Every dental professional will have those patients who, no matter how much advice and encouragement you give them, they simply do not improve their home oral hygiene routines. While it may be frustrating to give the same guidance over and over again, most patients don’t actively decide to ignore you – they either just forget what you say or they are unable to change their routine behaviours.
It’s a memory thing
Considering the former scenario first, a study[1]found that patients remembered a lot less information than dentists following their appointments. While dentists’ and patients’ memories of procedures and general issues discussed were similar, dentists reported having given much more oral health advice (almost twice as much) as patients recalled receiving. Dentists also reported double the amount of future actions agreed than the participating patients remembered. Interestingly, while dentists recalled more technical concepts discussed, patients had similar memory of any psychosocial issues mentioned.
This could have far reaching consequences on patient compliance – it is logical that they are highly unlikely to act upon professional recommendations if individuals can’t remember what they are. Whether this lack of memory is the result of misunderstanding, an overload of information or a failure to appreciate the significance of information provided is yet to be determined.
Behaviour change
Another barrier to improving patients’ home care regimes is the difficulty associated with changing behaviours. It is understandable that someone who has brushed their teeth for one minute every day for the past 30 years, for example, might struggle to suddenly change this habit. There has been much research into the psychology behind behaviour change and one of the main models used to explain it is the Transtheoretical Model.[2]This postulates that an adjustment in health behaviours requires six stages of change – precontemplation, contemplation, preparation, action, maintenance and termination.
According to the model, when the need for behaviour change is initially identified during an appointment, the patient is in the first stage – precontemplation. Expecting them to go from here straight to action may be a false hope. The Transtheoretical Model has been already applied to practice and proven successful for periodontal patients[3]and with regards to encouraging change in interdental cleaning behaviours of patients.[4]Therefore, it may offer a useful solution in other areas of dentistry as well.
In practice
So how can all this be applied in practice? Essentially, it means that communication between practitioner and patient remains key to helping patients enhance their oral health.
To improve patients’ memory of discussions during an appointment, it’s important to ensure that they actually understand what you’re telling them. Using appropriate language when explaining why certain oral health standards need to be achieved will help patients to appreciate the importance of the advice being given. Modern technologies such as the CS 3600 intraoral scanner and CS R4+ practice management software from Carestream Dental can help with this as they provide a visual aid to complement explanations of why procedures or oral health habits are needed. The animations available on the software also provide demonstrations of techniques to ensure patients understand exactly what they need to do.
Similarly, being able to provide take-home materials of the key points discussed in appointments and the future actions required by the patient might prove useful. This will give them instructions to refer to in their own time after the appointment and remind them of what they had agreed to do with their dentist. A simple leaflet or email would work, perhaps adapting a template of oral hygiene advice to indicate required products or routines to save time.
With regards to inspiring behaviour change, attention should be given to helping patients move through each stage of the process chronologically. By showing them why change is needed, what actually needs to change and then supporting them through it, you’re more likely to see the results you’re looking for. Starting small with one change at a time may be recommended and it’s important to remember that this will take time to come to fruition. Recalls should be arranged accordingly.
Helping patients to take responsibility for their oral health and encouraging improved home care routines is a process that many dental professionals will be involved with. Taking into consideration that patients will not remember much of what is discussed during appointments and following a model proven to encourage behaviour change should increase success.
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0800 169 9692 or visit www.carestreamdental.co.uk
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REFERENCES
[1]Misra S, Daly B, Dunne S, Millar B, Packer M, Asimakopoulou K. Dentist–patient communication: what do patients and dentists remember following a consultation? Implications for patient compliance. Patient preference and adherence. 2013;7:543-549. doi:10.2147/PPA.S43255.
[2]Prochaska JO, Velicer WF. The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion. April 1997; 12(1):38-48
[3]Emani S, Thomas R, Shah R, Mehta DS. Application of transtheoretical model to assess the compliance of chronic periodontitis patients to periodontal therapy. Contemporary Clinical Dentistry. 2016;7(2):176-181
[4]Morowatisharifabad MA, Fallahi A, Nadrian H, Haerian A, Babaki BNS. Interdental cleaning behavior and its relationship with psychological constructs based on the Transtheoretical Model. Oral Health Prev Dent 2011; 9:211-220
