B2B Healthcare Blog Using Behavior Change
For Friends of Hu-Friedy, an online community of dental hygienists supported by the dental instrument manufacturer, the Hu-FriedyGroup, I wrote a B2B blog that offers guidance on how to talk to patients about their oral habits, using the principles of individualized behavior change.
Talking to Patients About Harmful Oral Health Habits
Smoking, nail-biting — you’ve seen it all. But as much as you wish you could, there’s little you can do to control your patients’ habits when they’re outside the dentist’s office.
Many habits aren’t intentional, but over time, they become second nature — like chewing on your pen during a stressful workday or using your teeth to open mail packages when you don’t have scissors handy.
Changing the well-traversed neural pathways that constitute a habit takes time. Forming new behaviors that create habits can take up to 254 days. The timeline varies depending on the habit and person, but breaking habits based on pleasure-seeking, like dealing with a sweet tooth, is more challenging.
Without your guidance, your patients likely won’t change their harmful oral health habits on their own to keep their plaque at bay and prevent dental caries and periodontal disease. However, if you leverage your relationship with the patient and your inherent knowledge, they’ll be much more receptive to your messages on better oral health habits. Luckily, science teaches us the most effective ways you can encourage attitude and behavior change with your patients.
In this article, we’ll cover the steps of behavior and attitude change and how to talk to patients about their habits that need a tune-up for optimal oral health.
Create the Right Environment
Broaching topics like why someone should quit a habit that’s been part of their life can be tricky.
More than anything, it’s essential that your patients continue to come in for regular dental appointments so you can monitor their less-savory habits and make them feel safe discussing them without judgment. It’s crucial that they feel comfortable, respected, and supported by staff. Start appointments off right by greeting patients at eye level with a smile, and remember to keep a tone of empathy throughout.
Consider COM-B for Individualized Behavior Change
To ensure you don’t bite off more than you can chew when it comes to helping your patients change, take a moment to consider what they need to do first. Taking an individualized approach will feel less overwhelming and instill more confidence in your patients’ abilities to transform their habits.
Enabling successful action means that whatever you suggest should be practical to your particular patient, so first take stock of their capabilities, opportunities, motivations, and target behaviors (COM-B). Here’s a quick checklist using the COM-B framework to help make the new habit stick:
Capability: Does my patient have the skills, dexterity, and physical strength to do whatever I recommend? Do they know how to perform it?
Opportunity: Knowing what you know about your patient’s physical and social environment, do they have access to the physical and social resources they need to make a change?
Motivation: Where are you meeting your patient? Do they even want to make a change — or might they be fearful or have a negative attitude? Do they know why a change is necessary? Do they have confidence in reaching their goals?
Target Behavior: With the information you’ve considered above, get as specific as possible about what you want the patient to do. Specificity is the best way to ensure that your patient knows how to change. Be realistic and detailed, giving them an overview of which action they should take, where, when, and why.
Table 1 in the Community Dentistry and Oral Epidemiology’s article “Using behaviour change science to deliver oral health practice: A commentary” has exhaustive examples of how to use COM-B in your practice for whatever area you’re focusing on and whichever technique makes the most sense for your patient. For some, you may lead with empathy; for others, the best way to go is to be fact-forward about why making changes is necessary.
To make a case for teen oral hygiene care, check out our “Talking to Teens and Young Adults About Dental Hygiene” article, which breaks down the most common barriers and motivators for teens who may have to deal with orthodontia, social pressures, and an underdeveloped understanding of oral health behaviors.
Make a Plan
Let your patients know you’re in it together by setting goals and making a detailed plan. Have your patients self-monitor their attitudes, behaviors, and actions to keep their goals top-of-mind, and refer patients to them at the next appointment.
The 5A’s for When You’re Dealing With Addiction
Patients can present with addictions to a variety of things, from smoking to sugar-sweetened beverages or alcohol. Regardless of the habit or substance, addictions are complex and deeply engrained and often compound into feelings of shame — so tread lightly. Thinking through how to tackle these conversations is essential.
