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TePe Prevention Compass™ Protocol

Prevention Compass™ Protocol is a pragmatic, 7-step chairside protocol for behavior change. It provides clinicians a recommendation model that incorporates behavioral change theories, neuroscience, and digital technology into a comprehensive path for lasting change. By shifting from transactional, prescriptive care to patient-centered collaboration, dental professionals can better align with patients to successfully prevent oral disease.

Identity
Assessment
Motivation
Training
Environment
Planning
Evaluation
Identity
Assessment
Motivation
Training
Environment
Planning
Evaluation

IDENTITY

Behavior change starts first with an identity change.

Chairside Actions:
Complete Medical and Dental History
Explore your patient's beliefs and attitudes toward oral health
Co-create a realistic "I am..." statement that reflects your patient's identity related to their oral health

ASSESSMENT

Assess every patient using multiple approaches.

Chairside Actions:
Assess teeth, gingiva, and periodontal tissues
Assess implants and peri-implant tissues
Utilize diagnostics, digital tools, and risk assessments

MOTIVATE

Make biofilm visible to highlight urgency.

Chairside Actions:
Disclosing solution to highlight biofilm
Intra-oral photography and digital scanning to show areas of concern
Link assessment data (i.e. bleeding, carious lesions) to areas of uncontrolled biofilm levels

TRAINING

Build capability by focusing on one small change.

Chairside Actions:
Knowledge through models, videos, demonstrations, brochures
Skill through having your patient demonstrate the technique back
Use the teach-back technique to confirm understanding
Leverage personalized technology to reinforce correct technique outside of clinic.

ENVIRONMENT

Address external and social factors.

Chairside Actions:
Assess available resources, access, and time
Consider social influences, cultural norms, and support systems
Identify a cue to trigger the new behavior

PLANNING

Create a goal to initiate change that develops into lasting habits.

Chairside Actions:
Create a cue and routine (when, where, and how) to reinforce your patient’s identity using the formula:
Identity = Cue + Routine
Integrate TePe Digital Recommendation
Create a coping plan to address potential barriers

EVALUATION

Create a clear pathway to strengthen patient-clinician collaboration.

Chairside Actions:
Review identity statements and goals
Monitor clinical outcomes (e.g., reduced bleeding)
Document identity, goal (including cue and routine), current routine, a quote from the patient, and any product recommendations

As a fun and easy way to remember the protocol think,

“I AM TEPE”

Practical chairside strategies you can apply with your very next patient

Master the Protocol with Confidence

In this section, we break down each step of the protocol into clear, actionable techniques designed for real-world clinical use. While behavior science can feel complex—filled with overlapping theories and models—we’ve simplified it into a practical workflow you can confidently implement.

The tables and references at the end of the page highlight how multiple resources were thoughtfully integrated to develop these 7 essential steps.

 Summary of all resources

1. IDENTITY

TePe Oral Health Care, Inc.

Behavior change starts first with an identity change.

Chairside Actions:

  • Complete Medical and Dental History
  • Explore your patient's beliefs and attitudes toward oral health
  • Co-create a realistic "I am..." statement that reflects your patient's identity related to their oral health.

The overview:

This step is not about prescribing actions immediately but helping patients redefine themselves in relation to oral health. Once identity is established, new behaviors become natural extensions of self-image rather than forced obligations.

IDENTITY

This step is especially meaningful for clinicians because it requires intentionally stepping back from the instinct to immediately ‘fix’ the problem. The clinician’s main priority is to understand the patient and guide conversation.


Identity forms the foundation of sustainable behavior change. Before patients can adopt new oral health routines, they must first see themselves differently, as someone who values oral health and integrates prevention into their lifestyle. When we use the phrase “I am …” at the beginning of a sentence, this becomes a person’s reality.


The “I am” statement embodies who the person is, with behaviors following as an extension of their identity. This step establishes the foundation for all other steps in the Prevention Compass™ Protocol.

Patient-centered prompts to develop your patients' “I am …” statement:

Using the evidence for this step, here are examples of different patient-centered prompts you can use to explore how your patient relates to oral health.

  • “How does taking care of your teeth fit with the person you want to become?”
  • “What would change in your life if you lived that identity?”
  • “Who do you want to be in relation to this behavior?”
  • “What kind of person do you want to be when it comes to oral health?”
  • “Do you see a need to change your daily oral habits at home?”
  • “Are you thinking about changing any of your oral homecare routines?”

When reviewing the medical and dental history, explore behaviors, beliefs, risk factors, motivation, and potential barriers that may influence oral health outcomes and long-term adherence.

