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Gaining Patient Compliance for Dental Therapies
Many dental hygienists have instituted comprehensive periodontal programs in their practices. Frequently, however, as I consult with offices, I hear: “Well, we had a great periodontal program. We don’t seem to be into it as we were once before.” “Our patients don’t really care about coming back every three months.”
One of the major obstacles we face in obtaining optimal periodontal results is gaining compliance from the patients. Studies have shown that only half of patients really comply with what we suggest.
When hygienists were questioned about what patient behaviors concerned them most, noncompliance with oral hygiene instruction, lack of acceptance of periodontal therapy, and broken appointments ranked as the top three noted behaviors.
Studies performed with patients suggested that when the dental hygienist continued to positively reinforce instructions to the patient, plaque and bleeding scores went down. Other studies indicated that almost every dental patient at around 90 days after their preventive or periodontal appointment began to drop away from the regime. Most patients who do not brush optimally will use interproximal aids, so it is most important that we as dental health professionals carefully continue to reinforce home care with positive feedback.
As comprehensive, preventive dental professionals, we have to examine the reasons our patients fail to comply with our recommendations:
- Patients deny or want to remain negligent in their attitude toward dental disease. They do not want to take responsibility for their disease. Everything is always someone else’s fault.
- Patients fear dentistry. Fear is one of the major reasons for non-compliance.
- Economic problems. Dentistry is not a priority if other life-sustaining necessities come first.
- Perceived indifference or indifferent behavior. Dentist and dental hygienist indifference has been cited as the reason for non-compliance in 40 percent of patients in one study. Studies also indicate that a dental practice will have a 50 percent turnover in patients every five years. Half of the turnover is attributed to lack of satisfaction on the patients’ part. Other patients simply deny having a problem.
How can we improve compliance?
Simplify: Adhere to the “Kiss” method. “Keep It Simple, Stupid.” The simpler the required behavior, the more likely it will be carried out. If your goal is to hone in and accomplish both brushing and flossing instruction, start first with brushing until the point when the patient has “mastered the art” and then move onto flossing.
Customer service: The more you and the practice fit the patients’ needs, the more likely they are to comply. Satisfied patients tend to do more of the recommended therapy than dissatisfied patients do. Patients judge quality on their experiences in the practice, not great margins or squeaky clean teeth!
Close the case presentations: Always ask if the patient is absolutely clear on the recommendations and ask them if the therapy presented is what they want to have done for themselves. If the patients really want the dentistry, they will show up for the appointments. Make sure you always confirm the appointment time with a courtesy call two days before the appointment. Say, “I am really looking forward to seeing you on Thursday. I was calling to see if you had any questions about the therapy that will be done.”
Keep records of compliance: Patients can get lost in the “Black Hole,” and efforts should be made to keep up with them.
Inform before you perform: Remember, explaining the treatment recommendations before producing is considered a diagnosis, explaining the treatment after it is completed is considered an excuse! Put every treatment recommendation to paper both in the patient file and onto a written treatment plan that the patient can take home with them. Give them two business cards and say that if they have any questions, they should feel free to call you.
Be positive: Managing by fear only gives us short-term rewards. Pump up the patients with optimism. Everyone does better when positive feedback is given.
Begin studying human behavior: Remember that there is a person attached to that oral cavity. Everyone is different and will respond to different strategies. What will get you further with patients long-term is to be very honest, passionate, knowledgeable and caring in your actions towards and for the patient. Remember to always present the best treatment plan in the most optimistic way. Ask the patient to make a commitment to lifelong dental health and if they say yes, close the case by asking the patient if they are ready to schedule the treatment.
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