Identifying patient need for better oral health

patient valuesJohnson and Johnson explores how dental professionals can identify and make use of a patient’s values to help motivate them to adopt an effective, oral health-friendly at-home regimen.

‘Effective communication between patients and health professionals is a key component of patient-centred care’, wrote Nowak and colleagues (2018). They continued: ‘Effective communication leads to enhanced treatment outcomes, adherence to medical advice, a better practitioner-patient relationship, fewer treatment mistakes and higher satisfaction.’

Part of this process requires the patient to be able to ask and answer questions. To express their own opinion, and understand what the dentist says.

One step at a time

Inglehart (2019) has suggested that while optimal persuasion and subsequent behaviour change is indeed reliant upon effective communication: ‘…a message should focus on one aspect of change and should not try to address too many aspects at one time.’

She added: ‘Identifying which specific behaviour change might be most important is crucial. Trying to change more than one behaviour at a time is not likely to succeed.’

Continuing this train of thought, Inglehart (2019) wrote: ‘Once a behaviour has been identified as the target for a behaviour change intervention, the next step is to explore the patient’s considerations related to this particular behaviour change.’

Habit formation

Key to change may be identifying ‘affective’ behaviours, ie, how patients feel about the behaviour they need to change, how important is it to them, and how motivated they are to engage constructively to make the necessary oral health changes (Inglehart, 2019).

Patients might, for example, express an aesthetic focused motivating factor. ‘My teeth give me the nicest smile’ – or functional: ‘My teeth are great. I can eat and bite everything I want’ (Inglehart, 2019).

So, how might these motivating factors be used to best effect by the dental team?

Exploring this issue, Inglehart (2019) wrote: ‘Cognitions such as health beliefs, attitudes, and intentions, as well as patient knowledge about oral health-related matters determine a patient’s responses in a conversation. Understanding the patient’s perspective and background concerning the targeted behaviour is important when determining how to communicate with this patient and which information to introduce.’

Motivating factors

As part of their research into habit formation, Smith and colleagues (2019) also considered motivating factors. They reported that many people only cleaned interdentally when they felt food trapped between their teeth.

However, delving further into the subject, they found a number of other motivating factors. This includes wanting their mouth to taste and feel clean and avoiding bad breath. Also, awareness of the health benefits of good oral hygiene practices.

Placing this in context, Lally and Gardner (2013) wrote: ‘The type of motivation underpinning initiation of behaviour may also influence continuation. Health-promoting actions which are extrinsically motivated – ie, performed to attain tangible rewards or avoid punishments, comply with instructions, or otherwise satisfy external demands – may be less likely to be repeated than actions pursued due to genuine personal interest (ie, intrinsic motivation), at least when external support for action is removed.

‘Intervention developers must therefore promote behaviours in a way that encourages people to internalise the need and desire for change. Thus engendering self-determined, rather than compliant, behaviour change.’

The right kind of support

Taking periodontal disease as an example. It has been widely recognised that maintaining gum health depends in no small part on a patient’s behaviour in relation to their own oral health efforts, as well as seeking professional help when they recognise signs of the disease (Newton and Asimakopoulou, 2018).

Acknowledging this concept, Newton and Asimakopoulou (2015) wrote: ‘Perceptions of the benefits of behaviour change and the seriousness of periodontal disease (including the risk of periodontal disease) are related to adherence to oral hygiene instructions in adult periodontal patients.

‘Interventions based on the use of goal setting, self-monitoring and planning are effective in improving oral health-related behaviours as assessed by oral health status.’

Capitalising on motivating factors, Newton and Asimakopoulou (2018) suggest three inter-related elements need to be in place to facilitate change:

  1. Capability (C): the person must have the physical (eg, strength) and psychological (eg, knowledge) skills to perform the requisite behaviour
  2. Opportunity (O): the physical (eg, access) and social (eg, exposure to ideas) environment are such that the person feels able to undertake the new behaviour
  3. Motivation (M): refers to the person’s conscious (eg, planning and decision making). Also, automatic (eg, innate drives, emotional reactions, habits) processes said to underlie the occurrence of any behaviour.


Entwistle V, Firnigl D, Ryan M, Francis J, Kinghorn P (2012) Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map. J Health Serv Res Policy 17(2): 70-78

Inglehart MR (2019) Motivational communication in dental practices. Prevention and management of caries over the life course. Dent Clin N Am 63: 607-620

Lally P, Gardner B (2013) Promoting habit formation. Health Psychology Review 7(1): S137-S158

Newton TJ, Asimakopoulou K (2015) Managing oral hygiene as a risk factor for periodontal disease: a systematic review of psychological approaches to behaviour change for improved plaque control in periodontal management. J Clin Periodontol 42(16): S36-S46

Newton TJ, Asimakopoulou K (2018) Behavioral models for periodontal health and disease. Periodontology 2000 78: 201-211

Nowak MJ, Buchanan H, Asimakopoulou K (2018). You have to treat the person, not the mouth only: UK dentists’ perceptions of communication in patient consultations. Psychology, Health & Medicine 23(6): 752-761

Sbaraini A, Carter SM, Wendell Evans R, Blinkhorn A (2012) Experiences of dental care: what do patients value? BMC Health Services Research 12: 177-187

Smith AJ, Moretti AJ, Brame J, Wilder RS (2019). Knowledge, attitudes and behaviours of patients regarding interdental deplaquing devices: a mixed‐methods study. Int J Dent Hygiene 17: 369-380

Weinstein P, Milgrom P, Ratener P, Morrison K (1979). Patient dental values and their relationship to oral health status, dentist perceptions and quality of care. Patient dental values and their relationship to oral health status, dentist perceptions and quality of care. Community Dent Oral Epidemiol 7: 121-127

This article first appeared in Dentistry magazine. You can read the latest issue here. 

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