Disclosure: This article is sponsored content from LISTERINE® as part of our sponsored partner program.
As dental hygienists, our primary role is as disease prevention specialists. This means we must have tough conversations with patients about their oral health status, but we get to follow up with recommendations to help the patient. Educating on oral hygiene techniques and products is where dental hygienists shine.
When surveyed, 60% of patients report they won’t start a new healthy habit without the recommendation of a professional.1 This highlights the importance of a dental hygienist’s home care recommendations and the rapport they build with patients. With this rapport comes trust, and our patients trust us to provide guidance and recommendations to help them stay healthy and improve or maintain their oral health.
Stages of Change
Sometimes it may seem like patient recommendations go unheard because of a lack of compliance. However, consider the stages of change and how you present your recommendations. Dental hygienists can’t make a recommendation once and then never follow up.
The science behind changing habits has been extensively studied. The transtheoretical model is the most utilized due to the easy steps that help us understand human behavior. Developing a framework to follow will help patients and hygienists as they go through the process of changing and implementing healthy habits. The following are stages of change according to the transtheoretical model.2
“I’m unaware of a problem.” This stage is when the patient is simply unaware that a problem exists. This patient has either had a hygienist who avoided discussing the disease or the need to make changes to improve their oral health. Or, this could be a patient who has not received dental care in a long time.
“I’m thinking about it.” This is usually where you will find yourself with patients when you first discuss change. They have decided to make and attend a dental appointment, and you have decided to discuss an oral health diagnosis with them.
“I have made up my mind to take action.” Hopefully, this will be the stage you find your patient in upon their first recare appointment after your initial conversation.
“I have started to make a change.” This stage requires a lot of reinforcement and praise. It is tough to get here, and we want our patients to progress, not regress.
“I have a new routine.” This is the goal! We want patients to be aware of their role in their oral health, including acting on and utilizing the products and home care instructions they are given.
Understand that change may not be immediate, but being consistent with oral hygiene instructions and product recommendations will help your patient make the necessary changes to improve their oral health.
How to Effectively Make Recommendations
It has been reported that 40-80% of the medical information provided by health care professionals is immediately forgotten by patients.3 There are three basic explanations for this, the first being factors related to the clinician, such as the using terminology the patient does not understand. The second is how the information is presented, such as visual versus written. The third factor is related to the patient, such as the patient’s health literacy and perceived importance of the information.3 Patients’ memory function and anxiety and distress levels when receiving information also play roles in retaining medical information.3
Narrowing in on perceived importance, patients tend to focus on diagnosis-related information because this can be perceived as highly important. Though a diagnosis may be highly important, some patients fail to comprehend or remember instructions on treatment recommendations based on that diagnosis.3 This makes advising your patient of their oral health status and dental hygiene diagnosis an important first step in making oral health changes and effectively making product recommendations. If a patient presents with gingivitis, do not tiptoe around the diagnosis. Be clear and straightforward and tell them that they have gingivitis.
Being clear and straightforward is essential because if the patient is unaware of the problem, they are less likely to take action to fix the problem. They will remain stuck in the “precontemplation” stage of change until they are made aware of their problem. This may lead to noncompliance with oral hygiene instructions and product recommendations. When surveyed, 90% of respondents would change/implement a new recommendation if they knew they had gingivitis.1 This further highlights the importance of communicating a patient’s diagnosis at their dental visits.
After giving a patient a straightforward dental hygiene diagnosis of gingivitis, for example, educating them on how it occurs (disease process) and why their diagnosis requires adjustments to their home care routine may be helpful. For example, you might explain that gingivitis is a bacterial infection and how oral health and the presence of infection and inflammation relate to systemic health. Let them know specific adjustments to their home care routine you recommend.
Just as you are specific with guidance on brushing and interdental cleaning, if an adjunct or mouthrinse such as LISTERINE® Antiseptic might be beneficial, you should provide specific guidance for using the adjunct. Explaining the what, how, when, and how much can help increase the patient’s success rate.
For example, you could explain, “You have gingivitis, an early stage of periodontal disease. Luckily, gingivitis can be reversed, so we need to stay on top of your hygiene appointments and home care routine. This includes interdental cleaning daily and brushing twice daily to disrupt and remove pathogenic bacteria causing infection and inflammation. In addition, implementing a mouthrinse into your home care routine may help reverse the inflammation evident by the swelling, bleeding, and redness you see when you look at your gums. The type of mouthrinse I recommend for you is LISTERINE® Antiseptic. It is recommended that you rinse twice a day, morning and night, after brushing and interdental cleaning. Use 20 mL, swish it around for 30 seconds, then spit.”
Encourage Patients to Look for Results
As with any healthy habit and lifestyle change, we want results. Show your patients what healthy gingival tissue looks like and encourage them to evaluate changes in their own tissues. Seeing positive changes will reinforce the new healthy habit and make the patient feel good about their efforts. This can go a long way in the “maintenance” portion of the stages of change.
Additionally, it gives us something to praise patients for when they present with improved oral health. This is a team effort, and you are the coach. Coaching patients to better oral health can be easier with the proper guidance and an easy-to-follow plan to implement products to meet each patient’s individual needs, along with other healthy habits. As exciting as it is to see positive changes, remember this is playing the long game, and you may have to start back at the beginning if patients become complacent.
Discussing patient education and recommendations does not have to be a long conversation that takes up chair time at the end of the appointment. It can be accomplished while you are scaling – you can explain what you see. Meet patients where they are at regarding their stage of change and oral health literacy. Be specific about patients’ oral health status, dental hygiene diagnosis, and your recommendations. Patients may not always be fully compliant, but many want to improve, which is a good start.
Dental hygienists are profoundly important when it comes to patient education and recommendations. We are educated oral health prevention specialists, and our patients look to us for guidance. Our recommendations and education can be powerful tools for our patient’s health.
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- Study of Bold Oral Health Survey [Data on file]. (2015). Johnson & Johnson Consumer, Inc. Based on self-reported data from a survey of patients in the United States, United Kingdom, Thailand, Brazil, and Japan (N=4134).
- Raihan, N., Cogburn, M. (2023, March 6). Stages of Change Theory. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK556005/
- Kessels, R.P.C. Patients’ Memory for Medical Information. Journal of the Royal Society of Medicine. 2003; 96(5): 219-222. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539473/