Dentists' familiarity with tobacco cessation programs in dental settings in Iran

Objectives: The current study assessed Iranian dentists' practice, knowledge, perceived barriers, and attitudes toward helping patients to quit. We hypothesized that Iranian dentists would have limited knowledge and awareness of tobacco cessation methods or of their important role in encouraging patients to quit. We expected the combination of quantitative and qualitative research to yield important insights regarding effective methods of engaging Iranian dentists in tobacco intervention. Methods: From a list of registered dentists following an initial screening, we randomly selected a total of 1,000 dental practices in 10 randomly selected provinces. Following an initial letter describing the study, we mailed a questionnaire. For the qualitative part of the study, we used a convenience purposeful sampling of 16 dentists. Results: Despite repeated contacts, only 35 percent of those contacted returned completed surveys. Key findings not only included generally positive attitudes toward tobacco cessation programs, but also identification of major barriers including concerns about patient resistance, lack of supportive organization, and opportunities for training. Dentists were far more likely to ask patients about smoking than to provide actual cessation support. Female dentists were more likely to ask patients. The qualitative interviews shed further light on barriers to intervention. Conclusions: Interpretation of the findings is limited by the relatively low response rate. However, despite identified barriers to intervention, we are encouraged by dentists' overall knowledge and interest in tobacco cessation services. We plan to use the current findings to inform development of continuing education programs and incorporation of tobacco cessation counseling into dental school curricula in Iran.     

Substance-use screening and interventions in dental practices: Survey of practice-based research network dentists regarding current practices,policies and barriers

BackgroundDental visits represent an opportunity to identify and assist patients with unhealthy substance use, but little is known about how dentists are addressing patients’ use of tobacco, alcohol and illicit drugs. The authors surveyed dentists to learn about the role their practices might play in providing substance-use screening and interventions.MethodsThe authors distributed a 41-item Web-based survey to all 210 dentists active in the Practitioners Engaged in Applied Research and Learning Network, a practice-based research network. The questionnaire assessed dental practices’ policies and current practices, attitudes and perceived barriers to providing services for tobacco, alcohol and illicit drug use.ResultsOne hundred forty-three dentists completed the survey (68 percent response rate). Although screening was common, fewer dentists reported that they were providing follow-up counseling or referrals for substance use. Insufficient knowledge or training was the most frequently cited barrier to intervention. Many dentists reported they would offer assistance for use of tobacco (67 percent) or alcohol or illicit drugs (52 percent) if reimbursed; respondents who treated publicly insured patients were more likely to reply that they would offer this assistance.ConclusionsDentists recognize the importance of screening for substance use, but they lack the clinical training and practice-based systems focused on substance use that could facilitate intervention.Practical ImplicationsThe results of this study indicate that dentists may be willing to address substance use among patients, including use of alcohol and illicit drugs in addition to tobacco, if barriers are reduced through changes in reimbursement, education and systems-level support.     

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.     

Dental Care for Pregnant Women

BackgroundThe authors conducted a study to examine factors associated with general dentists' provision of care for pregnant women and the extent to which they provide comprehensive dental care.MethodsThe authors mailed an 86-item questionnaire to 1,000 practicing general dentists in North Carolina. Survey domains included provider knowledge about pregnancy and dental health, dental treatment practices, barriers to providing care, outcome expectancy, and personal and practice demographics. The primary dependent variables the authors analyzed were whether dentists provided any treatment to pregnant women and, among those who did, the extent to which they provided comprehensive services. The authors performed multivariate regression analyses to determine factors associated with dentists' provision of care to pregnant women (P < .05).ResultsA total of 513 surveys were returned (a response rate of 51.3 percent), of which 495 surveys had complete responses. The authors included the completed surveys in their analyses. The mean age of the respondents was 46 years. The results of multivariate analysis showed that respondents who perceived a lack of demand for services among pregnant women and provided preconception counseling were less likely to provide any treatment for pregnant patients than were those who perceived a demand for services and who did not provide preconception counseling, respectively. Dentists who were male, had a low knowledge score, provided preconception counseling and treated largely white populations of patients were less likely than female dentists, those who had moderate or high knowledge scores, and those who treated a population of minority patients to provide comprehensive care for pregnant women.ConclusionsMost general dentists in private practice provide care for pregnant women, but the authors found notable gaps in dental provider knowledge and comprehensive dental services available for pregnant women.Clinical ImplicationsAlthough many general dentists provide some dental care to pregnant women, more should be done to ensure that this care is comprehensive.     

