Behavior Change for Caries Prevention: Understanding Inconsistent Results

Most applied work on caries prevention acknowledges the role of oral hygiene and dietary control strategies in reducing the prevalence and incidence of caries. What we seldom address, however, is the necessity of initiating and sustaining behaviors that will ensure these strategies are implemented. Virtually every approach to prevention of caries requires the individual to do something, that is, to engage in different behavior. We are continually confronted by the fact that to improve oral health, individuals must behave in new ways. Strategies for achieving better oral health most often have relied on providing information or telling people what they should or should not do. These approaches have not proven highly effective, yet they continue to be the mainstay of efforts to improve oral health. Acknowledging this failure, dental behavioral scientists have turned to the health beliefs model or to other cognitive-behavioral models, with their emphases on relative risks, barriers, and readiness to change. These models help us to conceptualize what people are doing to keep themselves, or their children, orally healthy, but the success of these models has been only marginal, especially among groups where disparities are extreme. In response, increasingly complex models that require attention to social and environmental variables, as well as individual behavior, have been proposed. Acknowledgment of “upstream variables” has become common—especially when working with populations experiencing health disparities, but overcoming upstream influences can appear to require sweeping changes that we often are not in a position to address. Consequently, research only picks away at individual elements of models, seeking the behavioral “magic bullet.” In an effort to elucidate the challenges, this article introduces the construct of overdetermination of behavior and encourages more rigorous documentation of potential determinants, as well as personalized development of behavioral approaches for implementing strategies to improve oral health.

This article reexamines our inconsistent results in effecting behavior change for better oral health using 2 important psychological constructs: "upstream variables" and the "overdetermination" of behavior.