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.