Applied Behavioral Models at a Glance

COM-B (Motivation component) (Michie, 2011)-provides the behavioral system linking capability, opportunity, and motivation to behavior, with identity driving reflective and automatic motivation.
Motivational Interviewing (Miller & Rollnick, 2023)-explores identity, resolves ambivalence, and strengthens intrinsic motivation through guided conversation
Self-Determination Theory (Deci & Ryan, 1985)-supports identity formation by building autonomy, competence, and relatedness to increase intrinsic motivation
Health Locus of Control (Rotter, 1966)-shapes identity by aligning beliefs about control with personal responsibility, collaboration, or risk reduction
Transtheoretical Model (Prochaska & DiClemente, 1983)-guides progression through stages of identity-driven behavior
Identity-Based Models (Clear, 2018; Sincero, 2020; Eyal, 2019)-position behavior as an expression of identity, reinforced through habits, consistency, and self-alignment

Key Takeaways

  • Identity is the starting point for lasting oral‑health behavior change
  • Patients must see themselves differently before they act differently
  • Clinicians’ role is to guide identity formation before introducing solutions
  • By guiding a patient’s identity towards prioritizing oral health, intrinsic motivation will sustain long-term behavior change
  • “I am…” statements shape direction, motivation, and behavior
  • Behavior change models help patients align oral‑health behaviors with their values and identity. These models help clinicians tailor strategies around autonomy, control beliefs, readiness for change, attitudes, and motivation.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario incorporates an application related to specific behavioral change evidence.

Scenario A — Motivational Interviewing (MI): Evoking Identity-Based Motivation
Patient: “I brush most days, but flossing just isn’t something I stick with.”
Clinician: “It sounds like taking care of your health matters to you. How does cleaning between your teeth fit with the kind of person you want to be when it comes to your health?”
Application: Use open questions and reflective listening to connect behaviors with personal values. Guide the patient toward identity-based statements such as: “I am someone who takes care of my health, so flossing is part of what I do.”

Scenario B — Self-Determination Theory (SDT): Shifting external pressure to ownership
Patient: “My dentist always tells me to floss, but honestly it feels like a chore.”
Clinician: “What matters most to you about keeping your mouth healthy?
Application: When supporting autonomy, there is a shift in focus from external instruction to internal ownership, so the behavior becomes self-endorsed rather than externally pressured. Support the patient by reframing oral care as part of their overall wellbeing. Encourage identity statements like: “I am someone who takes care of my body, and my mouth is part of that.”

Practical Application Scenarios

Scenario C — Identity Based Models: Reinforcing identity through small actions
Patient: “Flossing between my teeth takes too much time, and I always forget.”
Clinician: “Set a small goal such as flossing one interdental space per night”, “By doing this, you are showing yourself that you are someone who takes control of their oral health.”
Application: Use small wins to reinforce identity, which increases consistency and motivation of the new behavior. Repeated actions build evidence for the patient’s identity and support long-term behavior change, rather than tasks to remember.

2. ASSESSMENT

TePe Oral Health Care, Inc.

Assess every patient using multiple approaches.

Chairside Actions:

  • Assess teeth, gingiva, and periodontal tissues
  • Assess implants and peri-implant tissues
  • Utilize digital tools, diagnostics, and risk assessments

The overview:

Assessment begins connecting clinical findings to the patient’s identity and behavior explored in step 1, Identity. A clear clinical baseline is established to understand the patient's oral health status and risk factors, while helping patients understand what is happening in their mouth and why it matters to them personally.

ASSESSMENT

Assessment is the systematic process of collecting and interpreting clinical data to support diagnosis, identify risk-factors, and get a full picture of the patient’s oral health status. All dental professionals should be aware of and assist within their scope of practice in gathering data.


Digital tools allow for thorough evaluation, whereas diagnostics enhance the depth of the clinicians’ assessment. Risk assessment identifies biological, behavioral, environmental, and systemic factors that may influence oral disease development, progression, and long-term outcomes.

Applied Behavioral Models at a Glance

ADHA Standards for Clinical Dental Hygiene Practice (2025) – provides a framework for comprehensive, evidence-based assessment, risk identification, and individualized patient care.
Dental Hygiene Theory and Practice (Canasi, 2024) – supports assessment as a continuous process that guides diagnosis, treatment planning, implementation, and evaluation throughout care.
Peri Implant Therapy for the Dental Hygienist (Wingrove, 2022) – emphasizes ongoing peri implant assessment for early detection, maintenance, and prevention of peri implant diseases.
Classification System (Caton et al., 2018) – provides standardized criteria for diagnosing, staging, and grading periodontal and peri implant diseases and conditions.
Health Belief Model (Rosenstock, 1974) – supports patient understanding of risk, severity, benefits, barriers, and self-efficacy by linking clinical findings to preventive behaviors.

