Dentists' attitudes and practice regarding smoking

The impact of smoking on oral health and patient assessment of tobacco cessation support from Turkish dentists

INTRODUCTION

Dentists are in a critical position to help patients quit smoking. This study analyses the effectiveness of Turkish dentists in smoking cessation as part of routine patient care.

METHODS

An in-person cross-sectional survey on previous dental visit experiences was completed by 226 patients recruited from the Department of Periodontology, Eskisehir Osmangazi University, Turkey, from March 2019 to September 2019. The questionnaire included topics on patient's smoking/quit characteristics, experiences on smoking cessation from their dentists, and willingness for the implementation of smoking cessation advice by dentists.

RESULTS

In all, 38% of the patients were current smokers, 8% were former smokers, and 68% tried to quit previously. Smokers demonstrated consistently higher scores for plaque index, gingival index, and probing depth, than former/non-smokers (p<0.05). Patients' knowledge of adverse effects was high, and the patients presented a positive attitude toward receiving cessation activities from dentists (86.7%). A total of 89% responded positively to be asked about their smoking behavior. However, the dentists' approach for cessation discussions did not go any further than listing the harmful effects. Only 32% of the patients were informed about side effects of smoking and one-third were encouraged to quit. In general, offering smoking cessation advice was relatively infrequent, and the majority of patients tried to quit smoking by themselves (76%) without using any nicotine replacement product (84%).

CONCLUSIONS

Smoking leads to oral health problems. Dentists in Turkey may ask their patients' about their smoking habits but less frequently offer practical help to quit.

Acquaintance and Approach in the Direction of Tobacco Cessation Among Dental Practitioners-A Systematic Review

Background:

Nowadays, tobacco consumption has become one of the major public health problems and is the leading cause of escapable illness and death. A significant role is played by dental professionals in the identification of smokers; they are, thus, in a better position to offer preventive care. The aim of the present study was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation.

Methods:

A literature search was performed in PubMed Central and Cochrane Library, Medline—PubMed, Embase, Google Scholar up to 2018 to identify appropriate studies. Full-text original research articles of the cross-sectional design were only included in the study. Our target was to systemically review the knowledge and attitude of dental practitioners toward tobacco cessation.

Results:

The present review included a total of nine articles (studies) that fulfilled the eligibility criteria. Two articles which were hand searched and one article which was obtained through contact with experts were included. The results of the review revealed that the dental practitioners in most of the included studies lack satisfactory knowledge and were unaware of existing referral pathways to specialist smoking cessation services. At the same time, most of the dentists have a positive attitude toward tobacco cessation.

Conclusions:

Dental professionals are aware of their obligations toward smoking cessation counseling for patients but certain barriers including lack of time, confidence, and training prevent them from practicing the same in their daily routine. The dental professionals should obtain appropriate training and attain knowledge along with quantifiable skills for the prevention and cessation of tobacco use.

Tobacco Cessation Counseling: Attitudes and Practices among Yemeni Dental Professionals

Tobacco use is a significant health problem in Yemen and worldwide. Dental practitioners can play a pivotal role in educating their patients on the risk of smoking and motivating them to quit. This study aimed to assess the attitudes towards and practices of tobacco cessation counseling (TCC) among Yemeni dental professionals and to evaluate whether such attitudes and practices are associated with gender, smoking status, and years since graduation. In this cross-sectional study, a self-administered questionnaire containing questions regarding the practice and attitudes towards TCC in dental clinic was used. SPSS version 20 was used for data analysis. For statistical analysis, Chi-square test was used with a significance level of P < 0.05. Of the 400 distributed questionnaires, 182 were completed and analyzed. 53.3% of the respondents were males and 46.7% were females. Around one fifth of the respondents were smokers. The majority reported that they routinely ask their patients about their tobacco habits (83.5%), and advise against tobacco use (85%). Around half of the respondents believed that tobacco cessation intervention may affect their clinical practice and their income negatively through decreasing number of attending patients and believed that provision of dental treatment is more important than TCC. The majority (92%) believe that health professionals should refrain from tobacco, and 83% agree that TCC should be included in dental school curricula. Recent graduates and non-smokers showed relatively better attitudes and practices. There is an urgent need for continuing educational programs in TCC. Also, inclusion of TCC to dental curriculum is highly required.

