Oral Health: Behaviour Change Part 1

• Behaviour change is relevant to oral and general health
• Evidence-based guidelines exist for oral health-related behaviour change
• Factors that influence behaviour can be identified using the COM-B model
• Patient-centered conversations support oral health-related behaviour change in dental hygiene and therapy practice
• Formative assessment includes active engagement and peer feedback
• Summative assessment includes E-assessment and OSCE

Links to prior learning

• History taking includes dental, social, and diet aspects
• The Delivering Better Oral Health Toolkit has evidence-based guidance for behaviours
• Communication involves verbal, non-verbal, and clinical conversations

Session Outline

• The following includes definitions, context, and evidence
• The following includes oral health-related behaviours, opportunity to change, and their evidence
• The following includes influences on behaviour, psychological theory (COM-B)
• The following includes behaviour change in action and its link to communication

Definitions

• Behaviour is what is done in response to internal/external factors
• Health behaviour is what impacts our health, positively or negatively
• Behaviour change is doing something that changes the way a person does something

Importance

• Behaviours impact health and well-being by increasing/decreasing the risk of long-term conditions/illness, including oral diseases
• Oral healthcare professionals can support patients in adopting positive health behaviours through patient-centered conversations

Evidence-Based Guidance

• Oral Health promotion in general dental practice (NG30) provides guidance on adopting a patient-centered approach
• Behaviour Change: Individual Approaches (PH49) provides interventions for targeting general health
• The Delivering Better Oral Health: An evidence-based toolkit for prevention, Chapter 3, Behaviour Change
• The NHS Long Term Plan promotes making every contact count

Oral Health-Related Behaviors Quiz

• What behaviors are related to oral health?
• What is the guidance for these?

Oral Health in the UK

• 75% of people clean their teeth twice a day
• 66% of people have visible plaque
• 9 in 10 people need support for oral health
• 1 in 10 people have excellent oral health

Toothbrushing Advice

• All tooth surfaces should be cleaned, including the gumline

Guidance

• Either a powered or manual toothbrush can be used
• Technique should be adapted to patient needs
• Brushing last thing at night and one other time during the day is key

Benefits

• Reduces the risk of dental caries
• Reduces the risk of periodontal disease

Dietary Guidance

• Reduce frequency and quantity of sugar intake
• Eat a balanced diet with lots of fruit and vegetables
• Daily free sugar recommendations from the NHS are as follows:
  • 30g/day for those 11 years +
  • 24g/day for those 6-10 years
  • 19g/day for those 4-6 years
  • OR no more than 5% of total calorie intake

Dietary Intake of Free Sugars

• Free sugar intake by age group/gender compared to recommended levels (5% or less) are as follows:
  • 1.5-3: ~ 11%
  • 4-10 Children: ~ 14%
  • 11-18: ~ 14%
  • 19-64 Men: ~ 12%
  • 65+ Men: ~ 13%
  • 19-64 Women: ~ 11%
  • 65+ Women: ~ 10%

Fluoride Exposure

• Fluoride toothpaste should be 1450ppm (less for under 6 years)
• Patients should be encourage to spit and not rinse
• 76% of people use fluoride toothpaste

Smoking Advice

• It is recommended to not smoke
• Encourage smoking cessation
• Around 14% of the UK population aged 18 years+ smokes (ONS 2019)

Alcohol Advice

• Do not exceed 14 units per week

Dental Attendance

• An individual's risk should determine attendance to the dentist
• Based on NICE guidance 3-24 months is the recommended interval for Dental Checks (CG19)

BSP UK Clinical Practice Guidelines

• Building foundations for optimal treatment outcomes are as follows:
• Explain disease, risk factors & treatment alternatives, risks & benefits, including no treatment
• Explain the importance of Oral Hygiene (OH), encourage, and support behaviour change for OH improvement
• Reduce risk factors including removal of plaque retentive features, smoking cessation and diabetes control interventions
• Provide individually tailored oral advice including interdental cleaning, adjunctive efficacious toothpaste & mouthwash, +/- Professional Mechanical Plaque Removal (PMPR) including supra and subgingival scaling of the clinical crown
• Select recall period following published guidance and considering risk factors such as smoking and diabetes
• Oral Health Educator (I, II), Hygienist, Therapist (I - IV), Dentist, Practitioner accredited for Level 2 and 3 care (I - V)

Impact of Oral Health-Related Behaviours

• Oral health is impacted by not only behaviours, but systemic health

Influences on Behaviour

• Behaviours are influenced by a wide range of factors, including personal, social, environmental, and economic conditions

Motivation

• Motivation can be intrinsic (internal) or extrinsic (external)

Habits

• Aim for behaviours to become habits
• It takes 66 days, on average, to build a habit

COM-B Model

• Interventions for effective behaviour change should be underpinned by an evidence-based theory
• Many theories are relevant to behaviours and changing them, but COM-B is key
• The headings of the COM-B Model are as follows:
  • Capability includes Physical and Psychological
  • Motivation includes Automatic processes and Reflective processes
  • Opportunity includes Social environment and Physical environment
  • Behaviour

COM-B Model Applied

• In relation to tooth brushing:
  • Capability is dependent on physical skill/dexterity and psychological capacity to do
  • Motivation is habitual and one needs to believe it is beneficial
  • Opportunity is having an appropriate social norm/culturally accepting and being able to afford/source a toothbrush

Psychology of Clinical Practice

• Bella attends the dental clinic for a routine visit
• She says she brushes every day but does not floss anymore
• She mentions that since starting to floss, her gums started bleeding so she stopped and the bleeding stopped
• It is recommended she starts again to prevent gum disease and decay

COM-B Model Applied to Bella's habits

• Which needs to be targeted?
• Why?
• How to address?
• Capability is the ability to floss, but the technique is damaging
• As well as having general knowledge of how to floss
• Motivation can prevent bleeding can prevent and emotional reaction, as well as beliefs about the consequences.
• Opportunity is if flossing is considered a social norm, and having the ability to source floss