Key Takeaways

  • Assessment establishes the clinical baseline needed to support diagnosis, identify risk, treatment planning, and linking findings to patient identity, belief, motivation, and future behavior change.
  • A comprehensive assessment includes evaluation of teeth, periodontal and peri‑implant tissues, systemic health factors, lifestyle behaviors, and social determinants, ensuring individualized, evidence‑based care.
  • Digital and diagnostic tools can improve accuracy, support early detection, improve risk assessment, and clearer communication through visuals such as intraoral images, scanners
  • Assessment findings help clinicians identify diseases, determine severity and progression, and guide communication with the patient
  • Current classification systems help clinicians diagnose, stage, and grade periodontal and peri implant diseases, supporting consistency in treatment planning and prognosis
  • Assessment also provides insight into behaviors, beliefs, and barriers that may influence long term oral health outcomes and preventive behaviors

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician interaction. Each scenario utilizes assessment data to create a diagnosis with a clinician response linking empirical data to behavior change.

Scenario A — Periodontal Evaluation
Patient presents with: Bleeding gums upon probing.
Assessment: Bleeding on probing, attachment loss, mobility, and radiographic evidence of bone loss.
Diagnosis: Stage II periodontitis (moderate), Grad B due to controlled diabetes.
Clinician frames findings in patient-friendly terms: “Your gums are showing signs of early disease. Together we can prevent the development of the disease.”

Scenario B — Peri-Implant Assessment
Patient presents with: Discomfort and occasional bleeding around a dental implant.
Assessment: Probing depth, bleeding on probing, supported by intra-oral photos and radiographs.
Diagnosis: Peri-implant mucositis
Clinician links explanation to homecare. “We can see inflammation around this implant. Consistent cleaning here will protect the investment you made.”

Scenario C — Systemic Risk Screening
Patient discloses during medical history: Poorly controlled diabetes.
Assessment: Bleeding on probing, attachment loss, mobility, and radiographic evidence of bone loss.
Diagnosis: Stage II periodontitis, HbA1c>7.0%
Clinician explains the connection: “Diabetes affects your gums, and gum disease can affect your blood sugar. Daily plaque control is critical for your overall health.”

3. MOTIVATE

TePe Oral Health Care, Inc.

Make biofilm visible to highlight urgency.

Chairside Actions:

  • Disclosing solution to highlight biofilm
  • Intra-oral photography and digital scanning to show areas of concern
  • Link assessment data (i.e. bleeding, carious lesions) to areas of uncontrolled biofilm levels

The overview:

Motivating patients begins by making the invisible visible. By helping patients see and understand clinical findings, clinicians create greater awareness and motivation to change.

MOTIVATION

Motivation is an important part of the chairside workflow, before instrumentation and biofilm removal, as it bridges assessment and action. Oral diseases like caries and periodontitis are often silent in their early stages, causing patients to underestimate their severity and the importance of prevention. This step allows patients to visualize the evidence, understand the connection between daily oral hygiene behaviors and disease, and become more engaged in preventive care. Assessment findings and visual documentation also help guide individualized goals for habit change and allow clinicians to monitor progress over time.

The role of the clinician is to translate abstract risks and clinical findings, making them visible, understandable, and personally relevant for the patient.

Applied Behavioral Models at a Glance

Dental Hygiene Theory and Practice (Kacerik, 2025): Supports the use of assessment findings, biofilm documentation, and patient education to improve awareness, motivation, and individualized preventive care.
Importance of Disclosing Solutions in Oral Hygiene Instruction (Lei et al., 2025; Mensi et al., 2020; Da Silva & Paranhos, 2006): Demonstrates how visualizing plaque accumulation through disclosing agents improves patient understanding, oral hygiene instruction, self-efficacy, and motivation for behavior change.

Key Takeaways

  • Motivation begins with visibility. Patients are often more engaged when clinicians make oral disease and risk factors visible and understandable, revealing issues that otherwise go unnoticed.
  • Disclosing agents, intraoral photographs, and digital technologies help patients see the relationship between daily oral hygiene behaviors and clinical findings such as plaque accumulation, bleeding, and early lesions.
  • Emotional connection enhances readiness for change, as patients better understand the urgency and personal relevance of prevention once they see their own clinical findings.
  • Ongoing documentation and monitoring allow clinicians to evaluate oral status over time, evaluate patient knowledge and motivation, and set achievable personalized goals and interventions.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario creates visualization of biofilm, calculus, or inflammation followed by dialogue linking data to the importance of homecare behaviors.

