- Examples of Communication Structure
- Shared Decision Making
- Caries Risk Discussions
- Patient Centered Communication Video Series
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode, this week brought to you by Elevate Oral Care.
Stephanie Eddy: Hi. I’m Stephanie Eddy, registered dental hygienist and preventive care consultant with Elevate Oral Care. Elevate Oral Care is a prevention-focused company who prides ourselves in teaching offices motivational interviewing strategies.
Motivational Interviewing is a person-centered, guided method of communication and counseling that is proven to elicit and strengthen motivation for change. In today’s TIPisode, we will give some examples of what that communication structure would look like.
Historically when it comes to prevention, we tend to just tell patients what to do. This type of conversation can be challenging if a patient doesn’t want to make a change in their behavior. You’ve heard it before. We’ve been telling patients to brush twice a day and floss daily for a very long time, yet the ADA reports that only 16 percent of patients floss at least once per day, and 20 percent said they floss when they need to.
How do we get the patient to change their behavior? We have to understand a patient’s needs, desires, values, and expectations if we want to see that change.
Imagine this: you want to take a trip to Florida. You’ve been dreaming of this trip for a long time, and you want it to be perfect. You hire a travel agent who will book the entire trip for you. You’re excited to see the ocean views from your hotel room, lay on the beach, swim in the pool, and do some scuba diving. It’s a quick flight from home so you can maximize your vacation time.
Now, imagine that your travel agent is booking your trip but never asks you what you want to do, where you want to go, and how you plan to get there. Your travel agent assumed you wanted to go to Disney World and booked you a hotel there. There’s no ocean, no beach, and no scuba diving. And did I mention you’re now driving 14 hours to get there because it’s an expensive trip, and you’re already over budget? This scenario would have a much different outcome if the travel agent had taken the time to ask more questions about your desires.
Now, let’s bring this into the dental world. At Mrs. Smith’s last recall visit, you determined that she was high risk for decay and recommended that she use 5000 parts per million toothpaste twice daily. Mrs. Smith bought the toothpaste and left the office. Today, she presents with three new cavities and moderate to severe gingivitis. Upon further questioning, she explains to you that she is too tired to brush at night and only brushes in the morning right before breakfast. She’s always had this routine.
Why didn’t she change when you told her to brush with the toothpaste twice per day? I’m sure everyone can think of a patient like this in your own practice. How do we communicate in a way that makes the patient shift the conversation from “I have to” to “I want to”? We do this by showing that we’re listening to their needs and their desires and helping them to understand that we share the same values.
I’ve never had a patient say they don’t want their teeth to be healthy or that they want more cavities. We take what we know, consider what we hear, and make the patient a part of the decision-making process. The patient becomes the voice for change.
Now, let’s go back in time and role play what a shared decision-making conversation might have looked like in this scenario.
[Start role play]
Dental Hygienist: “Hi, Mrs. Smith. It’s great to see you. I’ll be taking a look at your teeth today, but before I get started, I was hoping you could tell me what your goals are for your appointment today.”
Mrs. Smith: “Yeah. I just don’t want to lose my teeth when I’m older, and I don’t want cavities.”
Dental Hygienist: “Mrs. Smith, it sounds like it’s important to you to keep your teeth healthy and keep them for a lifetime. Your medical history looks great, and it sounds like you eat pretty well, but I’m a little concerned about the plaque build up on your teeth. This can make you at an increased risk for decay. Tell me a little bit about what you’ve been doing at home to keep your teeth healthy.”
Mrs. Smith: “Well, I brush in the morning with regular toothpaste, but I don’t brush at night because I’m just too tired.”
Dental Hygienist: “I understand it’s challenging for you to work up the energy to brush right before bed?”
Mrs. Smith: “Yes. I work in construction, and the heat from the day is exhausting. I return home, play with the kids before bed. I’m so exhausted at bedtime. Sometimes I even fall asleep on the couch. I know I should brush my teeth, but I’m just too tired to take the time to brush.”
Dental Hygienist: “It sounds like brushing at night is challenging for you, but you have thought about doing it to protect your teeth?”
Mrs. Smith: “Yes. But I just know myself, and I know that I won’t brush before bed.”
Dental Hygienist: “I wonder, how would you feel about brushing after dinner instead of waiting until bed when you’re tired?”
Mrs. Smith: “I haven’t thought of that. I can do that.”
Dental Hygienist: “Great! So that would be our first step towards your goal of keeping your teeth healthy.
