Sunstar Conversations

Supporting oral health behavioural change in middle age: why and how?

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During the SUNSTAR Conversations PRO series, we tackle oral health challenges that are typically associated with several life stages. Each month, we team up with a set of experts from the field, discussing relevant scientific developments and identifying tips and tricks that can be implemented in the daily practice of healthcare professionals. Following conversations on pregnancy and oral health, caries prevention in children, orthodontic treatment in teenagers and dentin hypersensitivity in young adults, we reached the middle age life stage for our July webinar. A life stage in which certain habits can be rigid, having been established over the course of several decades. How do you modify such established behavior in a positive manner, in order to improve oral and general health? Prof. Dr. Timothy Newton and Dr. Mario Rui Araújo, PhD, two experts in the field of oral health psychology, shed their light on this matter.

Behavioral change experiences: survey results

The conversation kicked off discussing the results from a survey that was distributed among the webinar registrants. The first question “how confident do you feel in your ability to change a patient behavior” yielded interesting results. A majority of 88% indicated they felt either confident or very confident about their ability to change patient behavior. A convincing figure, according to dr. Araújo and prof. Newton. While 50% answered “more than 10 minutes” to the question “how much time do you spend on each visit with a patient on their oral health related behavior?”, the other half indicated less than 10 minutes. As prof. Newton indicates, for those who have 10 minutes or less to spend, it is “really going to be key that you are maximally efficient and effective in that time. And for that, it’s important to have very good evidence-based techniques and practice, that we can talk you through”. For those with more time: “there will be additional things that you can do and perhaps tailor your interventions to the individual. That might take a little bit longer but would really enhance your effectiveness”. The final question aimed to identify barriers that hinder behavioral change. Although the survey revealed a lack of patient motivation as main barrier, prof. Newton thinks this isn’t necessarily an issue of the patient itself: “it’s more an issue of us not finding the right key to unlock those motivations. The real challenge is to think about what we can do about that and think about what our role is”. He also groups the barriers in three main groups: motivation (of both the patient and the dentist); skills (of both the patient and the dentist); and structural barriers, such as payment and lack of time. Dr. Araújo agrees: “behavioral change is not just the responsibility of the patient. It also depends a lot on how we approach them”.

For behavioral change, a lack of patient motivation isn’t necessarily an issue. More likely, it’s us not finding the right key to unlock that motivation

The core of behavioral change in oral health

Dr. Araújo starts by defining what behavioral change means to him, from the perspective of a clinician and a teacher: “With everything we know about controlling the dental biofilm, the oral microbiome, relationship with other diseases, treatment techniques, technologies, it’s all very much related with behavior. And to control behavior, we should embrace an evidence-based approach, not just relying on common sense.” Prof. Newton brings back personal memories to illustrate his interpretation of behavior change. At school, he struggled with the concept of “receiving information and then six months later, you had to give that same information back”, until when during math class, the teacher said: “there are lots of ways you could do this, it’s really a matter of choice. And I was caught instantly, because suddenly it wasn’t about this is right and this is wrong anymore, it was like: you think about how you want to solve this problem. There’s more than one way to do things, and different approaches might be more or less good or effective”. According to him, the key to behavior change is “the sense of understanding of where you’re trying to go, understand key ways of how you might get there, and then creatively apply those principles to find a solution for that person standing or sitting in front of you. It’s about finding that key to unlock the motivation or the changing behavior for that individual person”.

Empathy versus problem solving

Two general character traits that oppose each other are empathy on one side and the ability to solve problems on the other. In the oral care field, there is definitely a place – maybe even a need – for both. Prof. Newton: “It’s about understanding, are you the kind of person who’s really good at solving problems, are you the empathic person, or are you that incredibly rare and valuable person who can operate in both domains”. And this principle of empathy versus problem solving is not just limited to the oral care professional, but also to the patient: “The other side of that is: what is your patient looking for? Are they looking for the one who offers a quick solution, or for the empathy?” Dr. Araújo concurs: “We should never forget the basic principle that we are treating people, who can react in so many different ways. But that’s the beauty of the game, and it’s not an easy game of course, but it’s amazing!” He continues: “For us as oral care professionals, it’s important to work as a team, understand our different skills, and realize we are all in it together in order to be better in the future”.

