WHEN AND WHERE TO MOTIVATE

WHEN TO MOTIVATE

From clinical experience the authors consider that the best time to perform
motivation activities is before the oral hygiene session for the first time. Placing
such motivation before everything else puts it in a special light, emphasizing its
importance. In this case, what is being said will have a greater effect on the patient
who, in turn, will get much more out of the motivation. Moreover, prior to the
hygiene session, the patient will be much more attentive as he/she does not yet
know what is going to take place. He/she may be on the defensive and thus less
relaxed. Nevertheless he/she will also be more stimulated and receptive to any
outside stimuli: he/she will be more willing to listen.

The most important information must, therefore, be given right away, when patient
curiosity is at its peak. On the contrary, if the verbal communication is left to the
end of the session, it may fall on deaf ears: the patient may be uninterested and
distracted (FIG 1). He/she may already be thinking of what he/she must do after
leaving the office and, therefore, anxious to get going or he/she may be distracted
by the pain or irritation that such techniques as scaling or root planing can cause
(FIG 2). Indeed, particularly in the latter case, forcing a patient to spend even more
time listening to the hygienist or dentist "preach" could prove quite irritating. If
this is the case the patient could be alienated which, of course, would be counter-
productive to gaining patient cooperation. Furthermore, from a strictly clinical
point of view, it is not advisable for the patient to try out the appropriate brushing
techniques when blood clot has formed in the oral cavity. Indeed, this could
interfere with the healing process.

During the first session it is therefore essential that motivation be given absolute
priority, at least in terms of providing the most important information and oral
hygiene instructions. Providing secondary information can be postponed.

Thereafter, in subsequent sessions, it is up to the hygienist to decide whether to

renew motivation activities at the mid-point or at the end of treatment. In the latter
case, the most "critical" zones, neglected by the patient, can be more carefully
evaluated.

WHERE TO CARRY OUT MOTIVATION

The place where motivational activities are most commonly implemented is in the
dental chair. The patient sits upright with the back of the chair perfectly vertical
and at eye level with the hygienist. This minor psychological insight serves two
purposes: it captures the patient's attention more fully and, at the same time, puts
him/her at ease (if the hygienist were sitting above the patient he/she might feel in a
position of inferiority and, therefore, be ill at ease and less relaxed). All instruments
(curettes, scalers, etc.) should be carefully covered because a glimpse of them can
be a source of anxiety. (FIG3)

The patient is carefully instructed and then, while still in the chair, performs the
brushing maneuvers just learned. Brushing is practiced with the aid of a mirror
(set on a base) placed in front of him/her on the tray of the dental unit, thus leaving
both hands free to facilitate the required movements (FIG4). Good lighting is
essential so the lamp of the dental unit should be on and focused on the patient's
mouth.

Some dental offices have a special area for motivation. In this case, a room is
equipped with a large mirror and counter and, ideally, a sink (FIG5). The patient is
accompanied by the hygienist and, under his/her supervision, can practice the
hygiene techniques in a tranquil atmosphere, away from the sight of any anxiety-
producing items (i.e. the dental chair, instruments, etc.). In addition, not only is
time being dedicated to motivation but a special area has been set aside as well.
This lends credence to this moment, making everything said and taught on this
occasion quite special. Therefore, having a separate room for patient motivation is
certainly advantageous and can increase the effectiveness of the motivation itself.