Should the use of smoking cessation products be promoted by dental offices? An evidence-based report

To address the issue of whether dentists should promote the use of smoking cessation products, an evidence-based methodology was applied to find answers to 3 questions: Does tobacco use affect periodontal health? Are dentists effective cessation counsellors? Do smoking cessation products improve the effectiveness of cessation interventions? MEDLINE and manual searches uncovered relevant evidence to use in developing evidence-based recommendations. There is fair evidence that tobacco use is a major factor in the progression and treatment outcome of adult periodontitis and that quitting tobacco use is beneficial to periodontal health. There is good evidence to recommend that oral health professionals provide cessation counselling. There is good evidence to recommend the use of smoking cessation adjuncts. In view of the strong supporting evidence, dental offices should incorporate systematic smoking cessation services into routine patient care and should promote the use of proven cessation products by patients who are attempting to quit.     

Tobacco cessation for the dental team: a practical guide part II: evidence-based interventions

Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. By expanding the dental exam, diagnosis, and treatment to include tobacco cessation, a potentially life saving element of care is added to an established service. In addition periodontal disease and the potential for oral cancer mandate the inclusion of tobacco cessation services into dental care. Though dental professionals are aware of the health issues associated with tobacco use, they often feel ill prepared or uncomfortable presenting patients with a clear cessation message. In this, the second of a two-part article, the purpose is to provide dental professionals with the evidence-based strategies necessary to provide effective tobacco cessation as a normal part of patient care.     

Tobacco cessation within the dental curriculum in the United States and internationally

Tobacco use is a worldwide public health issue with enormous costs in morbidity and mortality. Dentists are in a unique position as health care providers to offer tobacco cessation counseling to their patients. In order to do so, clinicians must be properly trained in tobacco cessation skills. The onus falls upon professional schools to include information about tobacco use, its clinical effects, and ways to help patients quit into the dental curriculum. In the past 15 years, there has been an increase in the number of dental schools that have adopted anti-tobacco policies and included tobacco in their clinical courses both here in the United States and in Europe. Dental schools with functional tobacco cessation programs in place must follow up on the activities conducted in their clinics to ensure that dental students are appropriately employing the correct techniques and, thus, learning to provide optimal care to their patients.     

Tobacco cessation for the dental team: a practical guide part I: background & overview

Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. By expanding the dental exam, diagnosis, and treatment to include tobacco cessation, a potentially life saving element of care is added to an established service. In addition periodontal disease and the potential for oral cancer mandate the inclusion of tobacco cessation services into dental care. Though dental professionals are aware of the health issues associated with tobacco use, they often feel ill prepared or uncomfortable presenting patients with a clear cessation message. In this, the first of a two-part article, the purpose is to provide dental professionals with the foundational knowledge necessary to provide effective tobacco cessation as a normal part of patient care.     

Resolution of oral lesions after tobacco cessation

Background: Dentists and other health care professionals are familiar with the impact of tobacco on oral and general health. However, oral health care professionals do not often provide tobacco-cessation counseling to their patients, thus reflecting a significant disconnect between research and clinical practice. This report demonstrates the benefits of tobacco cessation in resolving oral lesions and improving overall periodontal and oral health. Methods: A 51-year-old white male presented to the University at Buffalo, School of Dental Medicine clinic requesting an oral and periodontal examination as part of a presurgical protocol prior to cardiac surgery. A review of the patient's history from a health questionnaire revealed that he was using smokeless tobacco every day. An oral examination revealed several white lesions (5 x 10 mm) on the maxillary right and left labial mucosa. The patient was provided with tobacco-cessation counseling as well as oral hygiene instructions and professional dental prophylaxis. Results: An oral examination 2 weeks after tobacco cessation revealed complete resolution of the oral lesions and overall improvement of periodontal and oral health. Conclusion: Although the findings presented in this article are based only on a single case report, the improvement in the patient's oral health after cessation of tobacco use was dramatic and reinforces the belief that tobacco-cessation counseling should be a routine component of the standard of care for tobacco-using patients.     

