Every dental professional will have certain patients who– no matter how much advice and encouragement they receive– do not improve their home oral hygiene routines. While it may be frustrating to repeatedly give the same guidance, most patients are not choosing to ignore you; they either forget what you’ve said or unable to change their routine behaviors.
It’s a Memory Thing
Considering the former scenario, a study found that patients remembered less information than dentists following their appointments. Reportedly, dentists remembered giving almost twice as much oral health advice during office visits than what patients remembered receiving. Dentists also reported recalling double the amount of future actions agreed upon than participating patients. Interestingly, dentists remembered more technical concepts discussed while patients had similar memory of mentioned psychosocial issues.
It’s common sense for patients to not act on professional advice they can’t remember. However, it is yet to be determined whether this lack of memory is the result of a misunderstanding, an overload of information or a lack of concern for the information provided.
Another barrier to improving patients’ oral health regime involves difficulty with changing behaviors. For example, it would be a struggle for someone who has brushed their teeth for one minute every day for the past 30 years to suddenly change their behavior. There has been much research into the psychology behind changed behavior, and one of the main models used to explain this is the Transtheoretical Model. The model postulates that an adjustment in health behaviors requires six stages of change: pre-contemplation, contemplation, preparation, action, maintenance and termination.
According to the model, when the need for changed behavior is initially identified during an appointment, the patient is in the first stage – pre-contemplation. It would be false hope to expect a patient to go straight into action right after the first stage. The Transtheoretical Model has been already applied to practice and proven successful for periodontal patients with regards to encouraging change in interdental cleaning behaviors of patients. Therefore, the model may become a useful solution in other areas of dentistry as well.
So, how can changing behaviors be applied in practice? Consistent communication between practitioners and patients is necessary for enhancing the oral health of patients.
To improve patients’ memory of discussions during an appointment, it is important that they understand the instruction given by their dental provider. Using appropriate language when explaining why certain oral health standards need to be achieved will help patients appreciate the importance of the advice given. Modern technologies, such as intraoral scanners and practice management software, can provide a visual aid and complement explanations of procedures or oral health habits.
Similarly, it would be useful to provide take-home materials on key points discussed in appointments and future actions required by the patient. This will allow patients to have information to refer to in their spare time. In this case, a simple leaflet or email would suffice. In addition, adopting a template of oral hygiene advice indicating the required products or routines could help save time.
With regards to inspiring behavior change, attention should be given to helping patients move chronologically through each stage of the process. By showing them why change is needed, what needs to change and then supporting them through the process, you’re more likely to see the changed behavior. It’s important to start small as it will take time for the changes to become a learned behavior.
Helping patients take responsibility for their oral health and encouraging improved home care routines is a process that many dental professionals are involved with. Following a model proven to encourage behavior change should increase the success of improved oral health.
 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.
 Prochaska JO, Velicer WF. The Transtheoretical Model of Health Behavior Change. American Journal of Health Promotion. April 1997; 12(1):38-48
 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
 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