Patient Behavioral Management

Pregnancy has also been identified as a critical time where women are more likely to make behavioral changes for the benefit of their fetus.93 Individualized techniques have proved effective in improving patient home care and oral hygiene levels,93,94 and motivational interviewing is often used to improve awareness of the importance of plaque control to oral health.95 Motivational interviewing is a person-centered, goal-directed method of communication that develops and strengthens a patient’s intrinstic motivation for positive change.96 The communication skills are broken down into four core areas: (1) open-ended questions, (2) affirmations, (3) reflections, and (4) summary. These are sometimes referred to by the acronym OARS.96 Open-ended questions are used elicit individualized information from patients and typically begin with “How,” “What,” or a descriptor asking for a patient’s description, e.g., “Tell me about….” Reflections serve to prompt further discussion from patients and to clarify a patient’s intentions. Affirmations are used to acknowledge and encourage positive health behaviors that patients are already practicing. Finally, summary reiterates the interviewer as an active listener and also sets the stage for change.97 An example of motivational interviewing might include:

Dental Practitioner: How did you feel about your cleaning today? (Open ended question)

Patient: Well, I am concerned about the bleeding in my gums that you found. 

Dental Practitioner: It sounds like you are worried about your bleeding gums. (Reflection) 

Patient: Yes. I know I have only been flossing a few times a week and I know that I should do it everyday.

Dental Practitioner: It’s great that you are using the floss a few times a week. (Affirmation) What do you think makes the times that you do use it work for you? (Open ended question)

Patient: When I remember to put the floss on the counter when I get out my toothpaste, I am reminded to do it before bed. 

Dental Practitioner: How do you think that you could prompt yourself to use floss more often?

Patient: I think that I could put the floss and toothpaste in a pretty jar on the counter together so that I can see them and see if that helps me remember!

Dental Practitioner: So, it sounds like you already have a great start flossing a few times a week, but you are going to try moving your floss to your bathroom counter to serve as a reminder to floss. (Summary) Sounds great!

Motivational interviewing has been shown to be a reliable method to affect change in patients’ health behaviors including improved oral hygiene techniques. Even a single session of motivational interviewing has been shown to improve gingival bleeding scores and plaque index.98,99 Furthermore, it has been demonstrated dental professionals can be trained in motivational interviewing that affects meaningful change in oral hygiene measures in a relatively short period of time.100 Motivational interviewing has been shown to impact oral health behaviors associated with reducing plaque and improving gingival and periodontal health, but the training and expertise of dental providers vary widely, making interpretation of results difficult.101 It has been suggested practitioners interested in motivational interviewing techniques consider a formal training  program, such as those identified by the Motivational Interviewing Network of Trainers.97,102