THE EXPERT ADVICE
to maintain contact, problem solve, reinforce
commitment, and provide support. Ideally this
would be done in a face-to-face meeting at the
dental office, but a conversation over the telephone is sufficient and has been shown to increase the effectiveness of MI.
Patient compliance begins with a good understanding of the human psyche and the motivations
behind our behavior. While most dental hygiene
programs require that students complete an introductory psychology and sociology class as part of
their degree completion, the content offered is barely
enough to make a dental hygienist proficient in any
of the techniques mentioned here. However, lifelong
learning is a responsibility dental hygienists take
when they assume the role of professional.
While the dental literature is lacking in content
regarding effective behavior modification techniques that oral health professionals can implement,
the medical literature offers a great deal of information and sources. The Journal for Patient Compliance
offers easy-to-understand, readily accessible,
peer-reviewed articles on all aspects of compliance.
Behavior Modification is another peer-reviewed
journal devoted exclusively to the topic of changing
behaviors in psychiatric, clinical, educational, and
Evidence-based decision making requires dental
hygienists to stay current with the most recent
evidence and master skills that improve patients’
health outcomes. Continuing to use outdated and
ineffective practices endangers patient health, minimizes the practice of dental hygiene, and contributes to the poor health of Americans. Exploring
new paths can be frightening.
However, dental hygienists in the past two
decades have done much to expand the body of
research regarding dental hygiene. There is no
single practice that has a greater, longer-lasting
impact on oral health than practicing proper oral
hygiene. If we can find the most effective way of
communicating with our patients, there is no
doubt that the incidence of oral disease in this
country would drop drastically. That is our greatest responsibility. RDH
Diana Macri, RDH, BSDH, MSEd, AADH, is an assistant
professor at Hostos Community College in New York City.
She can be contacted at firstname.lastname@example.org
1. Iuga AO, McGuire MJ. Adherence and health care
costs. Risk Management and Healthcare Policy.
2014;7: 35–44. doi: 10.2147/RMHP.S19801.
2. DiMatteo MR. Variations in patients’ adherence to
medical recommendations: A quantitative review of 50
aim to explore a person’s upbringing and develop-
ment the way that psychoanalysis does; rather, CBT
implies that distress is caused by irrational beliefs,
and notes that it’s within a person’s power to rec-
ognize those beliefs and change them. Maya Angelou
was on to it when she said, “Do the best you can
until you know better. Then when you know better,
CBT has received a lot of attention, and its suc-
cess in treating a variety of mental disorders (in-
cluding anxiety and depression) is well document-
13, 14 There is also evidence that it improves
medication compliance, which is, no doubt, what
has prompted some oral health researchers to apply
its principles to the broader topic of patient com-
pliance in oral health.
Motivational interviewing (MI)—MI is an
evidence-based, client-centered, personalized counselling approach based on the transtheoretical
model of behavior change. Miller and Rollnick15
state that “for a person to change, they must feel
both confident in their ability to change and believe
the change is important to them.” MI sees behavior
change as a partnership between the patient and
the dental hygienist . . . a partnership that respects
autonomy, enabling the patient to feel engaged,
understood, and empowered.
Rather than the dental hygienist assuming the
role of “expert,” MI places the patient in that role,
letting him or her decide how to integrate information and make the final decision as to whether the
behavior is relevant and important for him or her
to adopt. During MI, the dental hygienist’s goal is
to resolve ambivalence toward change in the patient
and tap into his or her already-existing motivation
by eliciting “change-talk” and using reflective listening, affirmation, and summations. Ambivalence is
the term used to describe patients whose actions
do not match their desires. A patient who states he
or she wants to prevent periodontal disease yet
does not floss or brush regularly is displaying
MI allows the patient to exercise autonomy and
encourages shared decision making. In contrast to
the old model of paternalism—where the dental
hygienist may have dictated recommendations to
the patient—shared decision making is a process
where a health-care provider and the patient arrive
at decisions regarding the patient’s care together.
MI has become the standard of care in medicine,
and dentistry is slowly catching on. Table 2 below
discusses the four components of MI.
Studies have shown an improvement in MI when
the clinician follows up the initial conversation
years of research. Med Care. 2004; 42( 3):200–209.
3. Rozier RG, Horowitz AM, Podschun G. Dentist-patient communication techniques used in the United
States: The results of a national survey. Journal of the
American Dental Association. 2011;142( 5):518–530.
4. United States, National Health and Nutrition
Examination Survey, 1999–2004. http://www.
5. Eke PI, et al. Prevalence of periodontitis in adults
in the United States: 2009 and 2010. Journal of
Dental Research. 2012;91( 10):914–920.
6. One Third of Americans Haven’t Visited Dentist in
Past Year. http://www.gallup.com/poll/168716/one-
7. Baer Justin, et al. Basic Reading Skills and the
Literacy of America’s Least Literate Adults: Results
from the 2003 National Assessment of Adult Literacy
(NAAL) Supplemental Studies. NCES 2009-481.
National Center for Education Statistics. 2009.
8. Yin HS, et al. The health literacy of parents in the
United States: A nationally representative study.
9. Vernon JA, Trujillo A, Rosenbaum S, DeBuono B.
Low health literacy: Implications for national health
policy. Available at: http:// npsf.org/askme3/pdfs/
CaseReport10 07.pdf. Accessed January 29, 2016.
10. Haans A, de Bruijn R, IJsselsteijn W. A virtual
Midas touch? Touch, compliance, and confederate
bias in mediated communication. Journal of
Nonverbal Behavior. 2014; 38( 3):301–311.
11. Steward A, Lupfer M. Touching as teaching:
The effect of touch on students’ perceptions and
performance. Journal of Applied Social Psychology.
1987; 17( 9):800–809.
12. Newton J, Asimakopoulou K. Managing oral
hygiene as a risk factor for periodontal disease:
A systematic review of psychological approaches
to behavior change for improved plaque control
in periodontal management. Journal of clinical
periodontology. 2015; 42(S16):S36–S46.
13. Tolin DF. Is cognitive-behavioral therapy more
effective than other therapies? Meta-analytic review.
Clinical Psychology Review. 2010.
14. Hofmann SG, Smits JA. Cognitive-behavioral
therapy for adult anxiety disorders: A meta-analysis
of randomized placebo-controlled trials. J Clin
15. Miller W, Rollnick S. Motivational Interviewing:
Helping People Change. New York: Guilford Press;
16. Mitchell SH, Overman P, Forrest JL. Critical
thinking in patient centered care. Journal of Evidence
Based Dental Practice. 2014;14:235–239.
17. Elwyn G, Frosch D, Thomson R, et al. Shared
decision making: A model for clinical practice. Journal
of General Internal Medicine. 2012; 27( 10):1361–1367.
18. The SHARE Approach. September 2015. Agency
for Healthcare Research and Quality, Rockville,