Motivational Interviewing: A Patient-Centered Approach to Elicit Positive Behavior Change
Course Number: 381
It is difficult to believe that preventive dentistry has only been in practice for less than 60 years in the United States. Prior to the 1960s, dentistry did not include routinely scheduled patient care. Although preventive dentistry is common practice in the U.S., we have seen an increase in dental caries in children age 2-11 years old. The most recent report by the National Institute of Dental and Craniofacial Research (NIDCR) indicates overall, dental caries in deciduous teeth in children age 2-11 declined from the early 1970s until the mid-1990s. From the mid-1990s until the latest NIH nutrition examination survey (1999-2004), this trend has reversed, and what is more troubling is that this trend is more severe in younger children. Currently 42% of children 2-11 years old have been diagnosed with dental caries in their primary dentition. Black and Latino children, and those living in families with lower incomes have more dental caries. With adolescent children ranging from 12-19 years old, dental caries did not decrease in Latino-Americans, and those living in families with lower incomes between 100% and 199% of the Federal Poverty Level (FPL). Current statistics indicate 59% of adolescents 12-19 years old have had dental caries in their permanent teeth and almost 5% of adults 20-64 years of age are edentulous. In this same adult age group, 92% have had dental caries in their permanent teeth. There also continues to be an unmet need where Black and Latino adults, younger adults, and those with lower incomes and less education have more untreated dental caries. In this same age category, we are also seeing White adults living in families with higher incomes and more education have been diagnosed with more dental caries than in past reports. The U.S. Census reports by 2060 the number of seniors is expected to reach almost 95 million or 24% of the overall U.S. population. For the first time in U.S. History, older adults will outnumber children by 2035. With seniors age 65 years and older, approximately 5% are edentulous and 93% of seniors have had dental caries in their permanent teeth. Again, we also see White seniors and those living in families with higher incomes and more education have had more dental caries. The National Center for Health Statistics (NHANES) of the Center for Disease Control (CDC) indicates the average older adult takes 4-5 prescription drugs. In addition, seniors reported also taking 2-3 over-the-counter drugs. Drugs most commonly prescribed for our patients include statins, antihypertensive agents, analgesics, drugs for endocrine dysfunction, e.g., hypothyroid and diabetes, anticoagulant and antiplatelet agents, and drugs for respiratory and gastrointestinal dysfunction. We know there are hundreds of drugs that contribute to xerostomia. A 2018 systematic review and metaanalysis examined medications that cause the reduction of saliva in the older population. The researchers found seniors who took medications for urinary incontinence had the greatest risk for xerostomia. They also found antidepressants and psycholeptic prescription drugs significantly affected saliva production. To learn more about pharmacological effects, see the additional resources section at the end of the course. In addition, this course reviews the fundamental elements of Motivational Interviewing (MI), a collaborative conversational style for strengthening a person’s own motivation and commitment to change.1 Guiding the patient’s internal motivation increases the likelihood his or her indecision (ambivalence) about personal behaviors will be resolved in the direction of change. The four key principles of MI are partnership, evocation, compassion and acceptance. Chronic dental diseases are largely preventable **if** patients perform self-care strategies for improved oral health, obtain successful treatment outcomes and comply with routine maintenance. As such, success in largely dependent on patient engagement. Working with patients can be discouraging for dental hygienists especially when patients, despite our "best efforts," fail to adopt improved oral health behaviors based on our professional advice and recommendations. Traditionally, patient education involved providing "knowledge," with the clinician having the expertise to set goals for the patient that were clinician-centered, not patient-centered. Patients not interested in changing behaviors may react by tuning out the clinician or may even become defensive.1,4 Even in the best case scenario, research has shown that adherence to health providers’ recommendations tends to be low; 30-60% of information provided in the clinician/patient encounter is forgotten within an hour of the encounter.5 Moreover, DiMatteo showed that 50% of health recommendations are not followed by patients.6 He also concluded adherence to healthy behaviors is equally as important in achieving positive outcomes as effective treatments. Improved adherence to professional recommendations has been demonstrated when knowledge and advice are combined with behavioral strategies. When patients are not ready for behavior change, the aforementioned health education advice or overt persuasion fails to motivate and can actually create resistance. It is no surprise that, despite our best efforts, many patients fail to change behaviors contributing to disease progression. In addition, when defensiveness develops between clinician and patient, patients may avoid returning for timely professional treatment which can add to the burden of disease.