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The Definition of a Habit
By Dr. Barry Outlton

15 March, 2019 - Haslemere, England, United Kingdom

Habits are routine behaviours done on a regular basis. They are recurrent and often unconscious patterns of behaviour and are developed through frequent repetition. Many of our habits are unconscious as we don’t even realise we are doing them.
Aristotle had this to share about habits: “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

Online dictionary definitions of habits include:
  • an acquired mode of behaviour that has become nearly or completely involuntary
  •  the prevailing disposition or character of a person’s thoughts and feelings 
  •  a settled tendency or usual manner of behaviour 
  •  a behaviour pattern acquired by frequent repetition or physiologic exposure that shows itself in regularity or increased facility of performance
A habit can also be thought of as a link between a stimulus and a response. It serves as a mental connection between a trigger thought or event (stimulus, trigger or cue) and our response to that trigger (the response or routine). Repeating this connection time and time again forms a habit and If repeated often enough, this connection becomes near permanent unless we take conscious action to change it or something occurs to break the link (running out of floss or sticks and not replacing them for several days)
The Cue is in the Link
When you think about motivating someone to floss their teeth, for example, we run into an obstacle of ‘the cue’.
The cue to putting your seat belt on is likely to be getting into the car and closing the door.

I make my first coffee as soon as I walk into the kitchen in the morning. 
I used to ask my patients to brush morning and night, i.e. twice a day, and to floss once a day. The issue with this approach is that it reduces the chances of tooth brushing being the ‘cue’ to their flossing. It’s almost impossible to create a habit for brushing and flossing when they are linked together if we expect them to brush once a day without flossing and brush once a day with flossing, there is no consistent link, 50% at best.

Our patients would create more of a habit IF we recommended flossing twice a day alongside brushing. Although, I think we would witness resistance from our patients due to perceived time pressures etc.. 
Try a Different Approach
I have had a great deal more success with my patients developing good interdental cleaning habits by asking them to link the action of flossing/tepe-ing to a different ‘cue’ that happens only once a day.
My most successful results have come from the link between showering and flossing.
I ask my patients do they shower or bathe nearly every day (so far, they have all answered yes to that question) I explain that it’s hard to create a habit of interdental (ID) cleaning with brushing and so I would like them to begin to ID clean in the shower, whilst perhaps leaving the hair conditioner to do its job for 2 mins. (Perhaps not for a bald man!!)

I invite them to purchase a fluorescent flossing device and bright brushes from reception, ones that are easily seen so that for the first few weeks they are within in their eye line when in the shower.

Over time the habit of interdental cleaning is developed because it becomes a part of their showering routine rather than their brushing routine. 

Have a Reason to Form the Habit (Interdental Cleaning) – "A Why"
This might seem really simple – you might say to me ‘Barry you floss to keep your teeth clean’ nope, that isn’t a deep enough reason for someone to floss because they haven’t flossed properly for 35 years and they haven’t had any problems from it, or so they think.
In order to have motivation to do something, it is important to have an emotional reason why to do it – 

As human beings we are motivated by avoiding pain and gaining pleasure 
Interdental cleaning helps reduce bad breath, not cleaning interdentally increases bad breath.

Bad breath can lead to rejection, embarrassment, negative comments, becoming self-conscious, loss of confidence etc…. 
Uncovering the Patients’ Motivation Direction
Do they want to keep their teeth for life or not lose their teeth? These two statements mean the same thing, don’t they? Seemingly yes, however, the use of one or the other will tap into your patient’s motivational preference or it won’t. in NLP we call this metaprogramme the motivational direction filter – towards or away from. It’s a continuum rather than a choice between one or the other.

By identifying what their motivational direction filter is enables you to increase their motivation in doing what you want them to do and avoiding what you think they should avoid. 

Identifying a motivational direction is really easy. By asking a question about what’s important to them about their dental health, their answer will in fact give you the indication of their direction filter. 

For example...

Mrs Patient, tell me, what’s important to you about your dental health long term?
Mrs P – well, I don’t want to lose my teeth.

Why not?

Mrs P – because I don’t want people to see me without teeth

Why would you not?

Mrs P – I don’t want to be embarrassed.
Well, Mrs P, if I could show you a simple way of looking after your teeth that will ensure that you don’t lose any teeth, which means you won’t be embarrassed about your smile would that be something you would like me to do?
Mrs Patient, tell me, what’s important to you about your dental health long term?
Mrs P – well. I want to make sure I keep my teeth for life.

Why is that?

Mrs P – I want to have a great smile

Why is that important?

Mrs P – so I feel confident when I talk to people.
Well, Mrs P, if I could show you a simple way of looking after your teeth that will ensure that you keep your teeth healthy, which means you will continue to have a great smile for years and therefore your confidence when talking to people, would that be something you would like me to do?
Regularly you will get a patient who answers with both away from tendencies and towards. Simple your response can include both too.
Mrs P, if I could show you a simple way of looking after your teeth that will ensure that you keep your teeth healthy so that you don’t lose them which means you will continue to have a great smile for years and not be embarrassed about gaps, therefore keeping your confidence when talking to people, would that be something you would like me to do?

Make it Easy to Do
In my experience making the action of flossing easy overcomes many patients’’ objections – I can’t reach my back teeth, I’m all fingers and thumbs. I hate flossing.
Using simple products like interdental flossers, flexible interdental brushes that don’t easily bend out of shape. Larger handles for the older patient or someone with poor dexterity. Bright coloured products that are easy to buy, either from you or the patient’s usual supermarket. There’s nothing better than running out of brushes to ensure we break the habit of ID cleaning.

Be Playful
I don’t want you to think that you have to clean in between all of your teeth, just the ones you’d like to keep.
Your Simple Guide to Forming Positive Habits
Have a why – the motivation – ideally a core value and have them value the change

Link it to a cue – applying conditioner in the shower

Make it easy – flossing with a handled device, easy to hold interdental brushes. Perhaps offer a postal delivery option for their ID cleaning products 

Visual Reminders –bright handled cleaners easily at hand in the shower

Focus on the benefits 
The Confident Dentist Blog is published by Dr. Barry Oulton of The Confident Dentist

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