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Emojis in text messages: Use them wisely and safely

Sept. 9, 2022
Do you communicate with your patients via text message? If you do (or are considering it), look at these best practices for using emojis in text.

Dentists used to collect magazines to put in their offices. Racks of Good Housekeeping, People, Motor Trend, and Highlights for Children offered patients something to occupy their minds while waiting for their appointments. Peek into your reception area today. Chances are the racks are empty due to the pandemic; however, patients’ gazes are now focused on their smartphones. Many of them are texting with friends, relatives, and coworkers. Texting has become relevant to communications, and for some offices, now extends to patient communications. The term “texting” extends to more than just words—messages are also filled with “chatspeak,” the blend of regular language, abbreviations, and emojis that make up online language.1

Texting is increasing in popularity as a method of receiving and sending communications for health care. A series of surveys conducted by Pew Research Center in association with the John S. and James L. Knight Foundation on the state of smartphone ownership in 2015 reports, “Fully 97% of smartphone owners used text messaging at least once over the course of the study period, making it the most widely-used basic feature or app; it is also the feature that is used most frequently.”2

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In dental offices, texting is used for appointment reminders, scheduling conflicts, and emergencies. Some communications platform companies offer ways to make your practice more text-friendly, giving dentists an option for contacting patients by text. Some texting applications can open a two-way texting chat that can help with tasks such as rescheduling in case of cancellation.3 Of course, if you are going to implement a texting application from your office, remember that security of protected health information (PHI) and maintaining HIPAA standards should be of utmost importance for both the dentists and the practice. If unsecure texting results in a HIPAA violation, the penalties could be costly.4,5

With the valuable appeal of texting, it is important to maintain a friendly but appropriate repartee between the clinician and the patient. Use of emojis can underscore the personality of the practice with a smile, a surprised face, or a cool guy with sunglasses. Communications company Rosemont Media notes that it is acceptable to use emojis in dental marketing but adds this caveat: “While it’s arguably better to keep medical or dental website content more straightforward and formal, emojis can be useful and engaging when it comes to your practice’s social media marketing campaign.”6

The same concept holds true for texting applications. RevenueWell, a marketing communications company, offers an “Emoji Guide for Dental Offices,” noting, “Texting emojis to patients is way more different than texting emojis to friends. Some emojis are perfect to use—while others can go way out of bounds.”7

Text messaging platforms are required to implement HIPAA safeguards to keep patient information secure. One such safeguard is signing a business associate agreement (BAA) with the company that provides your texting application. A texting platform is not considered HIPAA compliant without a signed BAA, because it ensures HIPAA compliance for both the doctor and the platform provider.8

On their website, communications platform Weave notes that while emojis may be appropriate in basic patient communications—for instance, in a follow-up after a hygiene appointment—you should not include one if the patient recently had some discomfort; for example, if they had a root canal or extraction. Be aware that patients suffering from dental office anxiety may not appreciate an emoji or may take it the wrong way.9

In a systematic review of emojis, the research shows that emoji use can be affected by the user’s individual characteristics, culture, and platform usage.10 Emoji use may lead to misunderstandings, though ironically, one of the goals of using emojis is to help add feelings to better comprehend the person’s intent in their text messages. A study by Miller et al. concluded that in five unique platforms rendering 22 emojis, there was disagreement in meaning that increased across the platforms.11

RevenueWell’s advice is probably prudent for any dental or other health-care office. Use the same tone and voice in your texts as in other communications, such as emails and phone calls. Document all forms of communication in your patient’s chart, and when texting,
“No eggplants. [Author’s note: The eggplant emoji debuted in 2010 and has evolved to symbolize a part of the male anatomy.12 Of course, this would not be appropriate for any communications from the dental office, even in a humorous way.] In other words, be professional. You might be texting, but you’re still representing your dental practice.”13 

Editor's note: This article appeared in the September 2022 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.


  1. Chatspeak definition. Your Dictionary. Accessed June 24, 2022. https://www.yourdictionary.com/chatspeak
  2. Smith A. U.S. smartphone use in 2015. Pew Research Center. April 1, 2015. Accessed June 21, 2022. https://www.pewresearch.org/internet/2015/04/01/us-smartphone-use-in-2015/
  3. Hogan B. How dentists can use text messaging to engage patients. Oral Health. May 13, 2020. Accessed June 21, 2022. https://www.oralhealthgroup.com/blogs/how-dentists-can-use-text-messaging-to-engage-patients/
  4. Follow the rules when phoning patients. American Dental Association. Accessed June 24, 2022. https://www.ada.org/resources/practice/legal-and-regulatory/follow-the-rules-when-phoning-patients
  5. Alder S. What are the penalties for HIPAA violations? HIPAA Journal. January 23, 2022. Accessed June 24, 2022. https://www.hipaajournal.com/what-are-the-penalties-for-hipaa-violations-7096/
  6. Hall T. Using emojis to make your practice relatable. Rosemont Media. February 21, 2017. Accessed June 21, 2022. https://www.rosemontmedia.com/social-media-marketing/using-emojis-%F0%9F%98%84-to-make-your-practice-relatable/
  7. Emoji guide for dental offices. RevenueWell. Accessed June 21, 2022. https://www2.revenuewell.com/emoji-guide
  8. Maheu M. What you need to know about HIPAA compliant texting. Telebehavioral Health Institute. January 7, 2022. Accessed June 24, 2022. https://telehealth.org/hipaa-compliant-texting-3/
  9. Stapleton-Charles N. Texting etiquette—how to text patients the right way. Weave. Accessed June 21, 2022. https://www.getweave.com/texting-etiquette-how-to-text-patients-the-right-way/
  10. Bai Q, Dan Q, Mu Z, Yang M. A systematic review of emoji: current research and future perspectives. Front Psychol. 2019;10:2221. doi:10.3389/fpsyg.2019.02221
  11. Miller H, Thebault-Spieker J, Chang S, Johnson I, Terveen L, Hecht B. “Blissfully happy” or “ready to fight”: varying interpretations of emoji. In: Proceedings of the 10th International Conference on Web and Social Media, ICWSM 2016. AAAI press; 2016:259-268.
  12. Eggplant emoji. Emoji Dictionary. February 28, 2018. Accessed June 24, 2022. https://www.dictionary.com/e/emoji/eggplant-emoji/
  13. Texting etiquette 101: messaging patients without ticking them off. RevenueWell. October 11, 2018. Accessed June 21, 2022. https://www.revenuewell.com/article/texting-messaging-patients
About the Author

Stuart Segelnick, DDS, MS

Stuart Segelnick, DDS. MS, is currently president of the American Association of Dental Editors and Journalists. He is editor of the Second District Dental Society of New York’s SDDS Bulletin and the Northeastern Society of Periodontists’ NESP Bulletin. Dr. Segelnick was the recipient of the ICD Journalism Silver Scroll Award in 2016 and the ICD Journalism Newsletter Award in 2019 and 2021. He has coedited five books on dentistry. He is a fellow of the Pierre Fauchard Academy, the International College of Dentists, and the American College of Dentists, as well as an adjunct clinical professor at New York University School of Dentistry in the department of periodontology and implant dentistry.

Updated September 8, 2022

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