Facilitating Patient Behavior

Hygiene Productivity

I saw this quote from Dr. Donald Berwick, the Director of Medicaid and Medicare and it really made me think. He said, “Healthcare is broken. We have set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. Despite the effort of the providers, we built it wrong. It is not built for modern times.”  

When you really think about it, we could say the same thing about dentistry. We’ve set up a delivery system that is fragmented, unsafe, not patient-centered, full of waste, and unreliable. I don’t think it’s the same extreme as the healthcare system is but there’s a lot of truth in that statement.  We see this from patients all the time.

Online we often see posts like ….

“Why do I keep getting cavities? I brush, floss, and rinse with fluoride twice daily.”

“Six months ago I was at the dentist and they didn’t do x-rays and said my teeth looked okay. This time, they did x-rays and said I had 7 cavities and would need a crown!”

“This is my third dentist, and I like him, but he cannot tell me why I keep getting cavities.”

Does this sound familiar? The sad reality is that these patients exist in every practice.

It’s going to take a new level of thinking to turn this problem around. It is often said that “We cannot solve our problems with the same thinking we used when we created them.”
Many practices are focused on repairing the damage, but when we really think about it, we should be focused on preventing the disease in the first place.

Too often patients don’t receive answers, guidance, or instruction on how to prevent the problems, they only receive information on how to repair the damage.

So how do we do this? Through engaging our patients at a higher level, partnering with them in their long-term dental health. In order to do this, we need to talk about how we can motivate behavioral changes. The reality is though, that you can’t motivate behavior changes. Thinking that we can motivate behavior change is an outdated view that removes personal responsibility. Our job is to facilitate behavior changes.

Our job is to build the patients understanding. As a moderator on multiple hygiene forums, I see a lot of scary things. In one practice, the doctor had written on the white board “If patient doesn’t want quads, fine. Write in the chart. Explain. Then give them their free cleaning. Better than the hygienist doing nothing and the patient not coming back.” To me, this is a clear example of lack of engagement. The team is often at a loss for what to do in these situations.

Here is another example – this was from a hygienist, “I worked for an office and did a regular cleaning on a perio patient. After informing the patient, documenting that the patient had perio disease, that patient went to another dental office six months later, and they denied them any cleanings except the scaling and root planing. The patient said, ‘Well, my last office did a regular cleaning.’ New office says, ‘You could sue.'” They did and won.

In both of these examples it was the patients lack of understanding that contributed to their reactions. They perceived that they were being upsold into services that they didn’t need. The patients saw the situation like a car wash – you can choose between the basic or the supreme wash. They didn’t understand that they were dealing with a disease that can become life threatening.

How can we build patients’ understanding? I am going to use periodontal disease as an example, because I think it’s a challenging circumstance that we all face.

To build patient understanding, they need to know what you know. BUT it needs to be explained in a simplified manner so they can understand it. If you have heard me speak before, you have likely heard me talk about the biggest breakthroughs that have come from studying biofilm and its effect on diseases.

There are 500,000 deaths each year from biofilm disease and we now know what we are dealing with – an oral biofilm infection. And we’re learning more and more through science what this can do to the body. We’re dealing with highly resistant, primarily anaerobic bacteria that can cause disease. Some of those are cariogenic but others are periodontopathic. We know a lot more now than we did even five or ten years ago about that biofilm and the risks that exist for the patient.

We’ve seen that the overuse of antibiotics and antimicrobials have contributed to the development of super bacteria that are incredibly resistant. This is what we are dealing with, in chronic periodontal infection. Now if we have a biofilm infection in the mouth, what does it really mean to the rest of the body? If the patient has periodontal disease, we know that the rest of the body is at risk. It wouldn’t be possible to write about all the evidence we have in one article, but I want to share with you a few very compelling pieces of information that you can take back to help you build your patients’ understanding when they have this disease.

  • We knew that the there was a connection between the bacteria in the mouth and heart attacks. In 2013 a study published in the Journal of the American Medical Association was able to show that 50% of heart attack events are triggered by oral bacteremia. So we can now say, it appears up to half of all heart attacks in the US are triggered by oral pathogens – that’s a big deal.
  • There was an article published December 21st, 2015 where they looked at the effect of periodontal disease associated with breast cancer, especially in post-menopausal women. These researchers found that among women, the risk of breast cancer was 14% higher in women who had periodontal disease, especially among women who had quit smoking within the past 20 years. Those with periodontal disease who had quit smoking within the past 20 years had a 36% higher risk of breast cancer. Why? There could be a systemic inflammation with periodontal disease that affects the breast tissues. But another possible explanation is that the bacteria from the mouth can enter the circulatory system, and attack breast tissues.
  • Periodontal disease and Alzheimer’s, there is historic evidence to support a causal relationship between spirochetes and Alzheimer’s. Here they found. T. Pallidum persists in the brain, sustains chronic infection and inflammation, and causes progressive dementia. It’s noteworthy that the human oral cavity harbors more than 60 different treponema species. These were previously considered as spirochetes or bacteria that don’t cause problems, but several of them have been revealed to be invasive periodontal pathogen. These pathogens are entering the blood and over time causing dementia and Alzheimers. It’s generally acknowledged that it is the invasion, the persistence, and the accumulation of t-pallidum in the brain which causes dementia.

So what we’re learning from all of this, if you shared even just a fraction of what I shared with you now when you’re discussing the infection you see in your patient’s mouth, does it help create a deeper level of understanding with your patient about why they need what they need?

This is how we facilitate behavior change. I talked with a couple hygienists who took these ideas back after hearing me speak. One was able to take a patient who had come in for regular cleanings every six months, but had ten-millimeter pockets. He always declined periodontal therapy. By helping build that patient’s understanding, he moved forward with treatment!

Remember, patients don’t know what they don’t know. In building patients’ understanding we have to guide them and help them learn why this is important, why it’s important to them, and why it’s more than just a ‘cleaning.’

We can gain a higher level of patient understanding by asking really great questions, helping motivate and inspire and facilitate behavior. Helping them choose more for themselves. And that’s really part of what our role is helping them chose more. To become champions of patient engagement, we have to understand what our patients value, and help them see the connection between what they value and where they are. This is how we begin to facilitate different behavior to help them achieve their goals.

I have a 60-minute video training on the New Breakthroughs in Patient Care where I dive deeper into the connection between biofilm disease and periodontal disease plus, I expand on the next 2 steps in practices are successfully implementing to help facilitate behavior changes. You watch the video by going to www.TheTeamTrainingInstitute.com/patientbreakthrough. There is no charge, and nothing is being sold – I just want to help more doctors help more patients

About the Author

Wendy Briggs, RDH

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Wendy Briggs is the author of "The Ultimate Guide to Doubling & Tripling Dental Practice Production" and "The Business of Dental Hygiene." A registered Dental Hygienist with more than 25+ years of experience. For the last 15 years she has taken her unique skills in doubling hygiene production directly to the practices. She has consulted with more than 3,718 dental practices in 12 countries. Hygiene is her passion ... and exploding hygiene productivity, case acceptance, and profits are her areas of expertise. Get a free copy of her book to double your production - the right way!