The invisible work with tobacco cessation - strategies among dental hygienists

To cite this article:
Int J Dent Hygiene 10 , 2012; 54–60
DOI: 10.1111/j.1601‐5037.2011.00530.x
Andersson P, Westergren A, Johannsen A. The invisible work with tobacco cessation – strategies among dental hygienists. Abstract: Objective: This study elucidates dental hygienists’ experiences of work with tobacco cessation among patients who smoke or use snuff. Methods: Data were obtained and categorized by interviewing 12 dental hygienists, who worked actively with tobacco cessation interventions. Qualitative content analysis was used for analysis. Results: The latent content was formulated into the core category ‘the invisible oral health promotion work’. The informants thought that they had a responsibility to work with tobacco cessation. They perceived the financial system in which they perform the activity as frustrating, because tobacco cessation has no treatment code in the dental care insurance. This was one of several reasons why they had to integrate it in other treatment procedures. The results identified three categories: ‘balance in the meeting’, ‘possibilities and hindrance’ and ‘procedures’. In the narratives, both positive and negative aspects were displayed. Conclusions: The financial conditions for tobacco cessation interventions need to be reformed and the activity has to be given a higher priority in the organization of dental care. Practical training in performing tobacco cessation interventions is important during the dental hygiene education; otherwise, tobacco cessation interventions will remain invisible in oral health promotion in the future.     

Tobacco prevention and control in dental practice: the future

Tobacco use adversely affects oral health and dental care. Globally, the health consequences of tobacco use are worsening, particularly those caused by cigarette smoking. Concerned government and nongovernmental organizations are attempting to contain the transnational tobacco companies' promotion of tobacco use and its disregard for the serious health consequences. Dependence prevents most tobacco users from easily breaking free from their high-risk behavior. Evidence-based clinical treatment methods that substantially increase quit rates are available in the Public Health Service clinical practice guideline, Treating Tobacco Use and Dependence. Guideline recommendations are as useful to dental clinicians as to other health care disciplines. Dental educators have a strategic role in ensuring that clinicians are well informed and are skilled in and committed to providing tobacco prevention and cessation services to their patients. Dental organizations must identify and overcome perceived and real clinician and practice barriers to adopting essential cessation services. The dental profession is in an excellent position to play a major role in several emerging issues, such as helping the public and policymakers understand the chronic nature of tobacco dependence and supporting cessation services for all people, particularly pregnant women and youths. Such messages should be presented in terms that resonate with the public because tobacco industry activities and products continue to undermine well-being, the health economy, and individual self-directed behavior of choice.     

Impact of Smoking Cessation on Periodontal Tissues

There is cumulative evidence supporting the negative effects of smoking on periodontal tissues. Smoking cessation can be successfully accomplished through specific programs, including behaviour modification and medications, and has been suggested as a suitable way to reduce the risk of several diseases, including periodontitis. The aim of this review is to provide a concise overview of the current knowledge about the impact of smoking cessation on periodontal tissues and therapy, with data from studies published in the last 15 years. Literature was searched using Medline database from 2005 up to and including September 2020 using medical subject heading (MeSH) terms and other search terms, restricted to the English language. Studies were evaluated and summarised in a narrative review format. Results demonstrated that there is convincing evidence to support the benefits of tobacco cessation in reducing the risk of periodontitis and tooth loss. In addition, the harmful effects of smoking on periodontal tissues seem to be assuaged as the number of years since quitting increases. The existing current evidence, even limited, also shows that smoking cessation may result in additional benefits to the outcome of nonsurgical periodontal treatment. Periodontal care providers should not only check their patient's smoking habit for estimating risk of disease progression and predictability of periodontal therapy, but they should also help smokers improve their oral and systemic health by providing efficient and personalised tobacco‐cessation counselling and treatment.     

Dental school-based continuing education in tobacco use cessation counseling for oral health care providers

The role of health care providers in patient counseling for tobacco use cessation has gained increased attention in recent years. The present survey examined the activities of dental school continuing education departments in providing continuing education in tobacco use cessation counseling to oral health care personnel. A questionnaire was sent to the director of continuing education at all U.S. and Canadian dental schools. The results indicate that few continuing education programs have been or currently are being offered. Respondents to the survey perceived little interest in this topic among their target audiences. The reasons for the current situation and barriers to practitioner involvement are discussed.     

