口腔门诊患者最小接触干预策略戒烟研究

目的：研究口腔门诊医务人员以最小接触戒烟干预策略（minimal intervention strategy,MIS）在患者戒烟干预中的作用。方法：对82名患者进行3个月的MIS戒烟干预,统计戒烟成功率,分析戒烟成功与戒烟失败患者的特点。结果：戒烟成功和失败者分别为37名（45.12%）和45名（54.88%）。戒烟成功组与戒烟失败组相比,年龄与开始吸烟年龄差异无统计学意义,戒烟意愿、尼古丁依赖性、每天吸烟数量和受教育程度差异具有统计学意义。结论：MIS在口腔门诊戒烟干预中具有很高的可行性;戒烟意愿强、尼古丁依赖性低、每天吸烟量少以及受教育程度高的患者更容易戒烟成功。     

The recurrent aphthous stomatitis frequency in the smoking cessation people

This study was aimed to evaluate the frequency of recurrent aphthous stomatitis (RAS) within the 6-week period after quitting smoking. The study group consisted of 90 subjects. Oral, medical findings and tobacco habits were recorded for all subjects. Nicotine replacement therapy (NRT) and behavioral treatment were applied to some of the subjects by a family physician. All subjects were evaluated for their RAS and periodontal measurements on baseline, 1, 3, 6 weeks by a periodontist. While the subjects were in this smoking cessation programme, 64 of the 90 smokers successfully quit smoking within the 6 weeks and 26 smokers dropped out during the third week of the study. Point prevalence of RAS among the subjects on the first day of the quitting period and at the end of the first, third and sixth week after smoking cessation was 3.3% (3/90), 18.9% (17/90), 21.1% (19/90) and 17.1 (11/64), respectively. In the following weeks, aphthous ulcer point prevalence was significantly higher than the quitting level (p < 0.05). As the time after quitting increased, the incidence of aphthous ulcer decreased. Of 64 patients, 35 (54.6%) completed the 6 weeks using NRT and 29 (45.4%) of them did not use any medication. The aphthous ulcer frequency observed in the patients taking NRT [11.4% (4/35)] was lower when compared with the subjects taking no NRT [24.1% (7/29)] (p > 0.05). The results of this study confirm that RAS is a complication of quitting smoking. Further studies are needed to identify the effects of NRT on RAS.     

Assessment of lingual nerve functions after smoking cessation

Objective: Cigarette smoking is associated with a variety of oral diseases. A previous study showed a reduction of thermal sensitivity in the innervation area of the lingual nerve in smokers possibly caused by a degeneration of thermosensitive receptors as a consequence of smoking. The current study investigates somatosensory changes in ex-smokers.

Materials and methods: Sensory functions in innervation areas of lingual nerve were investigated in 40 ex-smokers by psychophysical means. Functions of lingual nerve in 40 ex-smokers were compared to those in 40 smokers and 40 non-smokers. Subjects were investigated using quantitative sensory testing (QST, cold and warm detection, thermal sensory limen, heat and cold pain, and mechanical detection).

Results: Significant differences were found in both groups, ex-smokers and smokers compared to non-smokers. Cold (p?p?p?p?Conclusions: The lower temperature sensitivity of ex-smokers compared to that in non-smokers indicates a reduction of somatosensory function of the tongue, possibly caused by irreversible nerve degeneration associated with smoking. Influencing factors leading to sensory changes could be modulation of thermo-receptors, demyelination as well as a change of the epithelial structure.     

