Amanda Gallie, current President of the British Association of Dental Therapists, looks at how to persuade patients to make oral health during orthodontics a top priority.


There are various oral hygiene risks associated with orthodontic treatment. Essential to the prevention of tooth decay, white spot lesions and gum disease, is good oral hygiene. In my experience there are four cornerstones to achieving good oral hygiene:

  • Awareness – of the oral hygiene risks associated with the treatment be undertaken
  • Products – the right tools for the job
  • Technique – having the right products is no good if patients don’t know how or are unable to use them correctly, due to lack of dexterity
  • Motivation – patients need to be made aware of how they are doing and encouraged to up their game if they are falling short in their daily care regime.

With patients returning to the practice at six to eight-week intervals, orthodontic practices are better placed than general dentists when it comes to creating and establishing change and compliance. It is our duty as professionals to make the most of this frequent face time to ensure that patient oral hygiene is being maintained at the desired level and intervening when this is not the case.

Leaving a Legacy

Oral health compliance more often than not involves changing behaviour. Health behaviour change is a science in itself and one which demands several elements: education, awareness, time and the desire to do it. However, a lack of time and financial pressure can make this difficult; and the opportunity can be somewhat underutilised. So we need to ask ourselves, ‘what legacy can I leave with the patients that I come into contact with?’

I often talk of the legacy that having contact with orthodontics leaves behind. If time and care is taken, a patient can achieve optimal oral hygiene, experience dental health and assume dietary habits that will keep them on the right track for life; not to mention a fantastic smile which boosts confidence, well-being and personal success.


Team training in behavioural change is a good investment of time. Bringing the team together to galvanise messages, aims and objectives sets the scene. After all we are all there in a role to provide care, support and expertise. Oral hygiene product awareness is also an important consideration; all patient facing members of the team need to be clear about the products being recommended to patients, their correct usage and application.

Patient oral hygiene education is probably best carried out in a non-surgical room. Clinical treatment rooms can be too traditional; where the patient sits in a supine position, creating a submissive role while the clinician is in control in their chair.

Try and create a space for education where training materials are close to hand and sessions can take place in quiet and at a comfortable temperature. Creating different types of visual stimulation can help to inspire, activate and create awareness. Ensure there are facilities for disclosing and clearing up.

Communication Skills

Many of us underestimate the power of good communication skills. May I suggest that you create a written dialogue card for staff to use and practice from. In the early days, find time to act out role-play situations; do this as often as you can until you feel truly comfortable with the words, the delivery and the demonstration of the oral hygiene aids. Alternate either demonstrating on yourself or on a model. Ask the patient how they would like to see the demonstration. Would they like you to demo on the model or you yourself? The more you practice, the better the results will be.

Getting patients to comply with oral health messages requires a positive effort all round; the process involves a collaboration of patient, clinician, nurse and front desk staff. In my next piece we will cover communication styles and the delivery in some detail.

When asking patients about their oral health habits you need to tread carefully. Rather than asking, ‘How often are you brushing?’ ask, ‘How are you managing with your brushing?’ This is an open question and creates more dialogue and is less intrusive and nosey!

Support and Goals

Behaviour change and adaptation is hard and wearing a brace and cleaning a brace can also be challenging. There will be times when a patient may need our support; it may be that the need is not dentally related at all. However, remember this; it is easy to forget when we are giving instruction that there is a person at the other side of the table who has feelings and that person needs to decide to make the change. Always try and praise a patient for something during your session and provide reassurance. Showing that you care is paramount.

Finally to bring it all together, we need to explore goal setting. When delivering your message try and work towards a level of consistency in terms of advice given by all members of the team.

It is a good idea to create a worksheet for you and the patient, explaining needs and benefits for each product being recommended. I would recommend that patients be provided with a copy to take a home; and a time is arranged before or after a subsequent appointment for the patient to attend a review. At this time you can take stock of the patient’s oral health status, levels of compliance and motivation.

Good luck with your motivational changes!