Profiling a patient to tailor your treatment

One of the first steps of behavior change is profiling the patient in front of you. Prof. Newton suggests starting with a baseline assessment: where is the patient currently, and what does he/she do. “The relationship with your patient should be the foundation of everything you do. Try to understand them, find out about what they do, what they enjoy doing outside of work, what their values are. And in terms of oral health: what do they really want, what is really important to them? Is it the way it looks, is it the way it functions?” He likes to ask patients: “If I had a magic wand, and we could get you what you wanted, what would that look like?” And interestingly, patients tend to ask for the simplest and most basic things, such as white teeth that are even and look nice. And funny enough, their response often goes with a sense of embarrassment, although they’ve asked for something that’s incredibly deserving of. And that’s your starting point, now you have a shared value with your patient! From there, you continue asking the questions: “where are you now, what do you do currently, and how much time do you have for that?”. You can take it from there by offering a list of options that you think would be good for them, and ask them: “which one do you think would be easiest for you to start with?” That gives the patient the sense that you’re not forcing every bit of information out there on them, and they need to do and remember it all. Prof. Newton: “no, we’re in a long-term partnership to get you what you want, what I want, and I am going to see what’s the most effective way to get there”. He adds that he thinks it’s important to remain non-judgmental in your relationship with the patient.

Start the process of behavioral change by profiling: learn to know the patient in front of you.

Goal setting, planning, and self-monitoring

Continuing from that exploration of what you and your patient want to change, the next steps are: goal setting, planning, and self-monitoring. Prof Newton when he follows this strategy: “It ties back to what I mentioned about my school experience. I very rarely tell people anything, I don’t really give much information out at all. And if they need it, I direct them to videos we can show them, or refer them to the hygienist”. While this may sound controversial, there is actually logic behind this approach: “What I’d like to focus on is when I am with a patient: when are you going to watch the video, when are you going to buy the necessary products, when are you going to try your first attempt? And then after your first week, we’ll see how that went, see if we need to tweak the plan, moving on with the goal.” The reason he focuses on goal setting, planning and monitoring rather than providing information is time: “if you’ve only got five minutes, make a plan in order to be actionable”. The ultimate goal is to transfer the skills to follow those steps to your patients, so they basically don’t need you anymore.

If time with your patient is limited, don’t waste it on giving out information. instead, focus on planning

WHO resolution on oral health

On the 27th of May, the WHO published a resolution which puts oral health back on the global agenda, with a special focus on prevention. Dr. Araújo on what that might mean for the future of dentistry and the role behavioral change may have in it: “it places a huge responsibility on all of us oral care professionals. If we really want to improve, and take a step forward, we need to consider behavioral change more, because it’s fundamental to treating diseases such as periodontitis. And universities have an important role in bringing behavioral modification to the attention of the students, the new generation of oral health professionals.” Prof. Newton fully agrees: “It is a great possibility of changing the way we think about how we care for people’s oral health, and to turn things on its head.” He explains what he means by that: “We need to get to the perception that any oral disease is a failure, and with that, any dental treatment other than prevention is a failure as well.”

any oral disease is a failure, and with that, any dental treatment other than prevention is a failure as well

SUNSTAR celebrates the recent move from the WHO as we have been advocating the key role oral health plays in the global well-being for over 30 years. We strongly believe that is now the time to help our patients understand and change their behavior towards oral health since it can help them improve their overall health and prevent diseases from developing.

If you want to listen to the experts, you can watch the entire webinar here.

Make sure to catch all episodes of the SUNSTAR Conversations PRO series by subscribing to our YouTube Channel. The next one will be on oral frailty in the aging population. Register now!

See you all there!