Tobacco and dental implants

Dental implants are the ideal standard of care for many oral health care providers. Tobacco use is an impediment to the success of this sophisticated procedure. Dentists who are trained to help their patients stop using tobacco are in position to improve their success rates with dental implants. A suggested protocol for tobacco cessation in the implant practice, if utilized, could raise the standard of health care in the dental office.     

Tobacco use prevention and cessation in dental and dental hygiene undergraduate education

Oral health care professionals are aware of their responsibility to advise patients to stop using tobacco. However, they do not feel sufficiently prepared to help their patients to quit, and consequently are not confident in providing these preventive measures. This fact reflects the lack of emphasis on tobacco cessation in both dental and dental hygiene undergraduate education. It may therefore be assumed that improvement of dental and dental hygiene education in tobacco use cessation counselling may result in increased self-confidence and frequency of its provision. The importance of making space in the curriculum for tobacco use prevention and cessation has to be emphasised. Dental schools and dental hygiene programmes have to be reminded of the key role the dental profession has in tobacco control. Next to the public health aspect of tobacco control, such involvement may be both an ethical and a legal responsibility. The implementation of effective tobacco use prevention and cessation in a dental educational setting requires a multidisciplinary approach involving the school's entire teaching personnel and external experts. In general, a knowledge base attained through lecture, Problem-Based Learning (PBL), or E-Learning, and clinical skills attained through clinical instructions and practices is required. It is suggested that curriculum content should include (1) the biological effects of tobacco use, (2) the history of tobacco culture and psychosocial aspects of tobacco use, (3) prevention and treatment of tobacco use and dependence, and (4) development of clinical skills for tobacco use prevention and cessation.     

Tobacco cessation interventions by Swedish dental hygienists--a questionnaire study

The aim of the study was to investigate tobacco cessation interventions by Swedish dental hygienists and their perception of the importance of tobacco cessation to oral health. A questionnaire was mailed to 400 randomly selected dental hygienists (DH) in Sweden. The questions covered such topics as tobacco cessation interventions, perceived barriers, and their perception of the importance of tobacco cessation in relation to caries, gingivitis, periodontitis and dental implants. The response rate was 57%. Tobacco habits were routinely recorded by 94% of the respondents. 52% of the dental hygienists reported time constraints, 50% reported insufficient competence and 43% answered that they had lack of experience to work with tobacco cessation. All respondents perceived tobacco cessation to be an important determinant of treatment outcomes in patients with dental implants and periodontitis. Bivariate analysis showed an association between training courses in tobacco cessation and tobacco cessation interventions (OR 3.25, CI 95% 1.80-5.85). A logistic multivariate regression model disclosed two other factors significantly correlated with tobacco cessation interventions: competence (OR 2.4, 95% CI 1.16-4.85), and experience (OR 2.1, 95% CI 1.06-4.28). The analyses were adjusted for age, length of undergraduate training course, and dental care organization. The dental hygienists considered tobacco cessation to be very important in patients with periodontitis and in those with dental implants. Most of the DH in this study undertook some tobacco cessation interventions, though not extensive; the main barriers reported were lack of time, competence and experience.     

Effectiveness of tobacco counseling in the dental office

This article describes the results of studies among dental care providers regarding tobacco cessation in the past two decades. In the early period, surveys described what dentists were doing in their own practices. The results suggested that they were not adequately communicating to their patients the importance of quitting. There is good evidence that brief interventions from health professionals can increase rates of smoking cessation. The outcome from a number of trials that examined the feasibility of conducting smoking cessation in dental practices is reviewed here. The pivotal role of a team approach is highlighted in many studies. Dentists who implement an effective smoking cessation program can expect to achieve quit rates up to 10-15 percent each year among their patients who smoke or use smokeless tobacco. The challenge is implementing effective treatment in one's practice or institution while using available primary care resources to provide additional benefit.     