Scenario A — Biofilm Disclosure
Clinician: Applies a disclosing solution and provides the patient with a mirror to visualize plaque accumulation.
Patient: “I did not realize I was missing that much when brushing.”
Clinician explains: “This is the reason for bleeding gums. By focusing on these areas during brushing and interdental cleaning, you can help reduce inflammation.”

Scenario B — Intra-Oral Photography
Clinician: Uses intra oral photography to show plaque accumulation before brushing and the improvement after oral hygiene instruction.
Patient: “I can actually see the difference after brushing properly.”
Clinician explains: “These images help show how daily cleaning directly affects your oral health. Small improvements in technique can make a significant difference over time.”

Scenario C — Linking Behavior to Outcomes
Clinician: Shows bleeding gums while probing in a mirror. Patient is surprised since it doesn’t hurt.
Patient: “My gums bleed sometimes, but I thought that was normal.”
Clinician explains: “Bleeding is a sign of inflammation. Daily brushing and interdental cleaning will prevent the bleeding and progression.” By framing visible signs as preventable, patients feel empowered to act.

4. TRAINING

TePe Oral Health Care, Inc.

Build capability by focusing on one small change.

Chairside Actions:

  • Knowledge through models, videos, demonstrations, brochures
  • Skill through having your patient demonstrate the technique back
  • Use the teach-back technique to confirm understanding
  • Leverage personalized technology to reinforce correct technique outside of clinic.

The overview:

Training ensures patients are capable, confident, and equipped to perform the behaviors required for improved oral health, transforming intention into actionable knowledge and skill.

TRAINING

This step empowers your patient with the knowledge and skills needed to confidently manage their oral health between continuing care appointments. It transforms oral hygiene instruction into a partnership between clinicians and patients, supporting sustainable and prevention‑focused behaviors.


Training is the step where knowledge is translated into skill. Telling patients what to do is not effective. They must learn how to perform oral hygiene behaviors effectively, consistently, and with confidence. By utilizing the teach-back technique clinicians confirm understanding by having patients demonstrate the skill back and recall knowledge. The patient becomes an expert at maintaining their oral health with one small change at a time.

Applied Behavioral Models at a Glance

COM-B (Capability component) (Michie, 2011): Emphasizes the importance of knowledge, practical skills, and reducing barriers to support behavior change.
Self-Efficacy Theory (Bandura, 1997): Highlights how confidence in one’s ability to perform a behavior influences long term adherence and persistence.
Theory of Planned Behavior (Perceived Behavioral Control component) (Ajzen, 1991; Fishbein & Ajzen, 1975): Supports behavior change by strengthening the patient’s belief that the behavior is achievable and within their control.
Health Belief Model (Cue to Action and Self Efficacy components) (Rosenstock, 1974): Reinforces behavior through confidence building, reminders, and practical cues that support consistency.
Teach Back Technique (Schillinger et al., 2003; Talevski et al., 2020): Confirms patient understanding, skill retention, health literacy, and self-management through active participation and demonstration.
Video Based Instruction (Buck et al., 2024): Supports personalized reinforcement of oral hygiene techniques and improves patient compliance beyond verbal instruction alone.
Oral Hygiene Instruction Sequencing (Ashkenazi et al., 2014): Supports a structured step by step training approach using explanation, demonstration, guided practice, and reinforcement.

Key Takeaways

  • Focus on one small change that will make the biggest impact and start building capability.
  • Capability through knowledge and skill development is essential for effective and consistent behavior change.
  • Confidence and self-efficacy play an important role in long term behavior change. If patients believe they can perform a behavior, they are more likely to start, maintain, and overcome barriers.
  • Teach-back technique confirms understanding, strengthens health literacy, improves skill retention, and supports self-management, making it ideal for reinforcing both oral hygiene knowledge and skill.
  • Personalized videos, photos, and digital tools outperform verbal instruction alone and help patients repeat the correct technique at home.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario incorporates an application related to specific behavioral change evidence.

Scenario A - Self-Efficacy Theory (SET): Strengthening Confidence Through Skill Practice
Patient: “I’m not very good at cleaning between my teeth, so I usually give up.”
Clinician response: “A lot of people feel that way at first. Let’s practice together using these interdental brushes so you can see how easily they fit. Use an interdental brush on the upper right side every night this week, and then we will gradually increase when you feel confident.”
Application: Build self-efficacy through guided practice, positive reinforcement, and achievable steps. Early success helps patient develop confidence and strengthen the belief: “I am capable of flossing correctly.”

