Patient care

“Let’s guide our patients instead of telling them what they should do.” Prevention expert’s tips on how to develop positive habits around interdental brushing

The basis of new behaviour is it being a learned skill.

Are you a dental professional keen on prevention, but struggling to find effective ways to make interdental brushing part of your patients’ daily cleaning routines? Let’s have a look at some practical tips on how to support your patients in developing the habit of using interdental brushes daily, provided by experienced dental hygienist and dental therapist Theodora Little, RDH, RDT.

1. Skills to be learned

According to Theodora Little, cleaning teeth is a behaviour. And if it was as easy as everyone believed it to be, then, well, half the world’s population wouldn’t be suffering with oral diseases. “How did you learn to swim, or ride a bike? Did you watch a video? Did somebody do the activity whilst you watched them? I think not. So first things first. To be able to regularly carry out any behaviour ourselves, we have to start by learning the necessary skills to be able to perform that behaviour.”

2. Become an expert in the activity

As a dental professional, you have to become an expert in how to use the interdental brush, and how to ensure both you and your patients are using the right size brushes. “The more we practice on ourselves, the better we can teach the best techniques to our patients. When educating our patients on how to clean between their teeth, we first have to ensure we are recommending the right size of interdental brush, and then we need to help them learn the skills necessary to carry out that behaviour,” adds the prevention expert.

3. Teach your patients the right skills by involving more senses

The most engaging and connecting of learning strategies are those that involve all of our senses, with the main one being touch. Theodora explains: “A deeper learning experience is created when the patient can feel what they should be doing. Teaching learning skills on a mouth model just isn’t going to cut it. For patients to fully learn, we have to touch to teach.”

4. Educate your patients on why their gums are bleeding, and why interdental brushes work

Theodora emphasises the importance of the form of education. For it to be effective, it can not be boring or too academic. “Please don’t just show your patients what they need to do via a diagram or flip chart. We also have other capabilities, such as using a Bleeding on Interdental Brushing (BOB) Index. Now, by completing this index, not only are you creating a valuable record, you are also starting the process of showing the patient the techniques needed to use the interdental brushes effectively.” By using a bleeding on interdental brushing index, whilst the patient is watching in a mirror, can give the opportunity to learn and understand that the bleeding has occurred from a brush and not a probe.“As we know, there is inflammation present for this to happen, yet many patients instant reaction is that you caused the bleeding from the sharp probe. By using a brush, this can give a different feel and perception to the patient and therefore a better understanding and deeper learning experience around why there is bleeding. This can be ignited in the patient from you simply using a different tool which is the very tool that will also support the subsiding of the bleeding the more they use it,” Theodora explains. 

5. Guide your patients instead of telling them what they should be doing

According to Theodora, true empowerment comes from finding our own answers. Empowerment is a self-motivational tool, so motivational interviewing skills are a great tool to use with your patients. “This is a huge subject in itself, but the key is leaving open-ended questions that guide the patient into finding their own answer as to why they want to do something, instead of being told they should do something. “Should” and “want” create a very different emotion and people are more likely to carry out behaviours in which they “want to“ instead them feeling they “have to“. 

Have help at hand – get the Curaprox Chairside Box

To reach the goal of changing your patients’ habits and getting them used to daily interdental brushing, there is help in the form of our practical Chairside interdental box. The box includes interdental brushes of five different sizes and colours (with insertion diameters of 0.6mm to 1.1mm), an IAP (Interdental Access Probe), and IACs (Interdental Access Chart). You can keep it just an arm’s reach away from the dental chair while measuring your patients’ interdental spaces and instructing them on how to use the interdental brushes correctly.

Thanks to the Chairside Box you’ll also be able to gift your patients with some IDBs of the correct sizes, and their corresponding personalised colour-coded chart, which the patient can use at home as a reminder of the correct interdental brush they need for every interdental space.

6. Let’s talk about rewards

Ask yourself, how do you reward your patients, or how do you help your patients find their own reward? Rewards condition us to continue a behaviour. But first we have to cue our patients in knowing and noticing what their reward will be. “This reward can start the craving, not the habit itself. Yet it has the power to create the necessary change. For example, you may wish to reward your patient with a free Curaprox 5460 toothbrush on their next appointment if their bleeding-on-brushing score improves by e.g. 10%. Or you can guide your patient to their own personal reward: an emotion, something that is important to them, something they crave. It may be as simple as feeling the air between their teeth, or having fresher breath. You can also get them to smell the interdental brush, which is used in between their posterior teeth, just as a point of reference. Because smell is again one of those special senses that is part of a deepening and connecting learning experience,” explains Theodora.

Changing or implementing new habits isn’t just about teaching the necessary skills. There are other factors involved, such as the time you dedicate and the passion you share with your patients. It also takes a shift in mindset to be able to implement those new skills into somebody’s already busy daily schedule. It is a very challenging task to truly motivate someone to change their daily routines for the long-term. There has to be consistency given. “It is important to remember that prevention is a treatment and for there to be a change in how we provide prevention, and how patients accept prevention, we first have to create a change. Prevention is the priority and prevention must be profound. So also, as a final message, please try to include some fun because quite frankly, the industry can be a little bit snooty and scary for many patients,” concludes Theodora.


Theodora Little is a dental hygienist and dental therapist who qualified from Kings College London in 2013. Theodora has worked in a vast variety of dental areas for almost 15 years, however in the last few years Theodora’s passion for prevention and behaviour change has taken her around the world, working in Europe, Asia and the United States. Thanks to Theodora’s keen interest in patient behaviour within dentistry, she had the opportunity to join a project, Prevention One, which provides digital health to support clinicians and patients in prevention. With Theodora’s clinical experience within practice, she supported the clinical development of the Oral Hygiene Apps for Hygienists. Theodora now lectures worldwide on communication and behaviour change with prevention and how certain technologies can aid clinicians in this vital aspect of patient care. Theodora’s aim is to always support her fellow dental professionals from around the world, who may struggle with the everyday challenges they are faced with, and to work together with the aspiration of creating prevention as a number one priority.