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October 2009 | Modern Hygienist Rethink the sidelines Don’t just cheer—coach patients to better oral health.  Photo: ThinkStock Images/Getty Images A few years ago, the ADA posted results from a survey that showed only 32.9% of patients floss or use an interdental aid on a daily basis.1 At first blush, the results didn’t seem surprising. But upon closer reflection, I realized it didn’t just say floss, it said ‘interdental aids’ as well. In school, most of us learned the brush and floss mantra, and we have carried it out religiously in our daily practice. More recently, various studies have reported that many different products—including interdental brushes, toothpicks, floss holders/aids, wooden sticks and a pulsating dental water jet—work as well as dental floss.2-5 There are even indications that patients prefer these alternative products and find them easier to use. Is it me? If I’m to guess, it’s not because dental hygienists aren’t recommending them. More and more, over the last few years, hygienists seem to have embraced alternative products. Years of non compliance have made them open to recommending something new. If it’s not the product, could it be the approach? For most of us, it seems logical. If we tell patients what to do and why, then show them how to do it, they will. This is the standard approach used daily in dental practices whether the conversation is about floss or having scaling and root planing. When it doesn’t work, we are stumped, hurt, eventually frustrated and possibly burnt out. The truth is we need to get out of our own way. It’s not our fault exactly. We are simply following the script we were taught. We also are on a tight time schedule, and every minute with the patient—from reviewing the medical history to scheduling the next appointment—is filled. Dialogue seems like a luxury; telling a necessity. Coaches create gameplans One way to shift our approach with patients is to take on the role of coach. Coaching works on the principle that to help people grow and change, you assist them in tapping into their own values and aspirations and use those as the impetus for change. Rather than tell, you guide using a balance of asking, listening and informing.6 Here is an example. In the more traditional approach, with a patient who isn’t flossing, the response would likely be: “You really need to use floss every day. I’m worried about some areas. You have several places that bleed, and some 5 mm pockets around a couple of teeth. Let me show you. If you don’t start flossing, the pockets could get deeper, and then we might need to do scaling and root planing again.” During this conversation, the patient is lying back in the chair the entire time. In comparison, the coaching approach might go like this: “I would like to review with you the findings from today.” The patient is lying back in the chair, and the hygienist hands him or her a mirror to show the bleeding and pockets. “These findings tell me there is some inflammation and infection going on.” This is the informing part of coaching. The hygienist now sits the patient up in the chair so they are at eye level when they talk. Here are some possible questions she could ask the patient for the asking phase:
Asking questions is an invitation for the patient to speak and for practitioners to listen. Patients who feel a practitioner has listened to them actually think the provider spent more time with them than they actually did. In the long-run listening can save time because it can help prevent having the same conversation over and over again.6 Next level listening Most dental hygienists are pretty well versed with the skills needed for active listening such as nodding or smiling, and acknowledging (by saying “uh-huh “or “I see”) while maintaining eye contact with the patient. One additional valuable piece is the art of learning to reflect back to patients what they have just said in summary.6 For example, if a patient says “I really do try to use floss, but I just can’t seem to get it between my teeth; it always breaks and can be uncomfortable.” A response might be: “So, it sounds like you have been trying to work on your homecare but using dental floss is challenging.” This allows the hygienist to ask another question, such as “Have you tried or considered other products?” In this way, the dialogue is flowing and moving both parties closer to finding a solution. Coaching patients is a skill most dental hygienists can learn to do. It might feel uncomfortable at first, but once you start getting better results, the learning process will seem more rewarding. A great place to start is in the area of interdental care. There are many, evidence-based alternatives to dental floss that can help you open a new dialogue with patients to help them achieve better oral health. Carol A. Jahn, RDH, MS, is the Manager, Professional Education and Communications for Water Pik Inc. She is a nationally recognized speaker having provided more than 200 continuing education courses. Additionally, she has published more than 60 papers and contributed to 6 textbooks. She has been a lifelong active member of the ADHA; she is a past president of the West Suburban Dental Hygienists’ Society and the Illinois Dental Hygienists’ Association and past treasurer of the ADHA.
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