Scenario B — Teach-Back Technique: Confirm Understanding and Skill
Patient: “I think I understand how to use the interdental brush.”
Clinician: “Just so I know I explained it clearly, can you show me how you would use it at home?”
Application: Use the teach-back technique to confirm understanding and skill. This helps ensure the patient not only hears the instructions but can demonstrate the skill accurately, improving retention and adherence.

Scenario C — Using Technology: Digital Support for Skill Development
Patient: “I start good habits but then stop after a few weeks.”
Clinician: “Can we take a video of you doing the technique on your phone while we practice together, so you can use it as a reference at home?” or “There are apps that can remind you and show short videos on technique. Would you be interested in trying one to support your routine?”
Application: Use technology-based interventions such as apps, digital reminders, photographs, or instructional videos to reinforce knowledge and maintain engagement with oral health behaviors. At the follow-up visit, clinicians can review app data with the patient to celebrate progress and positive changes.

5. ENVIRONMENT

TePe Oral Health Care, Inc.

Address external and social factors.

Chairside Actions:

  • Assess available resources, access, and time
  • Consider social influences, cultural norms, and support systems
  • Identify a cue to trigger the new behavior

The overview:

this step, clinicians become architects of the patient’s environment, ensuring it supports and sustains new oral health behaviors. Physical surroundings, social influences, and daily routines can either strengthen or weaken long-term behavior change.

ENVIRONMENT

The environment should make healthy behaviors easier, more visible, and easier to repeat consistently over time. Even highly motivated and capable patients will struggle to maintain behavior change when their environment creates barriers or friction. This step focuses on assessing and shaping the patient’s physical, social, and digital environments to support consistent oral health habits.

Applied Behavioral Models at a Glance

COM-B (Opportunity component) (Michie, 2011): Emphasizes how physical and social environments influence behavior change.
Theory of Planned Behavior (Subjective Norms component) (Ajzen, 1991): Highlights the influence of social expectations, family, peers, and cultural norms on behavior.
Social Cognitive Theory (Bandura, 1977): Focuses on environmental influence, social support, modelling, reinforcement, and observational learning.
Behavioral Cue Research (Graybiel, 2008; Seger & Spiering, 2011; Duhigg, 2012): Demonstrates how cues, routines, and rewards support habit formation and long-term behavior change.

Key Takeaways

  • The environment is a powerful driver of behavior change. Even highly motivated patients may struggle when physical or social surroundings create barriers or friction.
  • Clinicians act as architects of the patient’s environment by improving access to tools, adding reminders and cues, reducing barriers, and encouraging social support.
  • During the environment step, the clinician should start to discover potential social support and cues for behavior change.
  • Cues drive sustained habits, whether they stem from time, place, emotions, social relationships, or existing preceding actions—and when paired with identity‑based reinforcement, these cues transform daily oral hygiene into automatic lifelong routines.
  • Social support includes modeling behavior within social circles, considering peer and family influence, and exploring social and cultural norms.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario incorporates an application related to specific behavioral change evidence.

Scenario A — COM-B (Opportunity component): Shaping the Physical Environment
Patient: “I want to clean between my teeth, but I never think about it until I’m already in bed.”
Clinician: “What if we made it easier to remember? You could keep your floss or interdental brushes right next to your toothbrush so it’s part of your routine.”
Application: Modify the physical environment to increase the opportunity for behavior change. Keeping oral care tools in visible, convenient locations reduces friction and supports consistency.

Scenario B — Theory of Planned Behavior (TPB) (Subjective Norms component): Social Expectations
Patient: “None of my friends floss, so it never really seemed important.”
Clinician: “Many people who prioritize their health clean between their teeth daily because they want to protect their gums and smile.”
Application: Highlight social norms that support oral health behaviors. Patients are more likely to adopt behavior’s when they perceive them as common, valued or socially supported.

Scenario C — Behavioral Cue Research: Environmental Reminders
Patient: “I always mean to floss, but I forget.”
Clinician: “Sometimes a simple reminder helps. Keeping floss on the bathroom counter or setting a phone reminder can prompt the habit.”
Application: Use environmental cues to trigger behavior at the right moment. Visual reminders, alarms, or pairing oral care with an existing routine can support consistent action and habit formation.

6. PLANNING

TePe Oral Health Care, Inc.

Create a goal to initiate change that develops into lasting habits.

