The Significance of Behavioral Change in Dentistry

December 11, 2024

Organizations like the World Health Organization (WHO) have made prevention of oral diseases one of their global priorities. Prevention is not a new concept, and the prevalence of periodontal diseases remains high worldwide. The primary challenge lies in changing patients' behaviors, which are pivotal to effective oral disease prevention but are notoriously difficult to modify.

This article captures the highlights of the conversation between Sunstar’s Martijn Verhulst and Prof. Tim Newton, a professor in psychology as applied to dentistry at King’s College London, UK. Read on or listen to our Let’s Talk Oral Health podcast to learn more about behavioral change strategies for preventing oral diseases, particularly periodontal and peri-implant diseases.

Professor Newton explains that dental disease prevention largely hinges on two key behaviors: plaque control and dietary habits. For patients to maintain optimal oral health, these behaviors must become daily routines. This is where behavior change becomes essential. The central issue, however, is that many behaviors, like brushing teeth, are habitual and automatic, which makes them harder to modify or optimize.

The Role of Prevention in Oral Health

Professor Newton emphasizes the importance of prevention from the patient’s perspective. Oral health affects people’s ability to eat, socialize, and feel confident. More significantly, it impacts long-term health, enabling individuals to keep their teeth throughout their lives. However, given the limited frequency of dental visits, the responsibility for maintaining oral health lies predominantly with the patient.

The economic burden of oral diseases is another critical issue discussed. In Europe, oral disease ranks third in healthcare expenditure, surpassed only by cardiovascular disease and diabetes. Prevention, particularly in periodontal care, can significantly reduce this burden. This was highlighted in a study published by The Economist, which revealed that investing in the prevention of gingivitis offers a substantial return on investment.

Behavioral Change Models in Dentistry

Throughout the conversation, there is a discussion on various psychological models used to influence and understand behavior change. One model that stands out is the COM-B model, developed by Professor Susan Michie and her colleagues. The COM-B model provides a structured framework for understanding behavior change, focusing on three key components: Capability, Opportunity, and Motivation.

• Capability: The individual’s knowledge and skills to perform a behavior.
• Opportunity: The environment and resources that support or hinder behavior.
• Motivation: The drive to engage in the behavior.

Professor Newton highlights that this model is now regarded as the dominant approach in health psychology. However, applying the model in practical, everyday dental settings can be challenging. To bridge this gap, the GPS (Goal-setting, Planning, and Self-monitoring) model was developed, which Professor Newton describes in detail.

The GPS Model for habit formation

The GPS model is designed to simplify the application of behavior change techniques in dental practice. It consists of three primary elements:

1. Goal-setting: Establishing clear and achievable goals with the patient.
2. Planning: Creating a plan to implement these goals, addressing potential challenges and practicalities.
3. Self-monitoring: Encouraging patients to track their progress to reinforce their commitment and motivation.

In recent years, a fourth element, Perseverance, has been added to the model (now referred to as GPS-P). Perseverance is crucial for sustaining long-term behavioral change and transforming new behaviors into habits. According to Professor Newton, habit formation takes an average of 66 days, and encouraging patients to persist is key to maintaining their behavior.

Practical Application of GPS in Dentistry

The conversation includes a demonstration of how the GPS-P model can be applied in practice. Professor Newton interacts with a simulated patient, illustrating how to guide patients through the process of behavior change. The discussion starts by setting a goal, such as switching to an electric toothbrush, and moves on to planning when and how the patient will implement this change.

An important element of planning involves including cues. For example, the patient is encouraged to keep the interdental brushes next to their toothbrush as a visual reminder, or they can use a tracking chart.

Professor Newton emphasizes that asking many questions is a crucial part of the process. By doing so, dental professionals can better understand their patient’s needs and tailor their advice accordingly. This patient-centered approach not only helps in building a stronger relationship but also makes the intervention more efficient and relevant.

Using GPS to bridge the intention behavior gap

A major concern among oral care professionals is the time constraint during dental appointments. Professor Newton demonstrates that the GPS-P model can be effectively applied in just a few minutes by focusing on concise and targeted patient communication.

Instead of delivering lengthy instructions, dental professionals should focus on planning the behavior change with the patient, which Professor Newton relates to bridging the so-called “intention behavior gap.” This concept can be explained as the gap between what we think we want to do, and what we actually do. Planning is the most critical step in bridging this gap.

The importance of patient communication and relationship building

Moreover, Professor Newton recommends that oral care professionals practice and refine their patient communication skills. He suggests that they ask for feedback from colleagues and patients to improve their interactions. Soft skills, such as relationship building and active listening, are essential for success in guiding patients through behavior change. Professor Newton points out that professionals should view their role not just as providers of dental care but as facilitators of behavior change.

Scientific Evidence Supporting the GPS Model

The GPS-P model is grounded in psychological theory and has been validated through research. Professor Newton explains that studies conducted in both hospital and primary care settings show that GPS-P effectively improves oral health-related behaviors and periodontal outcomes. While different elements of the model may be more relevant for different behaviors, treating GPS as a comprehensive package is a simple and effective approach.

For example, habitual behaviors, like brushing teeth, may only require goal-setting to be improved, whereas more complex behaviors, like interdental cleaning, benefit from focusing on planning and self-monitoring. The overall evidence supports the use of the GPS-P model in improving patients' oral health behaviors.

Key Takeaways for Oral Care Professionals

The conversation wraps up with a reflection on the most important takeaways for dental professionals. Professor Newton advises practitioners to focus on planning with their patients, making behavior change a joint effort. By setting goals, creating detailed plans, and encouraging self-monitoring, dental professionals can support their patients in making lasting changes that prevent periodontal and peri-implant diseases.

Professor Newton emphasizes the importance of relationship building in this process. Changing behavior is not a one-time event but rather an ongoing collaboration between the patient and the dental team. The goal is to form positive habits through repetition, perseverance, and mutual trust.

Expand your knowledge on a 360º approach to periodontal and peri-implant disease prevention by listening to the other episodes in the Let’s Talk Oral Health podcast for experts. Don’t miss our discussions on the oral microbiome and the oral-systemic link.