INTRODUCTION TO HEALTH BEHAVIOR CHANGE FOR THE DENTAL PRACTICE
Health professionals working in this century are presented with a unique combination of patient care scenarios. The unprecedented advances in the development of scientific knowledge, means of knowledge dissemination, clinical skills application, public health initiatives, and workforce diversity are well recognized in today’ s health care environment. However, many additional factors influence the opportunity for patients and clinicians alike to achieve the goal of attaining health and continued wellness. Some of these may be derived from catastrophic events associated with the conflicts of war, natural disasters, and critical socio- economic factors. Others are more reflective of circumstances for individuals and the lifestyle choices they make throughout their lifetime. In many situations, health status is not a result of the influence of a single element working in isolation. It is more likely that we see a number of components present in the overall environment in which the patient chooses to exist. The acknowledgement of the potential impact of a variety of influences on health status allows the health professional to work with the patient to understand the individual approach for optimal wellness. As oral health professionals, this recognition is integral to the future development of patient care plans that are not limited to treating the signs and symptoms of common dental diseases.
There is increasing evidence suggesting oral health status can affect general health and quality of life in people of all ages. Most oral diseases are common chronic diseases and are momentous public health issues with a high prevalence across all populations worldwide. Some of the etiologies of oral diseases are well known. They include (1) the causal factors induced by oral biofilms, and (2) the lifestyle risk factors common to a number of chronic diseases: insufficient oral hygiene, tobacco use, diet, behaviors causing injuries, and stress. All of these elements are modifiable and associated with the influence of health behaviors as determinants of disease prevalence.
As we are living in a century of heightened awareness of chronic diseases, health care challenges are becoming more diverse, with an increasing percentage of the population in the developed world being diagnosed with health decline associated with “lifestyle” behaviors. Therefore, the health professional is continuously presented with a dual focus — control of current disease while facilitating the understanding of continuous self- management as part of an effective and equitable long-term solution. Oral health professionals are not exempt from this approach to patient care as we continue our efforts to manage common oral diseases as a chronic condition rather than simply treating the sequelae of acute episodes. This introductory chapter sets the stage for this book through a discussion of past, current, and future understanding of the dental clinician as a health professional supporting the promotion of total health rather than a provider of operative dentistry alone.
There is substantial evidence that oral health can be maintained by ade- quate behaviors such as regular oral hygiene, avoidance of tobacco, and consumption of a healthy diet. Future public health policies should be reoriented to incorporate oral health practices recommending behavioral support and the common risk factor approach for health promotion. Oral health care professionals should gain an understanding of the health effects of inappropriate behaviors in order to successfully target prevention and disease control. As a consequence, services for primary and secondary prevention on an individual level oriented toward the change of inappropriate behavior will become a professional responsibility for all oral health care providers.
From a practical point of view, it may be preferable to apply methods for health behavior change counselling in oral care that are shown to be effective in both primary and secondary prevention of oral diseases. These methods should be
- based on the best available evidence,
- applicable to oral hygiene behavior, tobacco use prevention and cessation, and dietary counselling, and
- suitable for implementation by the dental practice team in a cost- effective way.
The dental setting provides a unique environment for the provision of care for a range of health issues. For some time, in many developed nations, people have tended to visit the dental practice more frequently than they visit the medical practitioner. They have been more likely to seek medical advice when they are experiencing discomfort or have recognized symptoms that require assistance. The concept of the regular, 6 – month “dental check – up” has enjoyed strong recognition and relevance with many members of the public. In more recent times, health practitioners and public health care initiatives have embraced the concept of regular visits as part of a monitoring/preventive approach rather than a response to an acute episode. This frequency of visitation has allowed collaborative patient care plans to develop with interprofessional exchange. For example, many optometrists regularly screen for signs of diabetic retinopathy as a possible indicator of undiagnosed diabetes or as a consequence of managed diabetes. Within the context of the dental setting, a patient may be a part of the practice for many years and, in some cases, a lifetime. Additionally, the practice may also provide care for the patient’s family members and their friends, who all form part of the individual’ s environment and lifestyle. This unique situation allows the oral health professional to acknowledge and gain a broad understanding of the myriad of influential health care factors associated with patient care. The dental setting, therefore, provides a privileged situation in which the dental professional can realize the opportunity to form a lon/>