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prevention International magazine for oral health No. 1, 2017

science | motivation Effective patient motivation and recall management AUTHOR: DENTAL TRIBUNE INTERNATIONAL O ne of the most common frustrations for den- tal professionals is the lack of desire shown by some patients when it comes to changing their oral care routine. Though many clinicians pre- fer a prescriptive approach, various studies have shown that its efficacy can be somewhat mixed. Alternative strategies for engendering change in patients, such as motivational in- terviewing, have been shown to be able to more accurately address a patient’s unique attitudes and needs, allowing him or her to take a more active role in his or her own oral health management. “It is time to stop simply telling patients what to do and to start asking them questions about their dental habits,” accord- ing to Dr Christoph Ramseier, one of Switzerland’s leading educators in the field of periodontology. “We need to meet as individuals on the same level. This way, we can communicate with patients and build a relationship with them, motivating them to improve.” Cooperation and communication Ramseier’s advice is supported by evidence from a plethora of studies on the subject of patient motivation. A 2012 study published in the British Dental Journal investigated the rela- tive success of different strategies for motivating disagreeable patients. It found that patient motivation is generally more successful when a patient-centred approach that empowers them in the process of decision-making is used. The study recommended that a cooperative approach should supersede the act of simply giving advice, as it is the responsibility of both the dentist and the patient to ensure that the patient adopts good oral health habits. The cooperative approach, sometimes known as a thera- peutic alliance or co-therapy, can be applied to specific fields of dentistry, such as periodontology. In a presentation on periodon- tal patient motivation, periodontics specialist Dr Mary Gibson highlighted that engaging a patient in the treatment and post- treatment process is crucial to achieving positive behavioural change. This process of engagement, however, needs to be tailored to patients depending on their specific situation. For example, for sufferers of chronic inflammatory periodontitis, according to Gibson, encouraging good oral health and regular check-ups may suffice, whereas those with aggressive peri- odontitis will need to understand that periodontal therapy takes time and will be maximally beneficial if they cooperate. Periodontal patients are a frequent focus in motivational literature, as this form of treatment can require patients to make considerable changes and adaptations in their approach to oral health care and other factors. A 2014 cross-sectional study by Oruba et al. showed that periodontal patients with higher levels of motivation have better oral health outcomes, suggesting that it influences the quality of their self-treatment and self- management. This emphasis on compliance is echoed in the findings of Renz and Newton, whose 2009 study categorically affirmed its importance in long-term periodontal health. Renz and Newton were also adamant that distinguishing between patients who are simply unmotivated to change their behav- ioural habits and patients who are motivated, but may need some support in effectively adopting good behavioural habits is crucial to achieving optimal results. Recall frequency: What should it be based on? A popular and widely applied recall management has been to recommend twice-yearly check-ups. While this interval-based style is an easy and beneficial guideline to follow, many recent studies have suggested that a risk-based approach to recall management may be more suitable. A 2013 study published in the Journal of Dental Research investigated the relation- ship between tooth loss and the frequency of dental visits among adult patients with and without certain risk factors for periodontal disease. The findings demonstrated that an appropriate recall schedule should be based on an assess- ment of the patient’s oral hygiene and his or her associated risk factors and not a predetermined schedule. Encouraging patient compliance with an individualised recall plan is es- sential for its success. 50 issue #1

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