Understanding patient attitudes/knowledge gaps
Patients may refuse preventive treatments, such as fluoride, for various
reasons, including a lack of understanding, oral health literacy, cost, time
restrictions, or factors specific to the treatment, like flavor, mouthfeel,
post-treatment esthetics, diet restrictions, or past negative experiences.
Regardless, it’s essential to determine where the objection comes from.
It’s very easy to go into “teaching mode” and lecture about what you
know, but this may not address the issue at hand. Instead, use
motivational interviewing strategies to listen, and let the patient know
you care about what got them to that place. We can’t lead patients to a
place of change without knowing where they are coming from. We also
need to understand whether they’re receptive to change. Are they open
to receiving new information? Would they be willing to try a new product
that might be more pleasant? If not today, maybe next time.
From recommendation to results
As mentioned earlier, treatment will only be effective if the
patient complies with our recommendations—which means we
need to understand what will be most effective for the patient,
what motivates them, and what treatments or products are
realistic for their unique circumstances. If your high-risk caries
patient tells you time and again that they forget to brush, a nightly
prescription toothpaste might not be the best treatment option at
this time. Instead, you may want to consider a fluoride varnish at
every appointment. Having personalized conversations to
determine the best treatment plan for the individuals’ oral health
conditions and what will work in their daily lives helps us motivate
and inspire change.
We often recommend fluoride varnishes for children, but many of
our adult patients can benefit from extra fluoride, too. Consider
the type of fluoride you recommend based on each patient’s
needs and conditions. For example, as patients age, issues arise
with xerostomia and hyposalivation due to more medications and
decreased salivary gland output. However, they need the minerals
naturally available in saliva to achieve what we want with fluoride.
In these cases, we must recommend a product that contains
calcium and phosphate or one that delivers those
minerals alongside fluoride.
If the patient doesn’t want to stick with our home care
recommendations, we may have failed to make our suggestions
personal, relevant, and important to them—but we can try again
next time. We can’t change a patient’s habits in just one
appointment, but the more open and understanding we are, the
more open the patient may be to making changes down the road.
For a deep dive into talking to patients about fluoride, check out
our article: Fluoride and Your Patients – How to Start the Conversation.
Preparing your staff
While MI is a well-known strategy, it takes time and practice to
learn and use effectively, which can be challenging in a fast-paced
dental practice. To this end, many educational resources are
available to help introduce and develop MI skills into routine
practice. Studies have shown that MI training can help improve
and build confidence in dental professionals’ patient
communication abilities.2 Like introducing caries risk assessments,
committing to personalized patient communication can help you
develop strong relationships built on trust and improve
acceptance and compliance.
The money question: Insurance
As dental professionals, insurance isn’t our favorite topic, but it’s
an unavoidable part of working with patients—and often a
significant hurdle to acceptance. However, we should never
assume patients don’t want treatment because it isn’t covered. It’s
always better to build a relationship with our patients, educate
them, and present them with their options—including that while
preventive care may not be covered today, it could save them
substantial costs and natural tooth structures—so they can make
an informed decision.
Patients sometimes ask: if you prevent cavities, won’t you be out
of a job? But our job is to improve and maintain their oral health –
we want healthy patients. Dentists and hygienists have a
prevention mindset, and we must share that with patients so they
understand that we’re on their side. Caries risk assessments and
MI strategies help achieve our goal of creating healthy mouths by
identifying high-risk individuals and tailoring preventive plans to
their lives, including insurance coverage.