Routine dental care can learn from the 5A’s framework used in tobacco control: Ask questions about their habits, offer advice, assess their situation, assist them with whatever information and resources they need to succeed, and help them arrange further assistance.
Stages of Behavior and Attitude Change
It’s nice to think that humans are logical, but that’s not always the case! Research suggests that interventions based on theory are more effective, so refresh your understanding of how humans think before approaching patients with suggestions about what and how they need to change.
The transtheoretical model of health described in PubMed outlines the stages of breaking old patterns that patients face. It’s frustratingly true that this model provides granularity to set expectations, though it isn’t necessarily linear. At any stage, a patient may stall, quit progressing through the stages, or later re-enter the cycle at a different stage than the one from which they exited.
Here are the stages that you can expect when working with patients on changes:
When you first suggest change, patients will likely be at the “no” stage, called “pre-contemplation.”
Next is an attitude of “maybe,” or the “contemplation” stage.
Then, before they consider making a change, they’ll enter the “prepare and plan” stage.
If all goes well, they’ll “take action” next.
Lastly, they must work to maintain the habit.
Facing the Facts and Finding Solutions to the Most Common Bad Oral Habits
Lastly, for some of the most common harmful habits, here are some quick ways to frame conversations with patients:
Ice-Chewing
Fact: Chewing on ice can cause your enamel to crack and chip. It’s not only unflattering, but it can also cause pain and be expensive to fix.
Solution: Avoid using ice altogether by keeping a steady supply of drinks cooling in your fridge. But if you do have a beverage with ice, reduce the compulsion or temptation to chew it by using a straw or a lid.
Nail-Biting
Fact: Nail-biting may seem harmless, but it can cause your teeth to shift, break, and weaken their roots. It can also make your jaw dysfunctional or painful. Plus, nail-biting is unhygienic, because nails are (more often than not) dirty.
Solutions: Keep your nails short to reduce the temptation of biting them, or coat them with nail polish. Understand when and why you bite your nails to be more mindful of how you can change your habit. If this habit is tough to break, consider a mouthguard.
Using Teeth as Tools
Fact: Using your teeth to cut threads, open packaging, or other ways outside the norm is a no-no. Doing so can wear down the enamel, stress the jaw joint, and unevenly wear down your teeth. Worse, teeth can fracture.
Solution: Like conquering nail-biting, being mindful of your habit is the first step toward change. Chances are, you can afford to spend a moment to find a better tool to do whatever you’re about to do with your teeth.
Quitting Vaping
The Latest: E-cigarette smoking, or “vaping,” can impact people of all ages. E-cigarette use is decreasing for high schoolers but increasing among middle schoolers, according to newly published survey data by the Centers for Disease Control and Prevention.
Facts: While the amount of nicotine in smoking and vaping products differs, 15 puffs of an e-cigarette is like smoking an entire cigar, according to a Healthline analysis. The aerosol vapor from e-cigarettes also contains toxic and cancer-causing chemicals, like traditional cigarettes do. Some flavors can lead to attachment loss and lost teeth due to damage to the periodontal ligament. Check out our “e-Cigarettes and oral health” article to understand more of the risks and how to navigate conversations with patients on a topic that’s still being studied.
Solution: If your patient is unaware of the risks of smoking, get them up to speed. Use the 5A’s mentioned above to understand their situation and how you can help them quit.
Eating and Drinking Unhealthily
Fact: Foods and snacks that stick to the teeth, as well as sugary drinks (including alcohol), can lead to tooth decay.
Solution: Keep fruit and vegetables on hand to make eating well more accessible. Be mindful of what sensation you’re seeking when choosing food or beverages, and swap it for a healthier version. Seeking a crunch? Replace chips with nuts. Sweetness? Choose apples over candy bars. What about a little bubble? Nix sugar-sweetened beverages and opt for bubbly water instead. Also, floss and brush your teeth with fluoride toothpaste after each meal and drink water throughout the day.
Tell us in the comments:
Are there any habits we haven’t covered that you often see in the office? Tell us in the comments!
What is the most successful way you have conveyed the importance of healthier habits to your patients?
