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The ADA Practical Guide to Patients with Medical Conditions
With new medications, medical therapies, and increasing numbers of older and medically complex patients seeking dental care, all dentists, hygienists, and students must understand the intersection of common diseases, medical management, and dental management to coordinate and deliver safe care. This new second edition updates all of the protocols and guidelines for treatment and medications and adds more information to aid with patient medical assessments, and clearly organizes individual conditions under three headings: background, medical management, and dental management. Written by more than 25 expert academics and clinicians, this evidence-based guide takes a patient-focused approach to help you deliver safe, coordinated oral health care for patients with medical conditions. Other sections contain disease descriptions, pathogenesis, coordination of care between the dentist and physician, and key questions to ask the patient and physician.
eBook
Does motivational interviewing have a role in dentistry?
Traditional approaches to health promotion involve clinicians imparting knowledge to patients and ‘telling' patients what changes they should make to benefit their health. This so-called ‘fixing reflex' can be counterproductive and ineffective, creating unhelpful discord between clinicians and patients. There is little evidence that this approach is wholly effective in bringing about healthier patient behaviours. In contrast, motivational interviewing (MI) is a patient-centred consultation style aimed at developing patient motivation and commitment for a range of health-related behaviours. It focuses on discovering the values, beliefs and goals of patients and encourages clinicians and patients to work together collaboratively, to bring about change and growth. It is an effective, evidence-based approach, even when used as a ‘brief intervention' for a few minutes only. This paper discusses how MI can be applied in dental healthcare settings to enhance general and oral health. The evidence available for its use in dentistry is discussed, along with opportunities for training of the dental team in this skill.
Key points
Motivational interviewing (MI) is a style of communication which has been proven to empower patients towards making behavioural changes.
Within dentistry, MI has several applications, such as supporting smoking cessation and increasing tooth brushing frequency, among other health behaviours.
This article discusses its evidence base, applications in dentistry and opportunities for techniques drawn from MI training to become more available for the dental team.
This article adds to the existing literature by demonstrating how MI aligns with the essential core competencies required for the dental team, as outlined by recent General Dental Council guidance.
Journal Article
Longitudinal Impact of Brief Motivational Interviewing on Periodontal Clinical Outcomes and Patient Perceptions: A 3-year follow-up study
The purpose of this study was to determine the longitudinal impact of multiple brief motivational interviewing (MI) sessions on behaviors as measured by clinical indicators of periodontitis and patient perceptions of importance, interest, and self-efficacy for oral hygiene behaviors.
Fifty-eight patients in the periodontal maintenance phase of therapy who had completed all study visits from a 1-year single-masked, examiner randomized clinical trial were invited to participate in this 3-year follow-up study with no intervention. Clinical outcomes of O'Leary plaque score, bleeding on probing (BOP), gingival index (GI) and patients' perceived interest, importance, and self-efficacy for oral hygiene behaviors were collected. Results were reported using means with 95% confidence intervals (CI). Analyses were performed using statistical software (R version 4.3.2).
A total of 41 patients participated for a 72% retention rate. The brief MI group yielded a statistically significant reduction in BOP from baseline to 3-years (0.02) and significance in the reduction of GI scores from baseline to 3-years (
<0.0001). Perceived self-efficacy in maintaining a change long-term was sustained from baseline (4.19) to 3-year follow-up (4.14) for the brief MI group as compared to the traditional OHI group (baseline 4.23; 3-year follow-up 4.04). Time of interaction between traditional oral hygiene instruction (OHI) and brief MI groups did not achieve statistical significance for plaque score from baseline to 3-years (0.12).
A brief MI intervention achieved longitudinal reductions in clinical indicators of periodontitis and enhanced patient's perception of self-efficacy for oral hygiene behaviors at a 3-year follow-up.
Journal Article
A Narrative Review of the Utilization of Motivational Interviewing for Nutritional Counseling in Dentistry
The purpose of this narrative review was to explore how motivational interviewing (MI) and brief MI are utilized for nutritional counseling in oral health care to support patient-centered dietary behavior change.
This narrative review followed PRISMA format. A search strategy was designed using MeSH terms and keywords with inclusion and exclusion categories dictating the search. Searches were conducted in Ovid Medline
ALL, CINAHL, Scopus, and Web of Science. Studies were screened in Rayyan by two independent reviewers. Eligible studies were categorized into two domains: MI utilization by provider type or setting and MI application for a population or a condition.
The search yielded 122 articles. After title and abstract screening, 113 articles were excluded. Following full-text review, three more were removed, resulting in six (n=6) studies for inclusion. Four studies examined the utilization of MI by provider type or setting. These studies demonstrated MI training improved provider confidence and interest in delivering nutritional counseling, with brief MI interventions showing effectiveness in dietary behavior change. Two studies focused on the application of MI for a population or condition.
Motivational interviewing and brief MI can be utilized for nutritional counseling in oral health care settings by dental hygienists to enhance their confidence, promote patient behavior change, and contribute to improved dietary habits for improved oral and systemic health. The Nutritional Risk Assessment and Counseling Tool (NRACT) can be used as a risk assessment and guide to facilitate brief MI in a dental setting for nutritional counseling.