Attitudes of dental professionals toward tobacco use

BACKGROUND

The habit of tobacco consumption has plagued all nations from time immemorial. While tobacco use is decreasing in many developed countries, it is increasing in developing countries like India. Health care professionals have a key role to play to motivate and advise tobacco users to quit.

AIM

The aim was to assess the attitudes and practice of dental professionals in Mumbai and Navi Mumbai toward tobacco cessation and the potential barriers faced.

MATERIALS AND METHODS

Questionnaire-based survey was conducted with 500 dental surgeons in Mumbai and Navi Mumbai. The questionnaire contained close-ended questions and assessed the smoking status of the professional, whether they impart tobacco cessation advice to their patients, whether the professional is trained for basic intervention, whether they would be eager to undergo training and also the potential barriers encountered by the professional.

STATISTICAL ANALYSIS USED

The SPSS version 17 was used. Frequencies and percentages were used to determine distributions of the responses for each of the variables. Chi-square test was used for analysis.

RESULTS

It was observed that the majority of dental clinicians do not use tobacco and although 93% believed that it is the role of the dental professional to offer advice, 21% do not. Potential barriers reported were: Little chance of success, lack of training, lack of time, lack of remuneration, and the possibility of losing patients.

CONCLUSIONS

Dental professionals must expand their horizon and armamentarium to tobacco intervention strategies inclusive of their regular preventive and therapeutic treatment modalities. Furthermore, the dental institutions (schools) should include tobacco intervention in the curriculum, but it should not be just theoretical knowledge rather it must have a practical component.

Knowledge and attitude of tobacco use and cessation among dental professionals

Aim

Smoking is the one of the most preventable causes of death worldwide. Dental professionals may play an important role in anti-smoking campaigns. The aim of this study was to evaluate current knowledge of and attitudes toward smoking and its cessation among dental professionals.

Materials and methods

This questionnaire-based study was carried out among general dental practitioners (GDPs) and dental students in Saudi Arabia. The questionnaire was used to collect data on sociodemographic characteristics, knowledge, and attitudes toward tobacco use and cessation. Data were analyzed using SPSS software (version 18.0; IBM) and the Mann–Whitney U-test, with a significance level of p < 0.001.

Results

A total of 342 participants (130 GDPs, 212 dental students) with the mean age of 24 (standard deviation, 5) years participated in the study. One-third (33.8%, n = 44) of GDPs and 30.2% (n = 64) of dental students were smokers; small percentages (GDPs, 9.1% [n = 4]; dental students, 7.8% [n = 5]) were heavy smokers. The majority of participants rated both smoking cessation and prevention together as a very important preventive measure. Families were rated as the most important factor responsible for smoking cessation, whereas general practitioners were rated as the most important factor for providing assistance with cessation.

Conclusion

More meaningful participation of dental professionals in tobacco cessation is needed, with implications for related curriculum changes.

Tobacco cessation practices of senior dental students in Iran

OBJECTIVE

Tobacco use is prevalent in Iran, especially among men. The aim was to assess cessation practices and identify perceived barriers to delivery of tobacco cessation services by Iranian senior dental students.

DESIGN

Descriptive, cross-sectional study.

SETTING

Iran, Schools of Dentistry, 2009-2010.

PARTICIPANTS

370 (response rate 82%) officially registered senior dental students selected through stratified random sampling.

INTERVENTION

Students at 11 dental schools throughout the country completed the survey.

MAIN OUTCOME MEASURE

Students' practice of the US Clinical Practice Guideline 5 As (ask, advise, assess, assist, arrange); interest in training; intention and barriers addressing tobacco use in dental settings.

RESULTS AND CONCLUSIONS

Respondents were primarily female (67.8%). The students were far more likely to be actively involved in asking, advising and assessing patients to quit than in assisting and arranging. Most respondents (68.5%) agreed that it is within the scope of dental practice to help smokers quit. The most important barriers to providing cessation services included perceived patient resistance (44%) and lack of a supportive organisation (36%). This was the first assessment of approaches to tobacco users by dental students in Iran. Although there clearly is room for improvement, the interest of the students toward tobacco cessation is encouraging.

Management of smoking patients by specialist periodontists and hygienists in the United Kingdom

OBJECTIVE

To assess the management of patients who are current smokers in dental practice.

MATERIALS AND METHODS

A postal questionnaire to the 243 periodontists on the UK specialist register and 239 randomly selected hygienists on the General Dental Council register.