Chairside Actions:

  • Create a cue and routine to reinforce your patient’s identity using the formula: Identity = Cue + Routine
  • Create a coping plan to address potential barriers.
  • Integrate TePe Digital Recommendation

The overview:

Planning bridges the gap between knowing what to do and making it automatic. It moves motivation to action. By co-creating simple, achievable, and trackable plans, clinicians help patients transform goals into lasting, automatic oral health habits.

PLANNING

Planning transforms patient intentions into structured, actionable, and skill-based routines. While motivation sparks change, planning sustains it by creating clear goals with a cue and routine. The cue triggers the new behavior, while the routine addresses where, when, and how the new behavior will take place.
This step requires the clinician to reflect on and integrate the previous steps of the protocol and make an actionable plan.


IDENTITY: How does this one small change support your patient’s “I am” statement, thus reinforcing the behavior change as intrinsic motivation?
ASSESSMENT: Do assessment findings support that this small change will improve the patient’s oral health?
MOTIVATE: Use clinical findings and feedback to enhance awareness and self-monitoring between appointments.
TRAINING: Ensure the patient has the knowledge and skills to complete the one small change.
ENVIRONMENT: Use environment cues, routines and support systems to reinforce consistency and habit formation.

Applied Behavioral Models at a Glance

Goal Setting, Planning, Self-Monitoring (GPS) (Newton & Asimakopoulou, 2015; Tonetti et al., 2015) – supports structured goal setting, action planning, coping planning, and self-monitoring to strengthen behavior change.
Self-Regulatory Theory (Leventhal, 1970; Bandura, 1982; Kanfer & Kanfer, 1991; Schwarzer et al., 2015) – emphasizes self-monitoring, self-evaluation, feedback, coping plans, and behavioral adjustment over time.
Habit Formation Research (Lally et al., 2010) – demonstrates the importance of repetition in stable contexts to build automaticity and long-term habits
Implementation Intentions (Gollwitzer, 1999) – uses “If–Then” planning to increase follow through and prepare for barriers.
Neuroscience of Habits and Goals (Graybiel, 2008; Seger & Spiering, 2011; Duhigg, 2012) – explains how repeated cue-based behaviors gradually shift from effortful decision making to more automatic habit pathways.

Key Takeaways

  • Planning connects and activates the previous steps of the protocol by translating identity, assessment findings, motivation, training, and environmental cues into a practical and personalized behavior change plan.
  • Focus on one small and achievable change at a time to support long term habit formation.
  • Effective planning uses the formula Identity = Cue + Routine by linking a specific cue to a clearly defined behavior, including when, where, and how the behavior will occur.
  • Goals initiate change, but repetition, routines, and stable cues help behaviors become more automatic over time.
  • Integrating goals, action plans, coping plans, and self-monitoring helps patients build sustainable oral hygiene routines grounded in confidence, consistency, and self-efficacy.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario incorporates an application related to specific behavioral change evidence.

Scenario A — Goal-Setting and Planning (GPS): Creating a Clear Plan
Patient: “I am someone who wants to take better care of my gums, but I’m not sure where to start.”
Clinician: “Let’s set a simple goal together. What if you clean between your teeth every night right after brushing before bed?”

Identity = Cue + Routine

  • Identity: “I am someone who wants to take better care of my gums.”
  • Cue: After toothbrushing
  • Routine: After brushing teeth before you go to bed, use an interdental brush in your bathroom.

Application: Use specific and achievable goals to translate intention into action. Define what the behavior is, when and where it will happen, and how it will be performed. Linking the behavior to an existing routine increases consistency and follow through.

Scenario B — Self-Regulation Theory (SRT): Monitoring and Adjusting Behavior
Patient: “I start flossing regularly, but after a few weeks I fall off track.”
Clinician: “Some people find it helpful to track their progress. Would checking off each day on a calendar help you stay consistent?”
Application: Support self-monitoring and feedback, the key components of self-regulation, to track behaviors, identify barriers and adjust routines to stay aligned with their goals.

Scenario C — Neuroscience of Habits and Goals: Moving from Effort to Automaticity
Patient: “It is so much effort to have to think about this new routine of cleaning between my teeth every night.”
Clinician: “That’s normal. In the beginning the areas of the brain that are responsible for planning are active, but with repetition the behavior becomes more automatic.”
Application: Explain how behaviors initially rely on goal-directed systems (prefrontal cortex) but gradually shift to habit-based pathways (basal ganglia) with a repeated routine. This helps patients understand why consistency and repetition gradually reduce the mental effort required to perform the behavior, supporting long term habit development.