Education of tobacco use prevention and cessation for dental professionals ‐ a paradigm shift

The use of tobacco continues to be a substantial risk factor in the development and progression of oral cancer, periodontitis, implant failure and poor wound healing. Dental and dental hygiene education providers have made great advances towards the incorporation of tobacco education into their curricula in recent years. Unfortunately, however, both medical and dental education research has consistently reported schools providing only basic knowledge‐based curricula that rarely incorporate more effective, behaviourally‐based components affecting long‐term change. The limited training of oral healthcare students, at least in part, is reflected in practising dental professionals continuing to report offering incomplete tobacco interventions. In order to prepare the next generation of oral healthcare providers, this paper proposes a paradigm shift in how tobacco use prevention and cessation (TUPAC) may be incorporated into existing curricula. It is suggested that schools should carefully consider: to what level of competency should TUPAC be trained in dental and dental hygiene schools; the importance of establishing rapport through good communication skills; the core knowledge level for TUPAC; suggested instructional and assessment strategies; the importance of continuing professional education for the enhancement of TUPAC.     

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 and smoking cessation among third‐year dental students in southern Brazil

The aim of the present cross‐sectional study was to assess tobacco use and smoking cessation among third‐year dental students in southern Brazil. The Global Health Professions Student Survey questionnaire was used in eight dental schools in Rio Grande do Sul state, Brazil. Of the 663 eligible students, 576 (87%) participated. The prevalence of current smoking was 19.1% [95% confidence interval (CI): 12.9–25.3%], and 61.6% (95% CI: 54.9–68.3%) of students reported having smoked at least once in their lifetime. The prevalence of dental students who had smoked ≥100 cigarettes in their lifetime was 17.1% (95% CI: 12.5–21.7%). Being frequently exposed to other smokers at home or in other places (second‐hand smoke) increased the likelihood of current smoking by two‐ to threefold. Approximately 6.1% (95% CI: 3.5–8.7%) of the students reported that they currently wanted to stop smoking and 7.5% (95% CI: 5.3–9.6%) had tried to stop smoking in the last year. Friends and family were the most frequent sources of help or counselling, and only a limited proportion of students received help from health professionals. Tobacco use and exposure to second‐hand smoking is widespread among dental students in southern Brazil. Smoking‐cessation initiatives targeting health care students are urgently needed.     

A review of continuing professional development for dentists in Europe

Aim: To summarise findings from a literature review of dentists’ engagement in continuing professional development (CPD) and its effects on improving oral health care for patients. Method: The search strategy used key terms in a range of databases and an academic literature search engine, complemented by hand searching and citation follow‐up. Results: One hundred and fourteen papers were reviewed. The majority of dentists engaged in CPD. Factors affecting participation included time since graduation, costs, work and home commitments, postgraduate qualification, interest and convenience. Learning needs identification and reflection on practice were rarely evidenced. Common modes of CPD were courses and journal reading; no one delivery method proved more effective. Few papers directly explored recommendations for topics although suggestions related to common areas of error and gaps in knowledge or skill. Studies of CPD effectiveness and impact‐on‐practice suggested that courses can result in widespread new learning and considerable self‐reported change in practice. However, significant barriers to implementing change in workplace practice were noted and included availability of materials, resources and support from colleagues. Conclusion: To ensure high standards of care, alongside recommending core or mandatory topics, more attention should be given to reflection on learning needs, the learner’s readiness to engage with education and training and the influence of the workplace environment.     

Attitudes and smoking habits of dentists in Victoria: 16 years on

In 1977 a survey of Victorian dentists measured their smoking prevalence, and their attitudes to dealing with patients who smoked. In 1993 these questions were repeated as part of a telephone survey of Victorian dentists. From 1977 to 1993 their prevalence of daily smoking had dropped from 30 per cent to 6 per cent, and this was not attributable simply to an influx of younger dentists who had never smoked. Many of those who had graduated in 1977 or more recently had never smoked, but many of the earlier graduates had quit, and there was no difference in the current smoking prevalence of the two groups. There had also been a change in dentists' attitudes towards smoking patients, with more of the 1993 sample (55 per cent) than the 1977 sample (43 per cent) agreeing with the statement 'I encourage all my patients to give up smoking wherever possible'. Again, the more experienced dentists were adopting the new behaviours, not just the more recent graduates. Even so, in 1993 nearly half the dentists waited until the patient either was affected by smoking, or asked for advice before raising the issue.     

