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Why they don’t comply Compliance is a challenging, complex issue with expectations that have changed over the years, Chicago dentist Dr. Lou Graham said. Back in the 1970s, compliance meant brushing twice a day and flossing. Today, there’s a lot more involved from oral irrigation to proper diet to brushing properly. Medicaments for remineralization and products for caries prevention didn’t exist back then, and these days, GPs spend more time managing high-risk patients than ever before. And as many GPs know, it can be difficult to get patients to take the time to brush before running out the door to get to work, let alone spend 30 seconds on each quadrant. It comes down to this: Your patients are busy people. They have a lot on their minds, from financial worries to hectic schedules that never seem to let up. If they don’t understand why it’s important for them to comply, they likely won’t. “Compliance is a problem with the majority of patients, especially the flossing component,” said Dr. Jon Suzuki, a Professor of Periodontology at Temple University. “Patients simply run out of time. They have other priorities and they don’t feel oral hygiene is a critical care situation. It’s not on the same par to them as high blood pressure, cholesterol and cancer therapies.” Forget taking the time to floss and brush properly at home—fitting in an appointment for a simple cleaning can be a source of stress. Dr. Suzuki recommends making it easier by adding early morning, evening and weekend hours in your practice. Make it convenient for them to make an appointment and they’ll be more likely to do it. For patients who don’t have dental insurance, money also can be an issue, Dr. Suzuki said. Maybe they can’t afford the treatment you recommended or cover the cost of a cleaning. Setting up payment schedules can help alleviate some of that stress and give patients one less excuse. Help them get there As much as you might want to, you can’t force your patients to change their habits; they have to want to do it. And lecturing, scolding or trying to scare them likely isn’t going to get the result you’re after, said Terri Tilliss, RDH, PhD. So what can you and your team do? Start by finding out what motivates each patient. “If it doesn’t meet their goals, they’re not going to comply. Bottom line is people do what they want to do,” Tilliss said. “If having better oral health isn’t something they want to do, they’re not going to do what it takes to get better oral health. The idea is to explore what it is they want.” And, of course, the motivator will be different for every patient. For West, motivation came from the desire to have a healthy body. Have a conversation with your patients to find out why they’re there and tie that in to taking better care of their oral health. If a patient is motivated by esthetics, you would present the case differently than if the patient is motivated by disease prevention. Create value Lack of compliance is lack of value for something, said Gwen Smukowski, RDH, a hygienist at Dr. Graham’s practice. It’s not understanding the change process, which can lead to frustration. Patients need a time line. They need to understand what they’re going to gain from the behavior change and what the consequences are if they don’t make that change. And they need to be accountable. “It’s a very customized approach,” Smukowski said. “You have to look at what the patient is looking for, how that patient is going to benefit from this. It’s trying to get your patients to want what you’re selling them.” Create a situation where the patient is asking you what to do, Tilliss said. If a patient starts talking about cardiovascular problems keeping him from playing with his grandchildren, use that as an opening. “You can explain a little about the oral systemic connection and say, ‘Gee I really wonder if things don’t change with your cardiovascular situation whether you are going to be able to meet your goal of playing with your grandchildren. As we just discussed, the status of your mouth can be a factor in that,” Tilliss said. “The patient will likely say ‘I’ve never thought about it that way. What do I need to do?’ Then they’re asking you what they need to do rather than you telling them.” CONTINUED ON NEXT PAGE
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