7. EVALUATION

TePe Oral Health Care, Inc.

Develop a connection with your patient.

Chairside Actions:

  • Review identity statements and goal
  • Monitor health outcomes (e.g., reduced bleeding)
  • Document identity, current routine and any focus areas, goal (cue and routine), a quote from the patient, and any product recommendations

The overview:

Evaluation closes the loop of the Prevention Compass™ Protocol. Through ongoing monitoring, reinforcing, and adapting behavior strategies, clinicians collaborate with patients to sustain oral health behaviors beyond the dental chair.

PLANNING

This step strengthens continuity between visits, supports accountability, and helps patients maintain long-term change. Continued evaluation and documentation help patients remain aware of their habits, outcomes, progress, and barriers.

Reviewing progress over time allows patients and clinicians to adjust coping strategies, refine routines, and prevent setbacks from becoming long term patterns. Making improvements visible strengthens confidence, reinforces identity, and supports autonomy, all essential for sustaining long term oral hygiene habits.

Applied Behavioral Models at a Glance

ADHA Standards for Clinical Dental Hygiene Practice (2025): Emphasizes ongoing evaluation, documentation, continuity of care, and personalized evidence-based treatment.
Self-Regulation Theory (Kanfer & Kanfer, 1991): Supports monitoring, reflection, feedback, behavioral adjustment, and coping strategies over time.
Goal Setting, Planning, Self-Monitoring (GPS) (Newton & Asimakopoulou, 2015; Tonetti et al., 2015): Reinforces accountability, progress tracking, self-monitoring, and collaborative evaluation between visits.
Transtheoretical Model (Prochaska & DiClemente, 1983): Supports evaluation of readiness for change, maintenance of behaviors, relapse prevention, and long-term habit sustainability.

Key Takeaways

  • Evaluation and documentation maintain continuity of care by helping clinicians monitor progress and support long term oral health outcomes between visits.
  • Document should support a personalized patients centered approach by recording:

- Patient’s oral health identity
- Current homecare routines and barriers
- Focus areas
- The goal (cue and routine) that was planned until next appointment
- A patient quote to make each visit personalized
- Product recommendations

  • Continued evaluation increases patient awareness of behaviors and habits, identify barriers, and recognize oral health outcomes, helping patients better understand their progress and maintain long term change.
  • Reviewing progress collaboratively at continuing care appointments strengthens accountability, confidence, self-efficacy, and long term habit maintenance.

Practical Application Scenarios

These scenarios demonstrate practical chairside application through the lens of patient—clinician dialogue. Each scenario incorporates an application related to specific behavioral change evidence.

Scenario A — Self-Regulation Theory (SRT): Reflecting on Outcomes
Patient: “My gums don’t seem to bleed as much lately.”
Clinician: “That’s a positive sign your efforts are working. Let’s note that improvement and continue building on what’s helping you succeed.”
Application: Review behaviors, outcomes, and barriers to help patients reflect on progress and maintain successful routines. Documenting improvements reinforces motivation and strengthens the connection between behavior and health outcomes.

Scenario B — Goal-Setting and Planning (GPS): Tracking Goal Achievement
Patient: “I’ve been trying to floss every night like we planned.”
Clinician: “That was the goal we set together. How often were you able to follow through since your last visit?”
Strategy: Evaluate progress toward previously established goals and document adherence, barriers and adjustments. Revisiting goals at follow-up appointments reinforces accountability and ongoing improvement.

Scenario C — Transtheoretical Model (TTM): Assessing Stage of Change
Patient: “I’m flossing some nights now, but not every night yet.”
Clinician: “It sounds like you’ve moved from thinking about flossing to starting the habit. What has helped you make that progress?”
Application: Evaluate the patient’s stage of behavior change and document movement between stages, like contemplation to action. Recognizing progress helps reinforce motivation and guide future recommendations and support needed.
As a fun and easy way to remember the protocol think,

“I AM TEPE”

Learn more about Prevention Compass™ White Paper
Table 1

Key Dental Psychological Theories and Behavior Change Models

This table summarizes key psychological theories and behavior models within dentistry.

