There are many challenges the dental team face on a daily basis. Challenging contracts – internally as well as NHS – always seems to top the list, but improving patient compliance and shifting toward a preventive world remains one of, if not the greatest challenge of modern dentistry. Dental Hygienist and winner of the BSDHT's and WOHP ‘Oral Hygiene by Design’ Award Michelle Coles, gives us her 10 top tips for improving patient compliance.
1 Listen to your patients
Listening is almost a forgotten art. There is a lot to be said for just talking to the patient, finding out a bit more about their lifestyle and their oral hygiene habits. Dental hygienists do have a little bit more time than dentists, so use it wisely. Our widening role enables us to have conversations and gain a better understanding of our patients.
2 Use that to understand them
Once you've got all of that down, use it to understand them. So they might enjoy a few drinks at a weekend, which means you'll need to be a bit more vigilant in some areas. It will also mean that they don't brush their teeth when they get home at night, so by talking to the patient you can build a picture. Everyone is different, so you can't approach things with a rigid approach.
3 Build a rapport with them
At the end of the day we are healthcare professionals. We should have a rapport with our patients. I always find if you be memorable but not obsessive then they will be more likely to return having listened to the advice you sent them home with. Building that trust and confidence will go a long way, and chances are you will see higher levels of compliance. It is a skill building relationships. You can't teach it, but it is so important.
4 Give them relevant information...
If you have listened and used the information to build up an accurate picture of their habits and lifestyle, you're now in a better position to offer the right advice. Diet, alcohol and smoking are all areas that we should be talking to patients about. You need to find their interest trigger. I often use visual aids and props to support my oral hygiene discussions in clinic, but I wanted to create something simple and appealing that helps patients remember this advice once they get home. I recall chatting to one patient about their alcohol consumption, and they genuinely believed one bottle of wine per night was acceptable. Needless to say I was very surprised!
5...But don't overload them!
Dentistry is an incredibly complex area, so keep it nice and simple. That's where my Hooked on Oral Hygiene idea came from. It is a tool that houses strips of personalised oral hygiene advice, helping patients to ‘hang-on’ to their oral hygiene advice even after they leave the clinic. Small, digestible chunks of advice are great, and always consider the way you're giving them information. Is it by video or leaflet, by email or by talking to them? Assess what works best for your patient.
6 Avoid jargon
We are so used to reading about gingivitis, periodontal disease, xerostomia and all that we actually forget patients will not have a clue what we're on about. Nice short, snappy bits of information they can understand like ‘spit don't rinse’ can be invaluable.
9 Provide user-friendly home care
I'm a firm believer that you don't need expensive gadgets or complex routines to improve compliance. For some people electric toothbrushes might be better than manual ones, and vice versa. The questions and advice should be are you brushing for two minutes twice daily, are you using a fluoride toothpaste, are you taking your diet into consideration. Dentistry is not as expensive as many people perceive it to be.
7 Don't be a mum and nag them
There are many approaches that I find can yield better compliance, but one of them is most certainly not nagging patients. Praise and positive reinforcement can go a long way to not only encouraging someone to start flossing (for example), it can be the deciding factor in them keeping it up. Fear and finance are two of the biggest barriers to care I see. Patients don't need any excuse not to visit the dentist, as they believe there are many already. We need to reassure them visiting the dentist is a worthwhile and cost-saving exercise.
8 Motivate, motivate, motivate
People have to want to make improvements to be onside, motivating them to get on board is absolutely critical to the success – or otherwise – of their care plan. You do need them on board, and the relationship and trust-building steps are a really key part of setting that in motion. There is a small percentage of patients who know how their oral health is, but still continue to do the absolute minimum. It's for the children who are visiting for the first time. Get them excited and you will find compliance improves.
10 Schedule regular recall periods
Lifestyles and circumstances can change at the drop of a hat. One day you might treat a female patient, and the next day she might be pregnant. If you set a nine or 12-month recall period you are missing out on dispensing crucial information that will help her. I firmly believe the maximum recall period of two years is too much. I would definitely suggest more frequent appointments, even if you believe their oral health is of a good standard.
‘Hooked on Oral Hygiene’ helps patients ‘hang-on’ to oral hygiene advice even after they leave the clinic. The bathroom door hanger contains personalised oral hygiene advice and motivational tips. It will be launched to dental clinics nationwide in 2016 by the BSDHT and WOHP.
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10 top tips for improving patient compliance. BDJ Team 2, 15165 (2015). https://doi.org/10.1038/bdjteam.2015.165