Simply Science - Healthy habits

Despite the focus on prevention in the Swedish public dental health, studies have shown that plaque and gingivitis are common among Swedish teenagers. Person-centred educational approaches seem to work on adults – could this also be a tool to get teenagers into healthier oral hygiene habits?

 

What is a person-centred approach?

Refers to placing a person and their wellbeing at the centre of decision making, and including factors outside the dental office. It emphasizes acknowledging the person's own preferences, emotions, and needs.

 

Participants - dental hygienists and adolescents

30 dental hygienists (DHs), regularly treating teenagers, from different public dental health clinics in Västra Götaland county, signed up for the study. The dental hygienists were randomised to a test group (16 DHs) or a control group (14 DHs). A total of 312 patients accepted the invitation to be in the study. The inclusion criteria were as follows:

• 16-17 years of age
• Marginal bleeding and/or dental plaque at ≥50 % of tooth surfaces
• No difficulties in understanding and speaking Swedish

 

Training for the dental hygienists

After randomisation, the dental hygienists in the control group spent half a day of being informed about the study protocol and Good Clinical Practice in research and calibrated regarding clinical assessments. The test group received the same training plus an extra 1.5 days on health behavioural theory, behavioural change techniques, and a communicative approach inspired by motivational interviewing. The DHs practised under the supervision of a psychologist and were also given manuals for further training and support during the study appointments.

 

Collecting data

Marginal bleeding and plaque were assessed as either present or absent at four sites on each tooth, at baseline and the 6-month follow-up. The patients also answered a questionnaire on the same occasions. The questions covered information about background characteristics, self-rated oral and general health, and frequency of toothbrushing and interdental cleaning.

 

Interventions

The control group were treated with the “business as usual” philosophy and received conventional information/instructions on one or more occasions, as needed. The test programme followed a specific structure based on cognitive behavioural theory and principles and behavioural change techniques such as goal setting and planning (see figure 1 in the open access article for further explanation). The study participants attended three treatment sessions, 45-60 minutes each, during a period of 10-12 weeks. The dental hygienists used a person-centred and collaborative communication approach inspired by motivational interviewing.

 

Results

274 out of the 312 patients followed through with the 6-month follow-up. Both groups showed improvements in clinical parameters, but the test group had significantly greater improvements. The self-reported oral hygiene behavioural outcomes were also positive for the test group. The percentage of teenagers in the test group brushing their teeth twice daily was 68.8 % at baseline and 78 % at 6 months. Regarding the frequency of interdental cleaning, 10.1 % of patients in the test group reported cleaning ≥3 times per week at baseline, a number that increased to 20.6 % at 6 months.

 

So what does this study say about using health behavioural theories, behaviour change techniques, and person-centred communication in practice? It is more effective in improving oral hygiene and periodontal health among teenagers than providing them with instructions and information the conventional way.

Three tips from the author Sandra Lod Dimenäs to bring into your practice

 

1. If you’re new to using motivational interviewing, start with small steps. For example, practise asking more open-ended questions instead of closed questions. This means asking the patient “What does you daily oral hygiene practice look like?” instead of asking “Do you brush your teeth twice daily?”

 

2. If you want to use a collaborative and person-centred approach, try prioritising listening over talking. It might be challenging, but it’s also rewarding. Both dental hygienists and teenagers in the study described this approach as more enjoyable, resulting in a partnership in care. When people feel heard, they are more open to receiving feedback and oral hygiene advice and more likely to follow instructions.

 

3. I highly recommend dental professionals to pursue further education in health psychology and communication. I completed the course In-depth Study of Oral Health with a Focus on Theory-Based Behavioural Intervention* at the University of Gothenburg.

Want to read more about motivational interviewing? Try the book Motivational Interviewing in Health Care by Christopher C. Butler. Good luck practising on having a more person-centred approach!

 

*Original course title: Ämnesfördjupning i oral hälsa med inriktning mot teoribaserad beteendeintervention

Reference: A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study. Sandra Lod Dimenäs et al. J Clin Periodontology, 2022. Find the article here A person-centred, theory-based, behavioural intervention programme for improved oral hygiene in adolescents: A randomized clinical field study - PubMed