In practice

Practice identifying Toothpicks behaviour change techniques

Read through the following three cases carefully and think about how you might use the Toothpicks framework to discuss behaviour change in these examples.

Example 1

"Ali is a 15 year old male who is attending your practice for a filling, accompanied by his father, Abdul. Ali has a history of extractions and restorative work throughout childhood and has received lots of information about brushing techniques and cutting down on sugar in his diet. You note that his records show regular applications of fluoride varnish. Ali and Abdul both state that Ali eats healthily at home, and Abdul stresses that he always nags Ali to brush his teeth in the morning and before he goes to bed. Despite this, Ali still presents with poor oral health.

Ali’s teeth show some enamel erosion consistent with fizzy drink consumption. Upon further questioning, Ali discloses that he has a weakness for Dr Pepper, but states that he “doesn’t drink that much, so that can’t be the reason”. Abdul states that his teeth have never been any good either, it must be something that runs in the family. Ali goes on to talk about his Grandmother, who he states also has poor oral health, but she is always eating sweets and baking cakes – he knows this as he goes to stay with her often. Ali expresses frustration with his need for dental work and the possible aesthetic effects, but doesn’t think there is anything he can do.”

What cues are available to introduce conversations about behaviour change?

What conversation would you have/what could you say?

What other information would you want to know from Ali?

What techniques would you use?


Example 2

“Richard is a 42 year old man who attended for the first time as an emergency appointment, complaining of pain in his left lower 2nd and 3rd molar. Upon examination, both teeth reveal extensive caries with indication for extraction, with most remaining teeth showing signs of developed caries. Richard needs a referral to hospital for these extractions.

Richard states that he hasn’t visited a dentist in 6 years, and he only goes to the dentist when he is in pain. He doesn’t see the point of check ups, “they are just wasting NHS money, going when there’s nothing wrong”. Plus he works long hours as a boiler repair man and doesn’t have time to have check ups.

While taking his medical history, Richard reveals that he has recently been diagnosed with unstable angina and has consequently given up smoking. He also asks for teeth whitening prices, stating that he would like to get the nicotine stains off now he has given up smoking. He also discloses in an offhand way, that he might join an online dating site in next year, if he has whiter teeth and manages to lose a bit of weight. “

What cues are available to introduce conversations about behavior change?

What conversation would you have/what could you say?

What other information would you want to know from Richard?

What techniques would you use?


Example 3

“Laura is a 36 year old single mother who has visited your practice for one of her regular scale and polishes. She practices good oral hygiene and is proud that her children have good, healthy teeth, and that she has only two fillings in her teeth. Laura complains of a reoccurring ulcer on her lower lip, which is currently reduced in size and not bothering her, however it is prone to flaring up and often becomes larger and more irritating. You notice that she has staining consistent with nicotine use on her teeth.

Laura states that she only smokes when she has alcohol, and she will think about cutting down or giving up when she is older or if her life becomes less stressful. She drinks some alcohol roughly 5 nights per week. At the weekend when her children are at their dad’s she drinks around 20 units of alcohol, and has “a glass or two of wine” during the week. She does not drive and walks most places, feels she has a healthy diet and states that overall she feels her lifestyle is healthy despite her being on a low income.”

What cues are available to introduce conversations about behaviour change?

What conversation would you have/what could you say?

What other information would you want to know from Laura?

What techniques would you use?