This document provides information on educating and motivating periodontal patients. It discusses the importance of patient education, methods of instruction including demonstrating proper brushing technique and using disclosing agents. Motivation is key to changing patient behavior and various theories of motivation are covered such as self-efficacy and locus of control. Reinforcement is needed over multiple visits to help patients develop good oral hygiene habits. The document also addresses establishing rapport and communication with patients to help them learn.

1. EDUCATION,INSTRUCTION AND
MOTIVATION FOR PERIODONTAL
PATIENTS.
-DR. MRIGANKA RABI
GOSWAMI

2. • Patient education
• Methods of patient education
• Motivation
• Theories of motivation
• Oral hygiene instructions
• Disclosing agents
• Toothbrushes and brushing techniques
• Dentifrices
• Interdental aids
• Oral hygiene after regenerative procedures
• Conclusion
CONTENTS

3. • The background to oral health education
The term Dental Health Education (DHE) has
been gradually superseded in recent years by
Oral Health Education (OHE), reflecting a wider
concern than health only of the teeth.
PATIENT EDUCATION

4. • Problems with oral health education
Oral health education has, in the past, frequently
been given by untrained personnel, who were
likely to make many basic errors.
Therefore the message which has been contained
within the dental health advice has not always
been correct and has at times been totally
misleading. Eg : raw carrots…inadequate plaque
control with two –three previous oral hygiene
phase visit….

5. • Domains of learning
In education it is accepted that there are three domains of
learning
1. Cognitive domain: this relates to the acquisition of
knowledge.
2. Skills domain: this is the learning of practical skills.
3. Affective domain: this involves the creation of
attitudes and motivation.
THE LEARNING PROCESS

6.  The prevention and control of the two major dental diseases 
inflammatory periodontal disease and dental caries, depend to a large
extent on a change in the behavior of the patient.
Changing behavior
 The following are the steps which must be followed to establish
behavioral changes
• Factual education.
• Practical demonstration.
• Motivation.
• Reinforcement.
BEHAVIOR CHANGE

7. • Factual education
 By giving information to the patient.
 Should be accurate and comprehensible for lay- people.
 Should include realistic goals that the patient can
achieve.
 The amount of education should be appropriate to the
patient.

8. • Practical training:
It includes disclosing plaque, brushing,
interdental cleansing and the cleaning of
dentures and appliances.
Tell- show-do.

9. • Motivation:
The Oxford dictionary defines motivation as
‘that which induces a person to act’.
Motivation must come from within an
individual.

10. • Essentials for motivation:
 In order to become motivated to alter a behavioral pattern
an individual must be able to identify the following:
1. A problem exists which affects the individual
personally; for example the existence of periodontal disease in
the mouth.
2. The problem will have an unwanted personal
outcome; such as the premature loss of teeth.
3. There is a practical solution; such as adequate plaque
control.
4. The problem is serious enough to justify the in-
convenience of the solution.

11. • In relation to dental health education, as with
all other areas of education, people may be
divided into three broad groups:
 Those who are already motivated,
 Those with latent motivation,
 Those lacking the necessary motivation to change their
behavior.

12. • Reinforcement:
 The process of encouraging or establishing a belief or
pattern of behavior.
 Once the progression of the disease has been controlled,
then most patients require a regular (possibly 3 monthly)
maintenance programme of visits.
 This can be coupled with reinforcement of the oral hygiene
regimen.
 The frequency of reinforcement will vary from person to
person and will depend to a large extent on their attitudes
and the type of problem present.

13. • Learning is more effective when an individual is
physiologically and psychologically ready to learn.
• Individual differences must be considered if
effective learning is to take place.
• Motivation is essential for learning.
• What an individual learns in a given situation
depends on what is recognized and understood.
PRINCIPLES OF LEARNINNG
E M WILKINS 2005

14. • Transfer of learning is facilitated by recognition of
similarities and dissimilarities between past
experiences and the present situation.
• An individual learns what is actually used.
• Learning takes place more effectively in situations
from which the individual derives feelings of
satisfaction.
• Evaluation of the results of instruction is essential
to determine whether learning is taking place.

