The Challenges of Behavior Modification

Changing patient behaviors to incorporate positive health benefits is an important aspect of clinical hygiene practice.

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by Ann-Marie C. DePalma, RDH, MEd, FAADH

Changing patient behaviors to incorporate positive health benefits is an important aspect of clinical hygiene practice. Affecting this change requires making sure the patient “owns” the problem and has the desire to change. Debbye Krueger, RDH, BS, provides dental teams with the power and tools to motivate change in patients through her program, “Problem Identification and Patient Motivation.” Additionally, Debbye is an educational consultant for Sunstar Americas, the manufacturers of the Gum and Butler products. She presents programs to dental hygiene students on patient communication and product recommendations and tools for pain management. When not busy as an educational consultant, Debbye works full time as a public health dental hygienist for the state of North Carolina!

Debbye incorporates her 36 years of practice into her presentations. Her patient communication program stresses the importance of real communication with the patient and/or patient’s family. She feels the hygienist has the responsibility of making sure that the patient/family understands the oral-systemic health link, and uses that information to make product recommendations for that specific patient’s needs.

Debbye introduces students to the Sunstar product lines and encourages them to review research and literature about products. Her pain-management program delves into the aspects of providing quality dental hygiene care with minimal discomfort for the patient. In states where hygienists cannot administer local anesthesia, Debbye tells students about products available to help patients feel more comfortable in the operatory. Throughout her programs Debbye stresses the importance of belonging to the professional association, ADHA.

For the problem-identification and patient-motivation program, Debbye invites participants to understand behavior modification, the adult learning process and how to effectively initiate change that enables patients to make positive changes in their oral health. During the presentation, the most frequently asked questions by dental professionals are discussed:

  • Why don’t patients listen to me?
  • Why don’t they respond to my recommendations?
  • What can I do to build rapport and trust?
  • How can I become more effective with patient education so the patient will want to comply?
  • What adjunctive tools will help increase the patient’s long-term compliance when the standard home-care implements are not accepted?

Debbye also discusses motivational interviewing to assist the patient in making the desired change, and the stages that must occur for real change to be seen in the patient.

Debbye’s Sunstar programs expand on some of the concepts presented in the problem-identification program. The patient-communication program offers a glimpse into the link between oral and systemic health, presents patient compliance recommendations and techniques, identifies patient types and which products fit each type of patient, and discusses the benefits of proper home-care techniques as well as the science behind the toothbrush. The pain-management course provides in-depth knowledge with specific product recommendations for treatment of oral lesions, and also reviews patient compliance information.

Debbye was one of three hygienists hired in 1972 to provide dental hygiene public health services in North Carolina after graduating from East Tennessee State University dental hygiene program. She and the other members of the team traveled around the state to introduce workshops on “plaque control” to dentists by teaching them the theories of controlling plaque and using dental floss. They also recommended a two-row sulcus brush and taught the importance of cleaning the sulcus interproximally.

Coincidentally, the sulcus brush was designed by Dr. John Butler, a Chicago periodontist, who was the impetus for the Butler Toothbrush Company, and now, years later, she works for that very company! The summer of 1973 brought these same hygienists to lead teacher-training classes educating teachers how to teach their children this new “idea.”

Currently, she works with day-care providers to promote health wellness programs, speaks to pediatricians on the benefits of fluoride varnish, and counsels high school coaches about the dangers of smokeless tobacco. She sees her role as a public health hygienist to provide optimum oral health through science-based preventive practice.

Her role as an educational consultant evolved from the honor of being chosen as a RDH magazine/Sunstar Award of Distinction Award winner in 2003. While she was in Chicago during the award ceremony at RDH magazine’s Under One Roof Conference, she was awed by presentations given by other hygienists and the amount of information that was shared.

Sunstar at the time was embarking on a program to empower hygienists and hygiene students about the importance of “Healthy Gums, Healthy Life.” Along with four of the award winners and four other hygienists, she was asked to interview for one of four consultant positions being offered.

And the rest, as they say, is history. The programs and consultants have evolved over the years and Debbye’s commitment to the program induced her to maintain her public health position and combine the Sunstar position. In her community she has helped open and operate a sealant and periodontal clinic for indigent diabetic patients a few nights each month. She also coordinates her local police department’s Citizen’s Police Academy, which meets one night a week for 12 weeks each year.


Debbye Krueger
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A single mom who raised two children, Debbye is passionate about her family, and though both children are now grown and have children of their own, she continues to be very active in her grandchildren’s lives. She has learned to dance the shag, the state dance of North Carolina and a great form of exercise. In addition, she avidly follows college football. Debbye is a member of ADHA and has held several offices at both the local and state level, and she is currently serving as trustee for the North Carolina Dental Hygienists’ Association.

Debbye possesses a zest for life and dental hygiene. As a participant in one of her programs stated: “she captures her audience with her enthusiasm and passion for dental hygiene. She is an inspiration to us all.”

For information about Debbye’s programs contact: debbyekrdh@aol.com.

About the Author

Ann-Marie C. DePalma, RDH, MEd, FAADH, is an assistant professor at Northern Essex Community College. She is a Fellow of the American Academy of Dental Hygiene, member of ADHA and other professional associations. Ann-Marie presents continuing education programs for hygienists and dental team members and has written numerous articles on a variety of topics. She can be reached at amrdh@aol.com.

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