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC‐related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re‐address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.     

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.     

Addressing oral disease--the case for tobacco cessation services

There is strong scientific evidence from clinical and epidemiological studies that tobacco use, particularly cigarette smoking, is linked to periodontal disease as well as other serious but less common oral health diseases. Given the strength of this evidence, dentists must include tobacco cessation services (TCS) as part of their routine care. This paper describes barriers to the adoption of TCS as identified by Alberta dentists participating in a randomized intervention trial and discusses strategies for overcoming these barriers. As well, suggestions are made to professional associations and educational institutes on ways to increase the incorporation of tobacco cessation into professional practice standards.     

Tobacco cessation: a practical dental service

Tobacco use is a complex addiction that must be addressed in all aspects of health care. Despite the deleterious and costly outcomes of tobacco use, Americans still are smoking and using smokeless tobacco. Dentists are trained to detect oral lesions and periodontal problems that are related to tobacco use. Dentists also are in a position to help prevent the initiation of tobacco use by children and adolescents through the use of positive anti-tobacco messages. Over the past decade, tobacco cessation strategies have been modified for practical use in the dental setting.     

Oral health risks of tobacco use and effects of cessation

The purpose of this paper is to review the epidemiologic evidence for the effects of tobacco use and tobacco use cessation on a variety of oral diseases and conditions. Exposures considered include cigarette and bidi smoking, pipe and cigar smoking, and smokeless tobacco use. Oral diseases and disorders considered include oral cancer and precancer, periodontal disease, caries and tooth loss, gingival recession and other benign mucosal disorders as well as implant failure. Particular attention is given to the impact of tobacco use cessation on oral health outcomes. We conclude that robust epidemiologic evidence exists for adverse oral health effects of tobacco smoking and other types of tobacco use. In addition, there is compelling evidence to support significant benefts of tobacco use cessation with regard to various oral health outcomes. Substantial oral health benefits can be expected from abstention and successful smoking cessation in a variety of populations across all ages.     

The role of Pakistani dentists in tobacco cessation

Objective : To assess Pakistani dentists' ability, willingness and perceived barriers to carry out tobacco cessation activities for their patients in the dental office. The study is limited to the smoking form of tobacco use. Method : Using a structured questionnaire for a cross sectional study, 239 full time or part time practising licensed dentists based in Islamabad and Rawalpindi were recruited by two sampling techniques; convenience and cluster sampling. Participation rate was 66.2%. Result : Based on the characteristics, the study population is assumed representative of the average Pakistani dentist. Prevalence of smoking amongst dentists was 20.3%. Only one‐third rated their knowledge and ability regarding tobacco cessation messages as good/excellent. The majority of the dentists considered tobacco cessation activity as peripheral to their profession. The main barrier to performing tobacco cessation interventions was cited as gender. Conclusion : Dentists exhibit a superficial approach to delivery of smoking cessation care. It is recommended that dentists be trained in delivering effective tobacco dependence intervention, using the WHO/FDI advocacy guide for oral health professionals, modified to incorporate gender oriented culturally sensitive doctor‐patient interaction. Tobacco cessation clinics should also be set up in private and public sectors to augment the dentists' participation.     

Tobacco-use cessation programs and policies at the University of Manitoba's faculty of dentistry

The deleterious effects of tobacco use on general health and oral health are well documented. While one-third of Manitobans are current smokers, up to 79% report they want to quit. Counselling by health care professionals can help achieve quit rates of 15-20%. Yet many health professionals do not provide tobacco-use cessation counselling because they feel they are not trained to do so. In 1998, the faculty of dentistry of the University of Manitoba implemented a number of tobacco-use cessation interventions in its undergraduate curricula and general teaching clinic. The faculty has also successfully obtained the inclusion of a dental fee code for tobacco-use cessation services in the provincial fee guide and has received approval to allow dentists who have completed an approved course in tobacco-use cessation training to prescribe bupropion HCl (Zyban), in consultation with a patient's physician, to aid smoking cessation.