15. • The learning ladder illustrates the six steps from learner
unawareness to habit formation.
1. Unawareness
2. Awareness
3. Self –interest
4. Involvement
5. Action
6. Habit
THE LEARNING LADDER

16. • Impaired function
 No appliance can function as efficiently as the natural and healthy
dentition
 Full dentures may be an extremely poor substitute for the patient's own
teeth.
• Personal hygiene.
 These days most people are concerned about personal cleanliness and yet
there may be a marked contrast between the patient's general
appearance and the state of his mouth.
 This usually represents a lack of awareness of oral hygiene and when the
true state of affairs is demonstrated the individual who is truly concerned
about personal hygiene will be ready to change his habits.
 The patient is given a hand-mirror to witness the examination of the
mouth, and deposits of plaque and calculus can be pointed out.
 The use of a disclosing agent is valuable.
CHANGE IN ATTITUDE TO DENTAL
HEALTH
DM ELEY, JD MANSON 2OO4

17. • Social handicap
 Periodontal disease produces halitosis, inflamed gingiva and
eventually tooth loss due to mobility
 The idea of possessing offensive breath or an ugly smile is often
sufficient incentive for patients to improve their home care.
• General health
 The fact that periodontal disease can have an adverse effect on
general health should be explained to the patient.

18. • Based on the concept that one's beliefs direct behavior; model
is used to explain and predict health behaviors and acceptance
of health recommendations; emphasis is placed on perceived
world of individual, which may differ from objective reality.
• Components:
 Susceptibility-individuals must believe that they are susceptible
to a particular disease or condition.
 Severity-individuals must believe that if they get the particular
disease or condition, the consequences will be serious.
HEALTH BELIEF MODEL
M L DARBY 1998

19. • Asymptomatic nature of disease-individuals must
believe that the disease may be present without
their full awareness.
• Behavior change will be beneficial-individuals must
believe that there are effective means of preventing
or controlling the potential or existing problem
and that action on their part will produce positive
results.

20. "Maslow's HIERARCHY OF NEEDS
self-realization 
needs that drive the
individual to reach
the very top of his or
her field
components necessary for body
homeostasis, such as food, water,
oxygen, temperature regulation etc
Social needs

21. The first task of the practitioner is to establish rapport
with the patient, which then makes possible further
development of communication, learning, and
motivation.
ESTABLISHMENT OF COMMUNICATION :
RAPPORT
H E Goldman 1980

22.  Despite their importance, history
taking, clinical examination, and
diagnosis must all wait because,
according to Meares 1957, while they
may all occur concurrently with
rapport, rapport must come first.
 Rapport is an emotional state in which logical, intellectual, or
verbal factors may play only a small role.
 Expressions, gestures, and other nonverbal communication,
however small, may assume symbolic value to the patient as the
initial meeting with the doctor takes place.
 On the surface the patient may be reciting his symptoms and
concerns, but underneath this veneer he is assessing the
competence and trustworthiness of the doctor.

23. Meanwhile the doctor should be establishing
the emotional relationship with the patient
that we know as rapport.

24. SYMPATHY / EMPATHY
 In considering obstacles to rapport the dentist should note the difference
between sympathy and empathy.
 Empathy, a great gift for a professional to possess, means that although we
do not share the emotional feelings with the patients as in sympathy, we do
appreciate how he is feeling.
 Empathy is a blend of interest and objectivity.
 Many times the more sensitive the individual happens to be, the more apt
he is to possess a capacity for empathy.
 Lack of this qualification by professional is an obstacle to formation of
rapport with his patients or clients.