Year Founder(s) Core Concept
1950s
Rosenstock, Hochbaum, Kegeles³¹
Health Belief Model (HBM) – behavior depends on perceived susceptibility, severity, benefits, and barriers.
1950s–60s
Julian Rotter ³²
Health Locus of Control – whether individuals believe health is controlled by internal or external factors.
1960s–70s
Leventhal ²²
Self-Regulatory Theory – behavior guided by cognitive and emotional representations of illness.
1970s
Fishbein & Ajzen ¹⁵
Theory of Reasoned Action – intention predicts behavior, shaped by attitudes and social norms.
1985
Ajzen ¹
Theory of Planned Behavior (TPB) – extends TRA by adding perceived behavioral control.
1980s
Bandura ⁴˒ ⁵
Social Cognitive Theory (SCT) – reciprocal determinism between person, environment, and behavior.
1980s–90s
Deci & Ryan ¹²
Self-Determination Theory – intrinsic vs. extrinsic motivation drives behavior.
1990s
Gollwitzer ¹⁶
Implementation Intentions (Action & Coping Planning) – forming specific ‘if–then’ plans enhance follow-through.
1990s
Prochaska & DiClemente ³⁰
Transtheoretical Model (Stages of Change) – behavior change occurs in stages (precontemplation → maintenance).
1990s–2000s
Miller & Rollnick ²⁶˒ ²⁷
Motivational Interviewing – client-centered counseling to enhance motivation for change.
2003
Schillinger et al. ³³˒ ³⁷
Teach Back Technique-confirms comprehension by having patients demonstrate skill or recall instructions/knowledge.
2011
Michie, Atkins & West ²⁴˒ ²⁵
COM-B Model & Behavior Change Wheel – Capability, Opportunity, Motivation interact to produce Behavior.
2010s–2020s
Implementation Science (multiple contributors)
Translation to Practice – systematic approaches to integrate evidence-based interventions into clinical routines.
Late 2010s
Newton & Asimakopoulou ²⁸˒ ³⁸
Goal setting, Planning, and Self-monitoring (GPS) bridges the gap between patient intentions and actual oral hygiene habits.
2020s–2026
Emerging Digital & AI-Supported Models
Personalized, tech-enhanced behavior support (apps, wearables, AI feedback).

Key for Theory Acronyms

B-COM
Behavior: Capability, Opportunity, Motivation Framework
GPS
Goal setting, Planning, Self-monitoring
HBM
Health Belief Model
HLoC
Health Locus of Control
MI
Motivational Interviewing
SCT
Social Cognitive Theory
SDT
Self Determination Theory
SRT
Self-Regulation Theory
TBA
Theory of Planned Behavior
TRA
Theory of Reasoned Action
TTM
Transtheoretical Model, also known as Stages of Change
Table 2

Prevention Compass™ Protocol Theories and References

This table segments the theories and references used for each step. These models, along with insights from neuroscience and digital technology, form the foundation of each step in the Prevention Compass™Protocol.

Prevention Compass™ Protocol Integrated Theories and References
IDENTITY ¹˒ ¹⁰˒ ¹²˒ ¹⁴˒ ¹⁵˒ ²⁴˒ ²⁵˒ ²⁶˒ ²⁷˒ ³⁰˒ ³²˒ ³⁶
• MI
• SDT
• B-COM (Motivation component)
• HLoC
• TTM
• TPB (Attitude component)
• Identity Based Models
ASSESSMENT ²˒ ⁹˒ ²⁹˒ ³¹˒ ³⁹
• ADHA Standards of Care
• Darby & Walsh Dental Hygiene Theory and Practice
• Peri-Implant Therapy for the Dental Hygienist
• Classification System
• HBM
MOTIVATION ²˒ ¹¹˒ ²¹˒ ²³
• Darby & Walsh Dental Hygiene Theory and Practice, 2024
• Individual Studies
TRAINING ¹˒ ³˒ ⁵˒ ⁷˒ ¹⁵˒ ²⁴˒ ²⁵˒ ³¹˒ ³³˒ ³⁷
• B-COM (Capability component)
• SET
• TPB (Behavior Control component)
• HBM (cue to action and self-efficacy)
• Teach-Back Method
• Using Digital Tools
• Sequential Oral Hygiene Instruction
ENVIORNMENT ¹˒ ⁴˒ ¹³˒ ¹⁵˒ ¹⁷˒ ²⁴˒ ²⁵˒ ³⁵
• B-COM (Opportunity component)
• TPB (Subjective Norms component)
• SCT
• Behavioral Cue Research
PLANNING ¹³˒ ¹⁷˒ ²⁰˒ ²²˒ ²⁸˒ ³⁵˒ ³⁸
• GPS
• SRT
• Habit Formation
• Neuroscience of Habits and Goals
EVALUATION: ²˒ ²²˒ ²⁸˒ ³⁰˒ ³⁸
• ADHA Standards of Care, 2025
• SRT
• GPS
• TTM

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