RESULTS

Eighty per cent of both groups responded. There were significant demographic differences between the two groups of respondents: 88% of periodontists were in specialist practice and/or hospital or university departments, while 89% of hygienists were in general dental practice. Periodontists routinely asked their patients about smoking 99% of the time, hygienists 89%. More than 5 min. was spent advising a smoker patient by 35% of periodontists and 19% of hygienists. A proportion of both groups claimed to have had some recognized training in quit smoking (44% and 39%). When asked about the oral conditions of their smoking patients, 26% of periodontists stated that these patients did not have poorer oral hygiene, while 67% of hygienists thought that they did. While the majority of both groups discussed the oral effects of smoking, less than two-thirds discussed methods of giving up.

CONCLUSION

Both periodontists and hygienists are generally aware of the problems of treating smokers, and accordingly ask and advise their patients. However, lack of time and poor patient response may inhibit active involvement in assisting patients to quit smoking.

A comparison of tobacco smoking among dentists in 15 countries

This study was conducted as a systematic review of all modern literature describing the prevalence and associations of tobacco smoking among dentists. A keyword search of appropriate MeSH terms was initially undertaken to identify relevant material. Reference lists of manuscripts were also examined to locate further publications. A total of 35 English-language studies published in the past 25 years met the inclusion criteria. Results suggest that the prevalence of smoking is generally quite low among dentists, and that it has also declined in many countries during recent years. The lowest rates were documented in the United States (USA), Thailand, Finland, Australia and Canada. When multiple studies were examined over time, it appears that dentists in Australia and the USA consistently report the lowest prevalence. Overall, this review suggests that dentists have one of the lowest smoking rates among all health professionals. There were a few exceptions however, namely Italy and Jordan, where dentists appear to be smoking at fairly high rates. Nevertheless, it is important that tobacco usage continues its decline in future years so that the dental profession may remain exemplars at the forefront of preventive oral care.

Effectiveness of smoking cessation interventions: review of evidence and implications for best practice in Australian health care settings

OBJECTIVE

To review the evidence of the effectiveness of various smoking cessation methods and appropriateness for use in Australian health care settings.

METHODS

Cochrane and other existing reviews and meta-analyses of evidence were the basis for the review. Systematic literature searches were also conducted to identify relevant controlled trials published internationally between January 1999 and May 2002. The main inclusion criteria for studies were use of a controlled evaluation design and an outcome measure of continuous abstinence from smoking for at least five months. A three-tiered grading system for strength of evidence was used.

RESULTS

Clinic and hospital systems to assess and document tobacco use and routine provision of cessation advice can double long-term quit rates. While brief intervention can achieve a significant effect at population level, at individual level there is a strong dose response between the number and length of sessions of tobacco cessation counselling and its effectiveness. Effective behavioural interventions can increase cessation rates by 50-100% compared with no intervention. Some pharmacotherapies are safe and also help to substantially increase cessation rates.

CONCLUSIONS

Effective behavioural and pharmacological methods of tobacco cessation are available.

IMPLICATIONS

Every smoker should be offered evidence-based advice and treatment to quit smoking. This includes pharmacotherapy, unless contra-indicated. Health professionals and health care settings can play a significant role in motivating and assisting smokers to quit.

Australian dental students' views about smoking cessation counseling and their skills as counselors

OBJECTIVES

This paper seeks to determine Australian dental students' views about and skills to provide smoking cessation counseling.

METHODS

In 2000, we surveyed dental students enrolled in all five years of the undergraduate degree course at the Faculty of Dentistry, University of Sydney, Australia.

RESULTS

We obtained 248 questionnaires (response rate=88%). Of our sample, 31 (13%) were self-reported current smokers. Most students (n=203; 82%) indicated they were expected to give smoking cessation counseling to patients. While the majority responded they had been taught the risks from tobacco in the etiology of oral cancer (n=180; 73%), significantly fewer (n=111; 45%) indicated they were taught smoking cessation counseling (McNemars chi-square=41.66; df=1; P<.001). Independent of their own smoking status, most planned to advise patients about tobacco use in their graduate careers (n=219; 91%). However, significantly fewer (n=129; 54%) indicated that such counseling would be effective (McNemars chi-square=9.95; df= 1; P<.04). Students' confidence to counsel smokers to quit was low and did not differ significantly by year (chi-square=3.90; df=4; P=.42). Resources highly ranked for inclusion in the undergraduate curriculum were seminars with experts (50%) and practical skills training (49%).