Additionally, since you are at a higher risk for decay, we can put you on a prescription-strength toothpaste that would help you protect your teeth better than your over the counter. If you happen to miss brushing after dinner one evening, this toothpaste would provide better protection and could potentially reverse some of the damage. You won’t have to add any additional steps. You just brush in the morning and after dinner. How does that sound?”
Mrs. Smith: “Sounds great.”
[End role play]
Stephanie Eddy: So, in this situation, you work together to find out a solution. You listened to her needs and adjusted your recommendation to something that is more in line with a behavior change the patient is willing to accept.
One goal of motivational interviewing is to increase a client’s internal motivation for change. Enhancing motivation will also require your client to build confidence in their ability to make changes. If the goal of changing seems unattainable, it’ll be difficult to generate enough motivation to try.
Now, let’s take a look at some caries risk discussion.
[Start role play]
Jennifer: “Good morning, Mrs. Jones. It’s nice to see you again. My name is Jennifer, and I’ll be taking care of you today. What I’d like to do first is just kind of talk about what your experience has been in the last six months with your teeth and what your goals are with your teeth moving ahead. Then I’ll take a look at your xrays and mouth, and we can discuss ways to achieve your goals in the coming months. How does that sound to you?”
Mrs. Jones: “That sounds great.”
Jennifer: “When you think about your teeth long term, what would you say your goals are for your teeth?”
Mrs. Jones: “My goals are to keep my teeth healthy and to keep them for a lifetime.”
Jennifer: “Those are some great goals. Tell me, what have you been doing at home to help you keep your teeth healthy for a lifetime?”
Mrs. Jones: “Yeah. I brush twice a day and sometimes floss. I eat pretty healthy, and I don’t consume much sugar. I drink a lot of water since my mouth tends to be kind of dry. That’s good, right?”
Jennifer: “Yes. Water certainly does help.
It sounds like you’re doing a great job with your brushing and in limiting your sugar. The dry mouth that you are experiencing can increase your risk of decay due to the frequent exposure to acids. When you hear that, how does that make you feel?”
Mrs. Jones: “Wow. I had no idea. That really concerns me because I try so hard to keep my teeth healthy.”
Jennifer: “Yeah. I want to see you keep your teeth healthy for the rest of your life as well. One of the ways that I can help you do that is by completing a caries risk assessment, which is merely evaluating your risk for cavities based on your medical history, your dietary habits, your at-home care, and the findings from our exam today. I stay up to date on the evidence-based research so that I can give you options of things you could be doing at my office or at your home to help you achieve your goal. How does that sound to you?”
Mrs. Jones: “That sounds wonderful.”
Based on my findings today, the evidence-based research tells me that you are at a moderate risk for decay. That’s primarily because of your medications you’re taking that is causing you to have dry mouth. If you take a look at the patient menu here, there are three things that really stand out to me that I believe will help you in keeping your teeth as healthy as possible.
One is a fluoride varnish in our office every six months. This medication will absorb into your teeth and protect your teeth as they are being attacked by those acids.
Second is a prescription-strength toothpaste. This will be a paste you would use twice per day instead of your regular toothpaste. This paste would be helping to reverse some of the detrimental effects of the acid attacks. The evidence-based research tells us that the in-office fluoride varnish in conjunction with the at-home prescription-strength toothpaste is the best protection I can offer you towards keeping your teeth healthy.
Additionally, we can get some of that moisture back into your mouth by incorporating a dry mouth spray.
Tell me how you feel about these options”
Mrs. Jones: “Great. Whatever it takes to keep my teeth healthy.
I want to do the prescription toothpaste, and I’m very excited to try the spray for my dry mouth.”
Jennifer: “Great. Let’s grab these products for you to start using at home, and then we will do another caries risk assessment at your next visit.”
[End role play]
Stephanie Eddy: So, in this scenario, the patient was able to voice her concerns, and she felt heard. She was provided with options and had the autonomy to choose which products she would use at home.
We worked with dentist Dr. Matt Allen, a motivational interviewing network trainer, to provide a video series on patient-centered communications that include the following topics: steps and tips, caries risk, preventive and restorative costs, speaking to a parent about their child’s caries risk, caries risk in ortho patients, and changes in caries risk status. This great video series can be found at www.elevateoralcare.com/video-library.
Michelle Strange: Thanks for listening to another TIPisode, and thank you to Elevate Oral Care for sponsoring this week’s episode. You can find out more about their great products at elevateoralcare.com. And don’t forget to hit the “subscribe” button in your podcast app, follow us on Facebook or Instagram, and head over to our website, ataleoftwohygienists.com, to sign up for our newsletter. We always appreciate ratings and reviews. Thanks for listening to your unofficial dental hygiene podcast.