Dear Barry, how can I motivate my patients to clean interdentally?

The answer lies in patients developing the habit. Habits are recurrent and often unconscious patterns of behaviour that are developed through frequent repetition. A habit can also be thought of as a link between a stimulus and a response. It serves as a mental connection between a trigger thought or event (stimulus, trigger or cue) and our response to that trigger (the response or routine).

Repeating this connection forms a habit and, if repeated often enough, this connection becomes near permanent unless we take conscious action to change it or something occurs to break the link (for example, running out of interdental brushes and not replacing them for several days).

Right on cue

When we think about motivating someone to clean interdentally, we run into the obstacle of the ‘cue’. An example of an everyday cue is putting your seat belt on straight after getting into a car and closing the door.

I used to ask my patients to brush morning and night – ie twice a day – and to clean interdentally once a day. The issue with this approach is that it reduces the chances of tooth brushing being the ‘cue’ to their interdental cleaning. It’s almost impossible to create a habit linking brushing and interdental cleaning if we expect them to brush once a day without cleaning interdentally and brush once with; there is no consistent link.

A great act to follow

I have had a great deal more success with my patients developing good interdental cleaning habits by asking them to link the action of cleaning between the gums to a ‘cue’ other than tooth brushing that happens only once a day.

My most successful results have come from the link between showering and interdental cleaning. I ask my patients whether they shower or bathe every day (so far, they have all answered yes to that question). I then explain that it’s hard to create a habit of interdental cleaning with twice-daily tooth brushing and so I would like them to begin to link the use of an interdental brush with washing.

I invite them to purchase a fluorescent flossing device and bright brushes from reception. These are easily spotted, and I recommend that, for the first few weeks at least, they are kept within in their eye line when in the shower.

Over time, the habit of interdental cleaning is developed because it becomes a part of their once-daily showering routine rather than their twice-daily brushing routine.

The reason why

The reason why a patient should clean interdentally might seem simple. You might say, ‘To keep your teeth clean’.

But that isn’t a deep enough reason for someone to adopt the habit. To be motivated to do something, it is important to have an emotional reason. So, as human beings we are motivated, in part, by avoiding pain and gaining pleasure. Interdental cleaning helps reduce bad breath, whilst not cleaning interdentally increases bad breath. Bad breath can lead to rejection, embarrassment, negative comments, becoming self-conscious, loss of confidence etc, and there we have the reasons to share with patients to motivate them to form the habit.

Make it easy

In my experience, making the action of cleaning interdentally easy overcomes many patients’ objections, such as, ‘I can’t reach my back teeth’, ‘I’m all fingers and thumbs’, ‘I hate flossing…’.

Recommending simple products like flexible interdental brushes that don’t easily bend out of shape can overcome such perceived difficulties. Advocate larger handles for someone with poor dexterity.

Make it clear that these products are easy to buy, either from the practice or the patient’s usual supermarket. Once the habit is formed, running out of brushes will almost always result in patients breaking the habit of interdental cleaning, so this is key. In fact, you may even want to consider setting up a regular postal delivery for patients, to ensure this never happens.


For more information on The Confident Dentist and a free video on how you can improve your communications with your patients and your team, visit www.theconfidentdentist.com.