This course introduces the dental professional to the concept of oral health promotion and education as a means of preventing caries. The topics discussed include understanding patient behavior, the barriers to change a patient may experience, why it is important for a dental professional to provide continuous support even when a patient is slow to change, and helping a patient to set goals that promote caries-reducing habits.
Clinical Significance Snapshots
My patients seldom follow the advice and instructions I provide. Why not?
Habits that determine health outcomes are formed at an early age, and are not easy to change. Habits in the formative stage are shaped by many factors – ignorance (knowledge), family members (primary socialization), authority figures such as teachers, and peers and friends (secondary socialization). Merely passing on more information in the hope of overcoming ignorance does not work. For example, nearly every smoker knows the deathly consequences of their habit. So, they already have the information but choose to continue smoking for many reasons. Again, this is a prime example of cognitive dissonance. Mere ‘show and tell,’ as in oral hygiene instruction, will fail unless the patient accepts there is a problem that needs to be fixed (acceptance), is ready and willing to fix it, believes and trusts that what you are advising will fix the problem, and understands that any sacrifices made will be worth the benefit (contemplation). Telling a patient he or she has a dirty mouth that they are not cleaning correctly will not by itself interest the patient in the ‘show and tell,’ as they do not yet have the motivation and belief that the sacrifice is worth the benefit (no acceptance). In oral hygiene instruction, the dental professional is attempting to change a habit and ritual developed over many years, so it will not change in days or weeks. Think about how you would try to have someone change his or her handwriting style! It has become a habit, and it will not change merely by showing nicer calligraphy. Don’t worry, many healthcare providers do not enjoy great success in changing the behaviors of their patients – largely because they fail to recognize all the steps involved in this supportive, not prescriptive, process.
How can I further encourage my patients to follow the advice I give them?
Giving advice to patients in relationship to dental caries most often involves changes in the selection and consumption of foods and beverages, and the home use of fluoride agents. Patients need motivation to follow your advice, and therefore must understand the benefits of their actions. Patients need to feel empowered by the knowledge that they can make a difference through their actions.
There are five stages that must be recognized in following the change process of Prochaska and Di Clemente1: