ohe, motivation and concordance

Question 1

Why is plaque control important?

Answer 1

Classical studies- bacteria in plaque cause development and progression of perio diseases

Question 2

What is periodontitis?

Answer 2

Chronic, multifactorial inflammatory disease associated w dysbiotic plaque biofilms and characterised by progressive destruction of the tooth supporting apparatus
~Papapanou 2018

Question 3

What does BSP recommend?

Answer 3

Steps 1-4 of perio therapy

Emphasise OHE and engage patient in behavioural change

Question 4

What is compliance?

Answer 4

The extent to which the patients behaviour coincides with medical advice
~Sackett and Haynes 1976

Question 5

What are factors associated w compliance?

Answer 5

Patient
Disease
Treatment
Operator
Support system 
Facilities

Question 6

How is motivation categorised?

Answer 6

Already motivated- guidance and reinforcement
Latent motivation- only need a trigger
Lacking motivation- difficult

Question 7

How can we motivate patients?

Answer 7

Personal problem exists for patient
Unwanted outcome eg. Tooth loss
Practical solution
Serious enough problem to justify inconvenience and effort

Education and communication
Participation
Facilitation and support
Negotiation

Question 8

What is the importance of communication?

Answer 8

Patient trust/motivation/cooperation
Inv in decision making
Manage expectations 
Patient satisfaction
Prevents medico-legal issues/complaints

Question 9

What are barriers to communication?

Answer 9

Generally social, cultural, environmental

Patient centered- pain, anxiety, embarrassment, cognitive level

Clinician- interpersonal skills, lack of sensitivity, lack of active listening, time pressures, jargon

Question 10

What are types of communication?

Answer 10

Verbal- tone, pitch, inflexion
Non-verbal- body language, eye contact, facial expressions, gestures
Other- teaching aids, resources

Question 11

What is a starting point to OHE?

Answer 11

Explain disease
Explain importance of plaque control
Tailor OHE
Behaviour change for OH improvement

Question 12

How can you explain disease and plaque control?

Answer 12

Leaflet
Pictures/diagrams 
Photographs
Radiographs 
Perio indices (% plaque score)

Question 13

What are guidelines to OHE?

Answer 13

Must be repeated and tailored
Recommend powered over manual- cochrane review
Invite patient to demonstrate
Provide positive, non-judgemental feedback and modifications
Set realistic targets
Use Tepes over flossing, should supplement brushing
Demonstrate Tepes in mouth/models
Keep advice specific
Use other devices in inaccessible places
Basis of management is mechanical
Antiseptic mouthwash only in specific cases
Avoid subjective terms- poor, fair, good

Question 14

What are the 7 components of an individually tailored oral health programme?

Answer 14

1. explore beliefs, attitudes, expectations, self efficacy
2. behavioural analysis, biofeedback
3. practice manual dexterity and skills
4. goals and planning for brushing
5. self monitoring and feedback
6. generalisation of new behaviours in different situations
7. relapse prevention