25. • According to Cinotti and Grieder there are two
methods of patient learning applicable in
dentistry……
Conditioning
and
Insight learning
METHODS OF PATIENT EDUCATION

27.  OUR YOUTH - ORIENTED SOCIETY
 OUR DESIRE TO BE PHYSICALLY ATTRACTIVE
 SUPERSTITIONS AND FOLKLORE
 SELF-DISCIPLINE
FACTORS THAT INFLUENCE
MOTIVATION

28. • SELF EFFICACY THEORY:
 Is the belief in one’s ability to perform specific behaviors.
 In this case the dental hygienist plays an important role to
help clients acquire the confidence by training them to
perform persona oral hygiene skills and by providing them
with ongoing support and encouragement.
 Sometimes the success of peers and their endeavors to
improve health behavior can also strongly influence the
client’s feeling of self efficacy to accomplish similar tasks.
THEORIES OF MOTIVATION
DARBY , WALSH 1995

29. • ATTRIBUTION THEORY:
 It’s a cognitive theory that emphasizes the importance of
content of thoughts.
 What people attribute to their success or failure
determines their feelings about themselves, their
predictions of success at accomplishing the task and the
probability that they will try harder or not as hard at a
task in the future.
 Eg: when people attribute their failure to low ability, they
feel depressed, predict that they will fail again, and use
less effort in the future. Thus attributions affect
expectations of success, emotion and persistence at
future tasks.

30. LOCUS OF CONTROL
• Refers to the extent to which individuals believe they
can control events affecting them.

32.  Dentist is not the sole source of information about dental disease and
its treatment.
 Before a Patient makes a dental visit oriented toward prevention, he
must have already been informed to some degree about the dangers
of neglecting his dental health.
 He might have been informed by any one of great number of sources
some of which are listed as follows:
1. Family or friends
2. Mass media-television, radio, magazines,internet
3. Past experiences —personal and family
4. Fear of future pain and discomfort
5. Other authorities —physicians, school teachers,
nurses
6. Social and cultural background
SOURCES OF INFORMATION ON PERIODONTAL
THERAPY
(H E Goldman 1980)

33. • Actions that dentists and the dental profession may
take to improve the milieu in which the patient will
motivate himself can be considered as either
extramural or intramural procedures (Katz et al 1972)
Extramural procedures
Because most periodontal patients are adults, and
adults have beliefs that are often difficult to change,
the profession should concentrate on informing
patients when they are children.
Extramurally this could be done by the dental
profession through a more active participation in the
health program at the elementary school level
SUGGESTIONS FOR MOTIVATING
PATIENTS

34. It could be accomplished by supplying
attractive audiovisual materials to the school,
by participating in school functions, and by
cultivating and educating the teachers, who
are very powerful opinion makers in the
child's life.
Parents may be approached by other
dentally educated opinion makers such as
physicians and nurses.

35. Once the patient makes an appointment with
the dentist, he has evidenced a certain
amount of need, or the appointment would
never have been made.
After he arrives, stronger motivation is
evidenced.
Even though the patient has not come to the
office for relief of pain, you may assume that
he has come for the relief of some other
anxiety (disquiet of mind).
Intramural procedures

36. • Kegeles (1963) has suggested a procedure for dealing with such a
patient.
• He indicates that the following format is a useful framework in
which to educate the patient relative to dental disease.
• For a patient to make a dental visit and to undergo treatment that is
oriented toward prevention he must believe the following:
1. That he is susceptible to periodontal disease
2. That periodontal disease is personally serious
3. That there is something he can do to treat or correct the condition
4. To a lesser degree that the condition occurred due to natural
causes

37. ORAL HYGIENE INSTRUCTIONS

38. • Patients can reduce the incidence of plaque and
gingivitis with repeated instruction and
encouragement much more effectively than with
self-acquired oral hygiene habits.
• However, instruction in how to clean teeth must
be more than a cursory chair side demonstration
on the use of a tooth brush.
• It is a painstaking procedure that requires patient
participation, careful supervision with correction
of mistakes, and reinforcement during return
visits, until the patient demonstrates that he or
she has developed the necessary proficiency.

39. Any strategy for introducing plaque control to
the periodontal patient includes several
elements.
At the first instruction visit, the patient should
be given a new toothbrush, an interdental
cleaner, and a disclosing agent.
The patient’s plaque should be disclosed
because dental plaque otherwise is difficult for
the patient to see
Newman et al 2006

41. TWO TONE

43. INTERDENTAL CLEANING AIDS