So far in the last three articles we have covered the following blockages to the uptake of periodontal care by our patients:

• Initial attendance or failure to come in the first place

• Lack of case acceptance or the failure to sell the necessary care.

Now I would like to consider the last two areas:

• Compliance with preventive strategies

• Failure to attend recall visits.

Why don’t patients do what we ask of them? The failure to comply with periodontal preventive advice and the failure to attend recall visits are major reasons why periodontal care will ultimately fail.

I believe communication is the main problem. With regards to patient compliance, we must ask the question as to why patients fail to clean their teeth daily?

• The lack of education. Patients must understand the disease process; that they have the disease (they must own it) and what the consequences will be if the disease process continues. They must know which cleaning aids to use and how to use them.

This is where neurolinguistic programming (NLP) can be extremely useful in that it allows us to communicate with patients in a language that they understand. Show, tell and do is a well-known and extremely useful process in the education of our patients. NLP is also an extremely useful technique in the sales process. I will cover NLP further in a subsequent article

• They get bored. Daily oral hygiene regimes, particularly in periodontally susceptible patients, can be onerous. Teach patients simple techniques and do not overburden. If you overburden patients they are more likely to give up. Remember that they have a life outside of teeth

• They run out of stuff. If a patient runs out of interdental brushes, for instance, they will not be able to clean interdentally in an effective way. Consider getting patients to leave the practice with three months’ supply of interdental brushes

• Patients must be reminded and motivated on an ongoing basis. The further patients move away from their last appointment the less their compliance with procedures

will become.

Keep them coming

In specialist periodontal practice there is a very high failure of patients to attend recall visits. How can we keep our patients coming?

• Look after them in the first place. Make sure that patients perceive high value and are then reminded of this. A cardinal rule is to avoid hurting the patient. If you do they are highly unlikely to come back

• Keep reminding them. Send out newsletters, ring patients to remind them of appointments and generally keep them on board

• Innovate. Keep the practice, its philosophies and treatments, new and fresh whilst maintaining the core of the practice. Patients like to see continuity but also that things are kept to up-to-date

• Consider patient payment plans so that money becomes less of an issue on an ongoing basis.

Patient behavioural change is crucial in periodontal care. It may even be considered the most important issue. Failure to implement behavioural change as a fundamental part of a practice will be detrimental to both our patients and ourselves.