For many years now I’ve been absolutely fascinated by the small things that influence and encourage us to behave in certain ways. These small ‘nudges’ and ‘pushes’ may lead us to choose one brand over another, or even alter our daily routine.
As dental professionals we are in a prime position to similarly influence how people behave, though generally speaking, we are not very good at it. This may be because we don’t have the time, desire or even financial incentive to have a lasting impact on people’s lives. After all, we only see patients for a limited period, and changing behaviour takes time. Simply giving advice very rarely works as people listen, leave the practice, and return to their normal routine as they have no motivation to follow up on the things that we suggest.
The problem is that many people are not inclined to take advice if they don’t see immediate benefits. Take blood pressure tablets for example. This medication has very low levels of compliance as patients don’t see any direct benefits and therefore don’t appreciate the difference the medication makes. While a doctor may note a five-point drop in systolic blood pressure, this figure is completely academic from the patient’s point of view. It’s not until they actually meet someone who has suffered a stroke that they realise the awful consequences high blood pressure can create. The same is true of oral hygiene.
As dental professionals we all know the importance of regular twice-daily brushing, but to a patient, brushing might not seem like it makes a real and practical difference. It’s not until their oral condition deteriorates over time that they start to see a physical consequence of their poor habits – and by then it’s often too late.
Not so intelligent
Changing routines is no simple matter. We rely on people to be intelligent and motivated, but at the same time people are free to do what they like (within the boundaries of the law). So while we all know that we shouldn’t smoke, people still continue to light up, despite our best efforts to the contrary.
But this doesn’t mean we should give up! In their book Nudge, Thaler and Sunstein refer to something they call ‘libertarian paternalism’ – that is, that people are free to do what they want, but we really want them to act in their own best interest. We want people to act in a way that is positive to their wellbeing, despite the fact they may be tempted to act in other ways. We just need to find new and innovative ways to nudge them in the right direction.
A helping hand
Modern technology can be a great help in our mission to change patients’ habits. Mobile phones for example are an excellent tool, and there are literally hundreds of lifestyle apps out there that can send messages of encouragement and help to track progress.
I am also really intrigued by the new wave of ‘smart’ toothbrushes set to be launched this year. While I am sure some colleagues will perhaps doubt whether these brushes will really make any difference, I believe that any device that has the potential to influence people’s habits is a positive thing. After all, with oral hygiene it’s not so much the cleaning that’s important; it’s the motivation to do it each and every day. If a toothbrush that tracks brushing habits makes a difference, then that’s good with me!
Incentives
At the end of the day, we all need incentives. Though we may not like to admit it, we also all need to feel warm and loved. As the proverb goes, ‘Where there is no vision, the people perish’. So, if a lifestyle app, or a smart toothbrush makes oral hygiene measurable so that the user feels good or virtuous about their brushing activity, then that’s a good thing in my book. After all, there’s nothing worse than being unacknowledged, and some people just need that extra bit of encouragement to change their habits over time.
It is very easy to be cynical about any sort of ‘smart’ device that measures an activity and lets you track your progress – especially if it’s for something as simple as brushing your teeth. But then, as we know, not enough patients do brush their teeth, so maybe it’s not as rudimentary as we think.
There is also, I suppose, the argument that anyone who uses an item such as a smart toothbrush probably isn’t the sort of person who needs to use one in the first place. But then, even if that is the case, if it encourages people to actively engage in their oral health, then that can’t be a bad thing, can it? Who knows: one thing may lead to another and it may even encourage others to also think about their mouths and the things they can do to improve their oral wellbeing. After all, all it takes is a simple nudge…