Introduction

Current evidence of the importance of oral health to overall health is irrefutable. Epidemiologic and, clinical studies, emphasize the critical importance of oral health to systemic health. The multifactorial inflammatory connection between oral and systemic health include predisposing and precipitating factors, such as genetic factors (gene polymorphisms), environmental factors (stress, habits—such as smoking and high‐fat diets/consumption of highly processed foods), medications, microbial dysbiosis and bacteremias/viremias/microbemias, and an altered host immune response. Thus, in a susceptible host, these predisposing and precipitating factors trigger the onset of periodontal disease and systemic disease/conditions.¹

Successful treatment of these multifactorial conditions also requires behavioral modification, Behavioral interventions educate or instruct individuals about good oral health and disease management practices or how to handle psychological and social challenges that impact their oral health behavior. MI is a method of counseling designed to increase patient motivation for behavior change through use of a compassionate, collaborative, and autonomy supportive style.⁶ A number of meta-analyses indicate MI is significantly (10–20%) more effective than no treatment and generally equal to other viable treatments for a wide variety of problems ranging from substance use (alcohol, marijuana, tobacco, and other drugs) to reducing risky behaviors and increasing client engagement in treatment.

Examples include: a) motivational interviewing with mothers to prevent early childhood caries^2,3 or b) the 5A’s (ask, advice, assess, assist, arrange) in routine dental care to increase tobacco quit rates⁴; and c) dental office-based weight control interventions for children and adolescents to reduce dental caries and prevent obesity-related systemic diseases (e.g., diabetes) that negatively impact oral health.⁵ A number of meta-analyses indicate high fidelity MI is significantly (10–20%) more effective than no treatment and generally equal to other viable treatments for a wide variety of problems ranging from substance use (alcohol, marijuana, tobacco, and other drugs) to reducing risky behaviors and increasing client engagement in treatment.

Motivational interviewing is a person centered communication style used by many primary healthcare providers. The fundamental elements of Motivational Interviewing (MI), a collaborative conversational style for strengthening a person’s own motivation and commitment to change.⁶ 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.^6,9 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.¹⁰ Moreover, DiMatteo showed that 50% of health recommendations are not followed by patients.¹¹ 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.