Th 200397


Feb. 1, 2006
Consider patients’ interests when providing instruction.
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Consider patients’ interests when providing instruction.

How often do you zealously demonstrate to your clients how to floss and brush? You show the floss making a “C” around the interproximal surface of the tooth, sliding up and down along the whole surface. You ask them to demonstrate the technique themselves so they know kinesthetically how to do it, making sure they get the floss into the sulcus. Similarly, with the brush, you demonstrate the modified Bass technique and even explain that these and other home-care instructions are necessary if they are to get all the plaque off their teeth.

By now, your clients’ eyes are glazed over. They are not really listening and are responding only enough to get your approval. What’s wrong? Don’t they realize the importance of oral health and their roles in it? The answer is a qualified no; health is important, but it doesn’t fit into the scheme of priorities for every client as it does for our profession.

The ultimate goal of educating our clients is to attain or maintain health through modifiable behavior. Nevertheless, most people don’t visit dental hygienists with the intent of being educated. They want a cleaning and perceive the education as a lecture that interferes with the experience. We will not dispel this myth simply by going through the motions of oral hygiene instruction. Clients need to have authentic interest in learning their part in the provision of health care before any education will be effective.

We can gain each client’s interest in oral health by making it personally important to him or her. Personal conversation develops rapport during a client’s initial appointment. Toward the beginning of additional appointments, it helps us gain insight into that client’s values so we can individualize instruction in the way that a periodontal examination leads us to individualize mechanical dental hygiene care. People become interested in the education we offer when they recognize that it meets their personal interests in fulfilling a perceived need.

Understanding how adults learn will help us educate clients in our chairs. Rothwell, Kazanas, Palloff, Pratt, Smith, and Ragan stress the importance of designing instruction to individuals or groups1 rather than attempting to make a one-size-fits-all plan for all clients. Adults typically need a reason to learn why something will benefit their lives or careers. Furthermore, clients come to dental hygienists at will. They do not feel obligated to learn, as they did in grade school. Enforcing education, despite its importance during dental hygiene visits, would be counterproductive as clients tune out or avoid lectures.

Dental hygienists must consider each client’s experiences and interests to provide the most effective oral hygiene instruction. In many cases, we might need to provide information that alters clients’ sense of self so they will be receptive to instruction. For example, a person who rarely flosses might consider himself or herself perfectly healthy and think that flossing makes the gingiva bleed. A dental hygienist might need to show that client several healthy areas on facial surfaces to compare with the unhealthy interproximal areas to increase the reservoir of knowledge, and might need to explain the systemic relationship to oral health before that person will be interested in interproximal home care. Dental hygienists also might need to offer alternatives to floss with which the client is more familiar.

Rothwell et al. describes adulthood in stages. In the early stage, people form their families and careers. Their interests in learning revolve around developing values, accepting responsibilities, and gaining employment. The middle stage of adulthood includes people moving from operations into supervisory positions and bringing their children into adulthood. Their learning needs concern redefining themselves and their environments. Adults in the later stage face retirement, grandchildren, and loss of loved ones. They must learn to keep current.1

Dental hygienists can refer to the interests clients face as they progress through life. We can appeal to individualized needs. A young adult looking for a job or hoping to meet Mr. or Ms. Right is likely to consider appearance a high priority in his or her oral health care decisions. Such a person might also be short on cash. This is an opportunity to plant the idea of inexpensive, prevention-oriented health care as an investment in health that saves money. A more mature adult might emphasize function, considering that a small investment of time to prevent disease or treat it early in its progress would lead to less time spent in the dental chair later with more time for work and family. An older adult might be convinced of the value of oral health care on the basis of comfort and longevity of life.

Rothwell et al. also stresses the importance of respecting the learner’s present level of knowledge.1 An effective dental hygienist will guide an intelligent client in the process of home care rather than make the client a passive recipient of instruction. This is important in addressing the actual educational needs of the client and providing an atmosphere in which the client will feel he or she is being treated appropriately. A person who generally brushes thoroughly might need advice on improving the technique in only one localized area.

These authors also suggest a learning contract consisting of five points to clarify for the learner:

1) Objectives
Method to accomplish the objectives
3)A completion date
4)The data that determine success
5)Measurement of data 1

This contract fits into the dental hygiene process of care to the extent that it relates to client behavioral changes. The assessment provides initial data needed to produce a dental hygiene diagnosis. The dental hygiene diagnosis defines the behavioral deficits that the dental hygienist and client hope to overcome. The objectives can be defined in an instructional plan that will overcome these deficits. The plan is implemented through methods to accomplish the objectives and a time line. Finally, evaluation measures changes in data between initiation and completion of the contract to determine how well the objectives were met.

The periodontal exam and expected improvements if home-care instructions are followed and accentuate the educational experience. They give your client an attainable goal, a way to achieve that goal, and a way to determine whether that goal was achieved. As you call off pocket depths, bleeding, and other signs of periodontal disease, many clients will recognize whether there are improvements since last time.

Listen to cues your clients offer when they introduce themselves or raise concerns about the treatment you recommend. Common concerns for clients are cost, systemic health, and time constraints. As you see concerns pop up frequently in your office, practice short speeches that appeal to those concerns so you will feel comfortable responding as clients express needs. For example, if a person asks about cost or insurance reimbursement, discuss fees for the procedures and explain how spending a little effort and money on prevention will save money on treatment later. It will pique your client’s interest in your work, including oral hygiene instruction. A person with a family history of heart disease might not be interested in oral health until he realizes that periodontal disease is another risk factor for heart disease. A small business owner might not consider that a few minutes a day of personal care might save her from hours in your chair or the dentist’s chair. Developing client interest in home-care instruction might take several visits. After using this technique for several years, I have many clients who ask for instruction rather than wait for me to offer it.


1. Rothwell W, Kazanas HC, Palloff RM, Pratt K, Smith PL, Ragan TJ. Instructional Design. Phoenix: Wiley; 2002.

2. Rose AD, Leahy MA. Assessing Adult Learning in Adult Settings: Current Issues and Approaches. Phoenix: Wiley; 2002.

Malcolm Knowles is one of the most influential theorists on learning, particularly on adult learning, or andragogy. His theory is based on five assumptions that educators make when working with adults and younger students who are in adult roles as students, where they are consumers rather than a captive audience. Rose and Leahy describe these assumptions:

1)Experiences are an important reservoir of knowledge.
2) Learning aims at personal development.
3)The learner rather than teacher guides the course of study.
5) Education must be in the context of the learner’s social roles.
6)The diverse experiential nature of adults leads to problem-focused learning rather than subject-focused learning.2