of housing, it is more respectful to say “person experiencing homelessness” or “people without housing.” This language implies a condition that is temporary and does not encompass the individual’s entire identity.
The use of person-first language is not without its nuances. Some communities, particularly within the disability community, may prefer identity-first language, such as “autistic person” instead of “person with autism,” as a way of embracing their disability as an integral part of their identity. It is crucial for health care providers to ask individuals how they wish to be referred to and to honor their preferences. This dialogue reinforces the patient’s autonomy and self-identification.
Avoid stigmatizing words
It is important to navigate away from terms that inadvertently stigmatize communities or individuals. Adjectives such as “vulnerable,” “marginalized,” and “high-risk” can carry implications that reinforce negative stereotypes or suggest inherent weakness or deficiency within groups or individuals. Instead, the focus should be on describing the structural and systemic factors that contribute to differing health outcomes among populations.
To avoid stigmatization, we can explain the broader context that leads to disparities. For instance, rather than labeling a community as “vulnerable,” it may be more accurate and respectful to describe the specific conditions that contribute to their increased exposure to health risks, such as “communities with limited access to health care” or “populations affected by housing instability.” This language acknowledges the external factors that contribute to health status without implying that the community’s identity is the source of risk.
Similarly, describing groups as “marginalized” can be replaced with explanations of the mechanisms of marginalization. For example, we can specify that “policies and social practices have historically limited this group’s access to resources,” thereby focusing on the actions that have led to their marginalization, rather than presenting marginalization as an attribute of the group itself.
Some common language used in health care unintentionally places blame on the individual such as labeling someone as “noncompliant” with their medications or treatment regimen. There are many reasons why an individual may be unable to adhere to recommendations, including finances, access, or social issues. Alternating the language to something like “unable to adhere due to …” provides a clear description of the challenges the individual may be facing while not assigning blame to the patient.
It is also important to avoid language that has violent connotations. Patients come from many different backgrounds with a variety of personal experiences, some of which may be violent or traumatizing in nature. Some language may evoke negative responses from patients due to past trauma. Avoid language like “target, tackle, trigger” and replace them with alternatives such as “engage, prioritize, prompt” to provide a more neutral approach.
Being aware of stigmatizing language in the clinical setting and choosing to use inclusive alternatives is important, not just in the personal interactions we have with patients, but also in the language we utilize in the written medical record. Inclusive language reinforces health equity as it is well documented that language that reinforces bias and stereotypes leads to negative attitudes toward patients and diminished health outcomes. Table 1 provides inclusive language alternatives to common words and phrases. Table 2 demonstrates how small adjustments to wording, emphasizing neutral and person-first language, create a less stigmatizing patient encounter note.
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