Dental anxiety is common in India: studies report over half of adults feel moderately or extremely anxious about dental visits[1]. In fact, one survey found 82.6% of Indian patients report anxiety specifically about tooth extractions[2]. Since fear can lead patients to avoid care (worsening oral health), Indian dentists must excel at communication and behavior guidance.
By listening patiently, building trust, and applying evidence-based techniques, dentists can transform anxious patients into cooperative partners in care[3][1]. Effective communication—including clear explanations, empathy, and simple language—also improves health literacy, empowering patients to take charge of their oral health[4][5]. Overall, adopting a patient-centered, team-wide approach helps create a calming, supportive atmosphere where fear is met with understanding rather than frustration[3][5].
Motivational Interviewing in Dental Practice
Motivational Interviewing (MI) is a collaborative, goal-oriented counseling style focused on the “language of change”[6][7]. Rather than lecturing, the dentist (or hygienist) partners with the patient to draw out the patient’s own motivations. The patient is treated as the expert on their own life, and the dentist’s role is to guide rather than dictate.
For example, one definition describes MI as “a person-centered counseling style for addressing the common problem of ambivalence about change”[7]. In practice, MI acknowledges that patients may feel torn: “I know I should floss, but it’s so tedious…”. MI aims to explore that ambivalence, strengthen intrinsic motivation, and gently nudge the patient toward positive behavior.
MI is evidence-based and widely used in healthcare for smoking cessation, weight loss, and other habits. It is now being applied to oral health: studies show MI can improve oral hygiene habits in parents of children[8]and even increase the odds of patients returning for recall appointments[9]. Because oral health maintenance (daily brushing, quitting tobacco, routine check-ups) is a long-term commitment, MI is well-suited to dentistry[10][11].
Core MI skills (OARS)
MI practitioners use four fundamental techniques, often abbreviated OARS:
- Open-ended questions: Ask questions that cannot be answered by “yes/no”. E.g., “What do you feel about your oral health right now?” or “How important is it to you to quit chewing tobacco?” This encourages elaboration and self-reflection.
- Affirmations: Acknowledge the patient’s strengths and efforts. (“You’ve done a great job brushing daily for the past week.”) This builds confidence.
- Reflective listening: Mirror back the patient’s statements in your own words, adding empathy. If a patient says “I hate flossing,” the dentist might reflect: “You really dislike flossing.” This shows understanding and can help the patient hear their own concerns from another perspective.
- Summaries: Periodically summarize what the patient has expressed. This lets them hear their thoughts and motivations again. For instance, “So far, you’ve told me you’re worried about bleeding gums and you’d like to find a way to keep your teeth without too much work.”
These techniques help evoke “change talk” – the patient’s own arguments for change. The dentist’s job is to ask questions that draw out the patient’s reasons for improving habits: “How do you think brushing twice a day might affect your gums?” Or “What worries you the most about smoking?” Patient answers reveal personal motivators (e.g., wanting to smile confidently at grandchildren, or avoid medical bills). Emphasizing autonomy (“Ultimately, it’s up to you”) and expressing empathy reduces resistance.
MI for oral health behaviors
In Indian practice, MI can be integrated even in routine visits. For example, when an adult has poor oral hygiene or smokes, instead of scolding, the dentist might say: “It sounds like quitting tobacco would improve your mouth health, but it’s really hard. What makes it hard for you?”
Follow up by asking about past attempts and what the patient found helpful or not. Such conversation can reveal fears (“I’m afraid I’ll gain weight if I quit chewing”). The dentist can then work with these insights: “I understand. Some people find alternative ways to handle stress, like light exercise. Would you be interested in trying something small?” Even if the patient isn’t ready to set a change goal, MI plants seeds for future motivation.
Evidence from dentistry supports MI’s effectiveness: one trial found MI (plus dental education) led to higher brushing frequency and better attitudes in parents of young children compared to education alone[12]. Another study reported MI interventions roughly doubled the odds that parents returned with their children for recall visits[9]. These improvements occur because MI makes the patient an active participant in planning their oral care. Over time, as patients succeed in small goals (e.g., flossing a few times a week), the dentist praises progress and collaboratively sets new targets.
MI session structure
A practical MI conversation in a dental setting might follow these steps:
- Engage: Build rapport (as above) and ask permission: “Can I ask you some questions about your brushing habits?” Make sure the patient is comfortable.
- Focus: Determine the target behavior (e.g., brushing, quitting tobacco) based on the patient’s concerns.
- Evoke: Use OARS to draw out motivations: “You mentioned wanting fresher breath. How important is that to you?” Listen for statements like “I really want to quit, but I’m not sure how.”
- Plan: If the patient signals readiness, help them set a specific goal (“Let’s start by brushing after lunch today”) and make an action plan. If not ready, plan a follow-up: “Maybe think about the pros and cons of quitting, and we’ll chat about it next visit.”
This patient-led approach contrasts with lecturing. The ADA specifically suggests using motivational interviewing and teach-back to educate and empower patients[11]. By focusing on patients’ own values (health, family, self-esteem), MI taps into deeper motivation than simple instructions can.
Case Scenarios
Case 1: Older Patient with Low Literacy.