Journal Article
A Guide to Applying Motivational Interviewing in Nutritional Counseling in Dental Hygiene Education
Oral and systemic chronic health conditions are widespread in the United States, and nutrition plays a crucial role in their prevention and management. Dental hygienists, as prevention specialists, are uniquely positioned to incorporate nutritional counseling into patient care due to their education and expertise in risk assessment. Despite its importance, integrating effective nutritional counseling in clinical practice is often challenging, with barriers such as time constraints, patient compliance, and clinician confidence. This report presents a blueprint for incorporating motivational interviewing (MI) through a Nutritional Risk Assessment and Counseling Tool (NRACT) into dental hygiene education at Eastern Washington University (EWU). The five-semester dental hygiene curriculum at EWU integrates nutrition concepts early in the course of study, using MI strategies to enhance student confidence in patient counseling. Students receive foundational training in MI techniques, including open-ended questions, reflective listening, and evoking patient motivation. The NRACT supports both assessment and structured nutritional counseling, allowing students to guide patient interactions effectively. Through clinical practice, workshops, and peer feedback, students refine their MI skills and develop confidence addressing nutrition-related concerns. Initial outcomes from EWU suggest incorporating the NRACT, which includes MI, increases students' comfort in discussing topics like nutrition while enhancing patient-centered care. This short report provides the framework to foster the development of skilled oral health care professionals equipped to promote nutritional health. Additionally, this report offers a transferable model for integrating nutritional counseling into dental hygiene education across diverse educational settings.
Journal Article
Motivational interviewing for caries prevention in adolescents: a randomized controlled trial
ObjectiveThe objective of this study is to investigate the effectiveness of motivational interviewing (MI) in changing health behaviors (snack and toothbrushing) and preventing dental caries among adolescents.MethodsFive hundred and twelve adolescents with unfavorable caries-related behaviors (“snacking three times or more a day” and/or “toothbrushing less often than twice a day”) were randomly assigned to three groups. Group I received prevailing health education (oral health talks and pamphlets). Participants in group II joined a one-on-one face-to-face MI session. In group III, a patient communication tool (Cariogram) was incorporated to facilitate the MI process. At baseline and 24 months post-intervention, a self-administered questionnaire gathered information of participants’ sociodemographic characteristics and oral health self-efficacy and behaviors. Their oral hygiene and tooth status were assessed by a blinded examiner.ResultsAfter 24 months, 460 (89.8%) participants were followed up. Compared with group I, (i) restriction of frequent snacking was more likely in group II [OR (95% CI): 3.91 (1.48–10.33)] and group III [OR (95% CI): 6.33 (2.46–16.27)], whereas group III tended to adopt the behavior of toothbrushing twice a day [OR (95% CI): 4.80 (1.79–12.85)]; (ii) no significant between-group difference in plaque score reduction was found (p > 0.05); and (iii) groups II and III developed fewer cavitated teeth (△DICDASII 3-6MFT) [β (95% CI): − 0.19 (− 0.37, − 0.01) and − 0.20 (− 0.38, − 0.02), respectively], whereas increment of total carious lesions (△DICDASII 1-6MFT) was lower in group III [β (95% CI): − 0.63 (− 1.24, − 0.02)].ConclusionMI outperformed prevailing health education in improving oral health behaviors and preventing dental caries among adolescents.Clinical relevanceIncorporating MI into dental care for caries-prone adolescents contributes to optimal health outcomes.Trial registrationHKUCTR-1852 (http://www.hkuctr.com/) (Hong Kong, 2013)
Journal Article
Motivational interviewing in general dental practice: A review of the evidence
Key Points
Oral health education for patients works best when based on the principles of motivational interviewing
Understanding and accepting patients as they are helps to build the therapeutic alliance that is needed for chairside oral health promotion to be successful
Health psychology and an understanding of how people make choices is an integral part of dentistry
Objectives
The objective of this study was to systematically review the evidence regarding the use of motivational interviewing in the context of general dental practice, in order that practitioners can decide whether it might be an important skill to develop within their practices.
Data sources
The results reported in this study form part of a larger systematic review which sought to identify whether oral health promotion within dental practice is effective and how its effects can be optimised. Here, we focus on the papers describing motivational interviewing in dental practice published since 1994. The systematic review included searches of 20 online resources (including Ovid Medline and Embase).
Data selection
Papers which were not about oral health promotion and did not apply the behavioural and psychological theories, which underpin motivational interviewing, were excluded.
Data synthesis
This review included eight papers all of which were considered to be of robust quality, in terms of their research methods and seven of which were considered to offer externally valid findings. Five described randomised controlled trials and all of these RCTs demonstrated that interventions including motivational interviewing had a positive effect on oral health and health behaviour.
Conclusions
This review shows that the motivational interviewing technique, which is based on the concept of autonomy support, has potential for helping patients with poor oral health. Training in motivational interviewing for dental personnel could be a very useful addition to the skill set of practitioners and dental teams.
Journal Article
Dental professionals’ views on motivational interviewing for the prevention of dental caries with adolescents in central Norway
Background
Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients.
Methods
As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level.
Results
A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists.
Conclusions
A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry.
Journal Article
Motivational Interviewing and Case-Based Learning Approach Toward Tobacco Cessation Behavior Changes
Health care professionals and health care students need effective skills to address the public health issue of tobacco use disorder. An accredited tobacco treatment specialist (TTS) program that includes case-based motivational interviewing (MI) instruction and role-playing with case-based tobacco scenarios, provides an opportunity to obtain or improve tobacco cessation skills. It is important for health care students to develop competency in MI as part of the evidence-based strategies used to assist individuals with tobacco cessation. The purpose of this short report was to evaluate the effectiveness of case-based teaching of MI concepts and assess health care students' ability to apply these techniques during tobacco cessation scenarios. Ten percent of the TTS program's certification examination consisted of case-based questions in MI skills developed by a team of experts. A total of 156 West Virginia University Health Sciences Center students (including dental and dental hygiene students) were examined. The mean overall correct response for MI case-based questions score was 89.0% (SD, 0.29). With an 80% competency score, this assessment of tobacco cessation case-based learning questions displayed proficient application of MI and case-based learning was considered a valuable method to teach a complex skill.
Journal Article