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Lose the “plaque lecture”: Real talk with dental patients

Sept. 15, 2021
It’s time to get away from the same speech that most patients have heard over and over. Anne Nugent Guignon, MPH, RDH, CSP, offers advice and conversation-starters for having better, more productive conversations with patients.

Most people are smart and can quicky spot a canned conversation that is based on a prepared script. Dental patients have the “plaque lecture” memorized.

Patients expect it, and as a result, they often ignore our warnings. And honestly—many clinicians are bored with the chat, as well.

Information needs to be accurate and up to date, and the delivery needs to be genuine. If not, the message goes nowhere, and patients mentally disengage.

Is there a way to construct a conversation that allows a patient to discover information beyond the classic plaque talk? Of course!

One of the first steps is to drop the word “plaque.” Substitute it with biofilm and provide a short, one- or two-sentence explanation about why the term has changed.

The conversation can go something like this: “Bacteria love living together in slimy, sticky communities called biofilm. Bacteria cooperate at a very high level, and bacteria that cause disease are determined to survive and cause trouble in the human body. Decay, gingivitis, and periodontal disease are bacterial infections. We simply need to be smarter than the biofilm bacteria.”

A change in “responsibility”

This simple shift in the conversations signals that the tone is going to be different and there is new information.1, 2 Patients are expecting a talk about what they should use to “clean their teeth at home”—most are not anticipating an open discussion about what might fit into their lives. Putting the onus on the microbes changes the focus and implies a new strategic pathway. The shift also gives clinicians the opportunity to customize the plan as well as to explain how oral infections impact systemic health and the role of the immune system in fighting off the attacks.

Creating a different kind of conversation

Conversations need to be science-based but also from the heart. Patients perk up when the words out of your mouth are genuine. What you say needs to sound like you—not an academic lecture.

Here is an effective way to start off: Open with a nonjudgmental question, followed by a phrase that is focused on their needs. Ask permission to have a conversation that is not a rehash of what they’ve heard for years, but instead is intentional and helpful from their perspective. 3, 4

We all communicate differently. Some naturally transition to a new way to open a dialogue, while others simply don’t know where to start or feel uncomfortable with creating a different kind of conversation. If it feels awkward to change the way you are communicating with a patient, think of the process as a conversation between friends, and then think about an opening sentence. It may seem formulaic, but pick an opener from the list below, and then pair it with a closing statement. Once you're comfortable with a few openers, practice the starters with friends until the words feel natural.

Opening phrases

  • Are you open to learning about…..
  • Do you have a few minutes to hear about…..
  • Would you like to hear about other strategies……
  • There has been tremendous progress in what we now know…..
  • We now have other ways/strategies to…….
  • Can I show you another way that could stop/slow down…..

Concepts to keep the conversation productive

  • Reduce your risk
  • Create an environment where bad bacteria can’t survive
  • Add more beneficial bacteria
  • Help support or supplement what Mother Nature does so well
  • Take a load off your immune system
  • Help you fight the infection
  • Easy ways to keep the bacteria at bay
  • Strategies other than traditional string floss
  • Tricks you can do during your busy day

A real-life example

My friend Jeff doesn’t use string floss. How do I know? He has big hands and short, stubby fingers. I know he wants to stay healthy, but string floss is a disaster in his hands. Jeff also spends a lot of time driving and has frequent overnight trips.

Here's how I might open this conversation with him:

“Hi Jeff, so good to see you today! I know you are really interested in staying healthy, but string floss just doesn’t work well in your hands. I get it. Do you have a few minutes today to hear about a new product or two that might be perfect for you?”

Assuming Jeff responds positively, here are three potential replies:

1. “Jeff, there's a new version of a hand-held pick that is super easy to use. It has a longer gripping surface which means you don’t have to put your fingers into your mouth, and it does a really good job of cleaning between your teeth. You can use a pick while sitting in a traffic jam. Here’s a sample pack of the new Gum Soft-Picks Advanced for you to try.”

2. “There is another new product that might work for you, as well. I know you love using a water flosser at home, but you travel a lot. There is a new water flosser that is perfect for travelers. I’ve been using it myself and love the results. All of the components of the Waterpik Sidekick fit into a small, four-by-six-inch case that you can slip into your carry-on. Here’s some information about where you can order this new water flosser.”

3. “I know you were recently diagnosed with type two diabetes and are really concerned about reducing your risk for periodontal disease. Another interesting strategy to explore is PerioProtect Tray therapy. This system uses an FDA-cleared custom prescription tray to deliver a 1.7% hydrogen peroxide gel deep into pockets. The daily 15-minute sessions create an environment that is deadly to periodontal disease microbes. Many people find the trays are easy to wear while they are showering. We are seeing amazing results when people use the trays daily.”

The value of short chats

Boom! A short chat only takes a few minutes. It can be the tipping point when a patient is interested. If a patient isn’t (or gives a huge eye roll), don’t take it personally—they are simply not ready. Anything you say at that point will be considered nagging. Just smile and move on. It’s surprising how many times they will bring the subject up at the next visit!

If you think this strategy can’t work, just give it a try. It may not seem natural the first time the words roll across your tongue, but with practice it becomes easier and easier to offer a more accurate message. The new conversations will be effective when people are ready to hear the new information.

Sidebar: Critical patient considerations

The perfect product is perfect when a patient is interested, sees value, can afford it, can manipulate it physically, and will incorporate the product into their routine. This checklist of what a person will do, can do, and can afford to do makes it easier to find the right product or routine for each patient.

Will do

  • Lifestyle
  • Daily routine
  • Desire
  • Perceived value

Can do

  • Physically capable
  • Ease of use


  • Cost/affordability
  • Easy to purchase
  • Durable
  • Physical space requirements
  • Charging requirements
  • Consumable attachments

1. Vernon LT, Howard AR. Advancing health promotion in dentistry: articulating an integrative approach to coaching oral health behavior change in the dental setting. Curr Oral Health Rep. 2015 Sep;2(3):111-122. doi: 10.1007/s40496-015-0056-9

2. Gao X, Lo EC, Kot SC, Chan KC. Motivational interviewing in improving oral health: a systematic review of randomized controlled trials. J Periodontal. 2014 Mar;85(3):426-37. doi: 10.1902/jop.2013.130205.

3. Wu L, Gao X, Lo ECM, Ho SMY, McGrath C, Wong MCM. Motivational interviewing to promote oral health in adolescents. J Adolesc Health. 2017 Sep;61(3):378-384. doi: 10.1016/j.jadohealth.2017.03.010.

4. Wu L, Lo ECM, McGrath C, Wong MCM, Ho SMY, Gao X. Motivational interviewing for caries prevention in adolescents: a randomized controlled trial. Clin Oral Investig. 2021 Jul 13. doi: 10.1007/s00784-021-04037-w

Anne Nugent Guignon, MPH, RDH, CSP, has received numerous accolades over four decades for mentoring, research, and guiding her profession. As an international speaker and prolific author, Guignon focuses is on the oral microbiome, erosion, hypersensitivity, salivary dysfunction, ergonomics, and employee law issues. She may be contacted at [email protected].