Scenario: A 68-year-old grandmother speaks little English and has difficulty reading. She comes for dentures but seems confused about aftercare. She appears anxious when given complex instructions.
Approach: The dentist brings in a translator (staff or family member) to ensure understanding. She then speaks slowly, using very simple words and demonstratives: “This is your toothbrush,” “This is paste.” She shows how to clean the dentures using a model, asking the patient to do it herself to confirm understanding (teach-back).
When explaining the denture procedure, the dentist uses drawings or pictures (visual aids) rather than just verbal explanations[11][4]. Each instruction is broken into one step at a time. The dentist uses nonverbal reassurance, smiling and touching the patient’s hand gently as needed. During the visit, the dentist notices the patient is quiet and glances nervously.
She pauses and kindly asks, “Are you worried about anything?” The woman says through the translator: “I don’t know what you said.” The dentist offers to repeat more slowly and check again. She confirms comprehension after every major point: “Can you repeat how you will clean your teeth tonight?” This confirms that the patient isn’t merely nodding.
For ongoing behavior, the dentist uses MI to improve oral hygiene: she asks, “How do you keep your teeth clean now?” The patient says she just rinses with water. The dentist responds, “I hear you – it’s okay, many people think rinsing is enough. What do you think might help make it easier for you to brush regularly?” The patient considers perhaps switching to a soft brush. They set a simple goal: “Let’s try brushing after breakfast with this brush, one tooth at a time. If you brush for just one minute each day, we can build from there.” She ends the visit with a gentle reminder: “You can call me or come by if you have questions. We’ll do this together.” By combining simplified communication with empathy and motivational dialogue, the dentist helps the elderly patient feel respected and willing to engage in her care.
Case 2: Patient Needing Behavior Change (Tobacco User).
Scenario: A 35-year-old man with gum disease admits during history that he chews tobacco daily. He is defensive and hasn’t tried to quit before.
Approach: The dentist applies MI in this scenario. Instead of scolding, she starts with empathy: “I can tell quitting isn’t easy; I know several people who have struggled too.” She asks an open question: “What would be good things about quitting chewing tobacco? What would be hard?” The patient initially avoids eye contact but eventually shrugs. The dentist gently probes his own values: “You mentioned wanting healthier gums. How important is that to you on a scale of 1–10?” He says “a 9.” She reflects, “Wow, it’s really important to you to keep your gums healthy.” He admits he worries about teeth loss someday.
Building on that, she asks, “On that scale of 1–10, how confident do you feel about quitting, if at all?” He says “maybe a 3.” The dentist nods. They discuss past attempts (he says he tried for a week before). She affirms, “Trying once shows you have some motivation already. That takes courage.”
She listens to his reasons for using (stress relief, habit) and suggests small changes: “What if you chewed something else, like sunflower seeds, when you feel that urge?” The patient considers it. They make a plan: “Let’s just start with one day this week when you try not to chew after dinner, and see how that feels.” She does not pressure or demand.
Instead, she summarizes his own statements: “So, you really want healthier gums, but quitting feels hard because you’ve used chew for so long.” The patient nods. By respecting his autonomy (he chose the goal of just one day) and showing genuine understanding, the dentist increases his willingness. Over subsequent visits, she revisits the topic: “How did that one day go? What was difficult?” and adjusts the plan. If he slips, she simply re-engages and affirms progress rather than punishes failure. This MI-guided, empathetic counseling gradually helps the patient take small steps toward quitting, far more than a simple directive would have.
Conclusion
Motivational Interviewing adds an evidence-based layer: by helping patients voice their own reasons for change (improving oral hygiene, quitting tobacco), dentists can motivate better long-term habits[6][7]. As ADA and IDA guidelines emphasize, a dentist’s role is not just to treat teeth but to guide and comfort the whole person[3][4]. Ultimately, the goal is a dental experience where fear is met with understanding. With these communication strategies and psychological tools, Indian dental professionals can transform anxious visits into positive, trusting partnerships – for patients of all ages.
References
[1] [2] Dental Anxiety Among Adults: An Epidemiological Study in South India – PMC
https://pmc.ncbi.nlm.nih.gov/articles/PMC4325391/
https://www.ida.org.in/Accreditation/Details/ForPatientManagement
[4] Health Literacy in Dentistry | American Dental Association
https://www.ada.org/resources/community-initiatives/health-literacy-in-dentistry
[5] 5 tips to reduce anxiety and stress in dentists, patients during their visit | American Dental Association
[6] Introduction to Motivational Interviewing for Oral Health Professionals – Arcora Foundation
https://arcorafoundation.org/motivational-interviewing/
[7] [8] The effect of motivational interviewing on oral healthcare knowledge, attitudes and behaviour of parents and caregivers of preschool children: an exploratory cluster randomised controlled study | BMC Oral Health | Full Text
https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-015-0068-9
[9] [10] Active Listening:We hear it’s vital to respected dental practices | Dental Economics
[11] Beyond the drill: Creating connections through empathy in dentistry | Dental Economics
[12](PDF) J I D A Assessment of effectiveness of motivational interviewing of parents/caregivers on dental attendance of children: a systematic review and meta-analysis
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