Working with patients can be frustrating for dental hygienists especially when patients, despite our “best efforts”, fail to adopt improved oral health behaviors based on our professional recommendations. Although we know that chronic dental diseases are largely preventable, we also know that unless patients are engaged in self-care and strategies are identified for improved oral health, successful treatment and maintenance will be compromised.

Traditionally, patient education involved providing “knowledge”, with the clinician setting 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 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 that 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 defensiveness. It is no surprise that, despite our best efforts, many patients fail to change behaviors that contribute 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.