Patient demand for smoking cessation advice in dentist offices after introduction of graphic health warnings in Australia

BACKGROUND: The effectiveness of smoking cessation intervention by dentists has not been conclusively established. This study aimed to investigate whether the inclusion of graphic health warning pictures (including mouth and throat cancer) as part of the Australian National Tobacco Campaign strategy would elicit measurably increased demand for smoking cessation advice in dental practices. METHODS: A cross-sectional survey of private dental practices in New South Wales, Australia. Separate questionnaires were answered by dentists and patients from their practice. Questions comprised smoking practices and attitudes toward smoking cessation activities in dental practice. RESULTS: The majority of dentists (85.7 per cent; n = 29) and dental patients (92.4 per cent; n = 800) recalled seeing the graphic health warnings, with mouth and throat cancer the most commonly observed. Television was the main medium. Nineteen per cent of dental patients (n = 152) reported themselves as current smokers. Half of them were planning to quit within six months (49.7 per cent) and agreed that graphic health warnings made them more likely to quit (47.7 per cent). Dentists showed positive attitudes toward cessation activities but believed many patients lacked motivation to quit smoking; a perception that was seen to be the main barrier in offering smoking cessation advice. Forty per cent of smokers would try to quit if asked by their dentists, but only 28.4 per cent preferred a dentist for cessation advice. In general, dentists found no change in demand for smoking cessation advice since the launch of the National Tobacco Campaign in 2006. CONCLUSIONS: Health warning pictures seemed to increase the patients' awareness and intention to quit smoking, however it did not appear to generate more demand for smoking cessation advice from their dentists. Dentists had low expectations about their patients' motivation to stop smoking.     

Relationship of smoking and smoking cessation with oral health status in Japanese men

Yanagisawa T, Ueno M, Shinada K, Ohara S, Wright Clive FA, Kawaguchi Y. Relationship of smoking and smoking cessation with oral health status in Japanese men. J Periodont Res 2010; doi: 10.1111/j.1600‐0765.2009.01233.x . ©2009 John Wiley & Sons A/S Background and Objective: Smoking has been associated with the number of natural teeth a person has and with the likelihood of periodontitis. The purpose of this study was to determine the relationships between the number of teeth present and periodontal diseases with smoking habits in a cohort of Japanese men. Material and Methods: The study group comprised 1088 men, 40–75 years of age. Oral examinations were conducted in dental clinics. Information on smoking status and on oral health behavior was collected from self‐administered questionnaires. The relationship between oral health status and smoking status was estimated using adjusted odds ratios. Results: Compared with those whom had never smoked, the odds ratios of having more than eight missing teeth and having periodontitis, among current smokers, were 1.67 and 1.74, respectively. In those who had stopped smoking for 11 years or longer, there was no increase in the odds ratio of having more than eight missing teeth and periodontitis, compared with those whom had never smoked. Conclusion: Smoking has a positive association with missing teeth and periodontitis. However, smoking cessation is beneficial for oral health. The odds of having more than eight missing teeth, or of having periodontitis, in those who had never smoked was similar to that of individuals who reported that they had stopped smoking for 11 years or more.     

The involvement of New Zealand dentists in smoking cessation interventions

OBJECTIVES: To determine the attitudes and practices of dentists towards smoking cessation interventions (SCI), to identify perceived barriers to providing SCI, and to determine the level of interest in future training in smoking cessation for dental staff. DESIGN: Self-administered questionnaire. SUBJECTS AND METHODS: 204 NZDA members in Wellington, Otago, and Southland completed a self-administered questionnaire about SCI. RESULTS: There has been little change in attitudes and practices of dentists towards SCI over the last decade. Few are actively involved in providing these services for their patients. Most dentists believe that there are significant barriers to providing SCI in their daily practice. CONCLUSION: Dentists require greater access to appropriate forms of training in SCI, and increased support (including resources) in order to increase the level of SCI provided in the dental setting.