CDA Essentials 2019 • Volume 7 • Issue 2

28 | 2019 | Issue 2 S upporting Y our P ractice Visit CDA Oasis to hear Dr. O’Toole discuss her research findings and behaviour change intervention to help patients change their dietary habits: Does it matter if the acidic foods/drinks are consumed with meals? Yes, the risk was almost halved when these were had with meals. There were also different risks for drinks than for fruit. When fruit was consumed with meals there was no increased risk of tooth wear even when fruit was had with every meal. But when fruit was consumed outside of meals, the risk of tooth wear increased with the number and frequency of fruits eaten between meals. In contrast, acidic drinks were significantly associated with tooth wear, whether a person drank them with meals or between meals. What kind of advice can we give to patients who are concerned about tooth erosion? There is good evidence to suggest that only giving patients dietary advice like “Cut down on the amount of juices or carbonated drinks you have,” is ineffective in changing behaviours. So our research team developed a behaviour change technique called an “If-Then Plan,” which helps individuals plan how to make the change. In a randomized controlled trial, we gave basic dietary advice to half the group, while we gave the other half an If-Then Plan. We found that both groups claimed they reduced their dietary acid intake but only those who had the If-Then Plan actually showed a reduced amount of tooth wear over the six-month period. So we think the behaviour change intervention is more effective than advice alone in helping patients change their dietary habits. How does an If-Then Plan work? The If-Then Plan gets the patient to identify the behaviour they want to change, the dietary substitution they would make, and the steps they would take to make a change, which involves identifying any obstacles to making a substitution and how they might overcome that obstacle. For instance, I tell my patients, “If you want to have an acidic fruit or drink, have it less than daily and then if you are going to have it, try to have it with a meal.” And then I also try and incorporate some type of planning. So I might say, “When you go for your juice in the morning, what could you have instead?” And then they will usually say something like, “Oh, I’ll just have water,” which I think the patient may find to be an unsatisfying substitution. So I’ll say, “Is that going to be a nice enough drink for you, or is there something else that you’d prefer?” Or if they usually have a cola drink, I ask if they are looking for the fizziness or the caffeine, and then ask what would help them make a change. How does an If-Then Plan differ fromMotivational Interviewing techniques? Motivational Interviewing (MI) has also been tried in dental practice to change behaviours and there is evidence showing that it can be effective. However, MI techniques require intensive training and are reliant upon a good rapport between the patient and the clinician. This may not be possible to build in a single dental examination. In contrast, this behaviour change intervention is directive and prescriptive while requiring little training. The clinician and the patient quickly identify which behaviour they are going to target, make specific plans to target the behaviour, discuss obstacles to the specific behaviour change and plan to overcome these obstacles. This can be done objectively without establishing a strong bond. Planning actions have been successful regardless of motivation levels of the patient, which again contrasts with motivational interviewing techniques. What were your findings on dentin hypersensitivity? We know that dietary acids can cause dentine hypersensitivity. Our research showed that factors related to how the food or drink is consumed, in terms of the contact time with dietary acids, was a bigger predictor of dentine hypersensitivity than it was of tooth wear. People with dentine