Ross Walker explains how it can benefit patients’ oral health long term.
Patient compliance with oral hygiene recommendations is essential for their long-term dental health. Optimising their adherence to professional advice is one of the dental team’s many tasks during every routine or treatment appointment.
It has been proven that effective patient compliance with oral hygiene instructions (OHI) results in better dental health. For example, a systematic review and meta-analysis found that higher patient compliance was associated with a lower risk of tooth loss. Another study established positive correlations between high (complete) patient compliance and reduced plaque and bleeding on probing. There is extensive literature available today emphasising the importance of patient adherence to oral hygiene advice for good dental health – whether this is related to the provision of a specific treatment or not.
In order to encourage better patient compliance, it is necessary for the dental team to understand what factors influence each individual’s ability and willingness to follow instructions. Shah et al suggested that oral health awareness and treatment satisfaction affected a patient’s compliance with clinical instructions. So too, will their relationship with their clinician – the more they trust the professional team, the more likely they are to respect their recommendations.
The barriers preventing patient compliance
There are several other reasons why a patient may not fully comply with professional recommendations.
Research into patient recall of OHI following dental implant surgery found that only half of the participants remembered any details from the OHI at the time of treatment. Worryingly, more than 10 per cent did not recall OHI at any point after their implant surgery. This supports the findings from a previous study regarding patients’ recall of information after a general consultation, which suggested that patients remembered almost half of the oral health advice the dentist recalled providing.
Another issue is whether people understand the information they receive. A study of patient compliance across all primary care health settings demonstrated that some patients’ health education level and, therefore, understanding of the information they received is not good enough for them to either appreciate its significance or to implement it within their daily routines.
Sometimes, it is the oral hygiene products themselves that can lead to reduced patient compliance. Most notably, when it comes to mouthwash, chlorhexidine solutions can cause tooth staining, which has been shown to negatively influence patient use and adherence to the recommended oral hygiene routine.
Improving patient compliance
To help patients comprehend the advice provided, it is important to use language they can relate to and avoid clinical jargon. Effective communication is the cornerstone of building rapport and enhancing the patient-practitioner relationship, and it is essential when providing OHI.
When it comes to discussing habits with patients and inciting behaviour change, motivational interviewing has become a popular concept across healthcare. Meta-analyses have found this technique to be effective for patients with behaviourally influenced health problems, enhancing their treatment adherence. It is a cognitive psychological technique that encourages patients to realise for themselves the need for change, therefore increasing their commitment to forming and maintaining positive new habits.
Technology may also be used as a way of combating the lack of information recall patients have displayed following OHI. Research has shown that e-reminders and e-feedback reduce the number of poorly compliant patients undergoing clear aligner therapy from 24 per cent to nine per cent. Another oral hygiene reminder method that has been tested is a simple phone call – this proved effective in a study of patients one week after their third molar surgery. Similar techniques might well prove effective for patients following periodontal or implant treatment too.
As mentioned, the specific products recommended by the dental team will impact the frequency of use among patients. If solutions are prohibitively expensive or time-consuming, then patients are far less likely to incorporate them into their daily oral hygiene routines. Other factors to consider include accessibility, ease of use, size, convenience, taste and side effects.
As well as staining, mouthwashes containing chlorhexidine have been associated with an unpleasant bitter taste, which can also put patients off regular use. A better alternative would be Clinisept+ Dental Mouthwash, a next-generation hypochlorous solution that delivers superior antimicrobial control without any negative side effects such as a bitter taste or tooth staining.
A unison of health
Whether a patient requires dental treatment or not, it is imperative that they can maintain their oral health over time. This requires adhering to the professional recommendations of their dental team and implementing evidence-based techniques and products that will support and enhance their health. With an open, honest and tailored approach, clinicians can help patients overcome the barriers they may face to compliance.