CONCLUSIONS

Dental students' low perception of the effectiveness of smoking cessation counseling and the inadequacies of the current evidence-base invite more convincing research about dentists' role in tobacco control and better skills training in response.

Tobacco prevention in Swedish dental care

OBJECTIVE

To assess tobacco prevention in Swedish dental care and to identify barriers. Also, to investigate whether dentists and dental hygienists were familiar with recently published review of smoking cessation methods.

METHODS

A questionnaire was mailed to all 353 dental hygienists and 528 dentists in Stockholm County.

RESULTS

The overall response rate was 61% for the dentists and 67% for the dental hygienists. Nearly all considered smoking to be a major health issue, but one out of two was not convinced that smokeless tobacco use was a major health problem. A small minority was routinely engaged in cessation support. However, on the aggregate level, the active dentists and hygienists advised annually approximately 70 000 and 40 000 smokers, respectively. The main barrier to cessation counseling was lack of smoking cessation experts to refer to and was followed by a lack of reimbursement, a lack of knowledge, time constraints, and a feeling of inadequacy. Also, one out of two dentists and 3 out of 10 hygienists did not see it as a part of their job to help patients stop smoking. Approximately 10% in both groups made use of the review of smoking cessation methods. Fifty per cent of these had increased their cessation consultations by an average of 30% because of the guidelines. On the average, dentists and hygienists had spent approximately 1.4 and 2.9 h, respectively, during the previous month on all smoking cessation activities.

CONCLUSIONS

Despite several barriers, there is an excellent potential for a more active role in tobacco cessation counseling in Swedish dental care.

Training for dentists in smoking cessation intervention

BACKGROUND

Although dentists are ideally placed to deliver smoking cessation advice and assistance to their patients, smoking cessation interventions are not often incorporated as a routine part of dental care. Research is needed to identify factors that facilitate and inhibit dentists' capacities to deliver smoking cessation advice.

METHODS

An initial focus group discussion was conducted in Melbourne with 10 dentists. Six Victorian country dentists were interviewed in depth by telephone. Following this qualitative data collection, a random sample of 250 dentists (response rate of 57 per cent) was interviewed by telephone. Dentists were asked about their perceived role, current practices, knowledge of resources and services and opinions on training in relation to smoking cessation.

RESULTS

Dentists are willing to ask and advise patients about smoking, but are less inclined to assist patients to quit or arrange follow-up. Dentists are more likely to implement one-off, opportunistic interventions rather than take a systematic preventive approach. Dentists are interested in attending further education and say they require training to be relevant to the context of their day-to-day running of the dental practice.

CONCLUSIONS

Training should aim to legitimize the dentist's role in smoking cessation and provide strategies and resources so that dentists can practise interventions as part of their day-to-day work.

Older adults' contact with health practitioners: is there an association with smoking practices?

BACKGROUND

Approximately 12% of the North American population aged 65 and older smoke cigarettes daily. Late-life smokers represent an important population for intervention by health practitioners. The objective of this study was to determine the extent to which contact with health practitioners (dentists or physicians) affects smoking status among older adults.

METHODS

We used data on a probability-based sample of community-dwelling elderly respondents (N = 13,363) from the Canadian 1996-1997 National Population Health Survey. Descriptive statistics were calculated, and multivariate logistic regression analysis was performed to examine the associations between current tobacco use and contact with health care practitioners controlling for potential confounders, especially sociodemographic characteristics, selected health conditions, self-reported health, body mass index, functional status, perceived social support, and psychological distress.

RESULTS

Older adults without a regular physician (adjusted odds ratio [AOR], 1.33; 95% confidence interval [CI], 1.11-1.59), with infrequent physical (AOR, 1.22; 95% CI, 1.07-1.40), and dental (AOR, 2.68; 95% CI, 2.07-3.47) checkups were more likely to be current smokers. Age (younger), church attendance (infrequent), drinking behavior (former or occasional), body mass index (normal weight), and psychological distress were all independently related to current smoking.

CONCLUSIONS

Results indicate that patients' contact with health care providers is strongly negatively associated with smoking. More specific data are needed to learn the frequency with which physicians and dental professionals attempt to modify older individuals' smoking behavior and the degree to which such efforts are effective.

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets

AIM

The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers.

METHODS

The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated.

RESULTS

No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth.

CONCLUSIONS

The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.