Dentists' attitudes,behaviors, and barriers related to tobacco‐use cessation in the dental setting

Objective: This study assessed attitudes, behaviors, and barriers among general dentists in California, Pennsylvania, and West Virginia, related to patient tobacco cessation counseling. Methods: From 2004 to 2008, a baseline survey was mailed to 271 study dentists randomly selected from a master Delta Dental Insurance Company provider list in each state who had agreed to participate in a tobacco cessation randomized clinical trial. Four backward logistic regression models assessed correlates of the five As related to tobacco cessation: Asking about tobacco use, Advising users to quit, Assessing readiness to quit, Assisting with quitting, and Arranging follow‐up. Results: Most respondents (n = 265) were male, had practiced dentistry for over 15 years, asked about tobacco use (74%), and advised tobacco users to quit (78%). Only 19% assessed readiness to quit; 39% assisted with quitting; 4% arranged follow‐up; and 42% had formal training in tobacco cessation. Believing that tobacco cessation counseling was an important professional responsibility, practicing <15 years, and asking about tobacco use significantly related to advising users to quit. Providing cessation advice and feeling effective intervening related to assessing readiness to quit. Advising users to quit, assessing readiness to quit, feeling effective intervening, and having had formal tobacco cessation training related to assisting with quitting. Barriers to cessation counseling were perceived patient resistance (66%), lack of insurance reimbursement (56%), not knowing where to refer (49%), and lack of time (32%). Conclusion: Study dentists reported not fully performing the five As. Advising, assessing, having formal training, and feeling effective increased the likelihood of cessation counseling.     

Empowering Malaysian dentists to tobacco dependence treatment conduct

As a signatory to the World Health Organisation 2003 Framework Convention on Tobacco Control, Malaysia has policies in place and funded 300 public Quit clinics. Unfortunately, government dentists are not included to run tobacco dependence treatment. A cross‐sectional exploratory survey was carried out to seek Malaysian dentists' opinion on their knowledge, perception and willingness to conduct tobacco dependence treatment. Participation was voluntary from those who attended a specially designed one‐day, four‐module workshop on tobacco cessation intervention. Data were collected using the Audience‐Response‐System equipment which tracked immediate responses covering four domains namely: smoking as a public health problem, smoking as an addiction, the role of dentists in the programme and confidence in conducting smoking cessation in the clinic. Sample comprised more female dentists (73.5%), mean age 33.6 (SD 8.99) years and with more than 3 years working experience. Findings indicated that the majority agreed Malaysia has a rising problem in the prevalence of smoking (71.6%) and predicted that it will affect mostly the young (81.9%). Only half of the dentists surveyed (58.9%) routinely recorded their patients' smoking habits. The majority (71.6%) believed that dentists are effective in helping their patient to stop smoking and 76.3% agreed that dentists should discuss the smoking habit with their patients; however, 60% agreed that doing so is too time consuming. In addition, only 24.7% knew of more ways to treat a smoking habit. The majority felt comfortable giving advice to patients about changing their habits (76.5%) or discussing treatment options (60.5%): 75% would opt for a combined programme of counselling and use of medication if they have to do, 15% would choose to go on counselling only, while 8% did not want to treat. In conclusion, the findings suggest that dentists have a strong potential to contribute significantly to providing smoking cessation treatment if adequately trained.     

Treatment of obstructive sleep apnoea patients in community dental care: knowledge and attitudes among general dental practitioners and specialist dentists

Obstructive sleep apnoea (OSA) is an increasing problem worldwide. Yet, a large number of patients may remain undiagnosed. Dentists could suspect OSA, but little is known about their knowledge and attitudes towards the topic. An email questionnaire was sent to dentists working in Helsinki Health Centre, Helsinki, Finland (n = 226). It consisted of demographic data, items on dentists' overall knowledge of OSA and factors associated with it, and their possibilities and willingness to take part in the recognition and treatment of OSA patients. Altogether, 70·9% (n = 134) of dentists eligible for the study completed the questionnaire. Of them, 79·1% (n = 106) were general practitioners and 20·9% (n = 28) dentists with specialty training. Continuous positive airway pressure (CPAP) (99·3%) and weight control (99·3%) were both generally acknowledged as effective methods to treat OSA. Regarding the efficacy of other treatment modalities, significant differences were found between general practitioners' and specialists' opinions. For example, mandibular advancement devices (MAD) were less often reported by general practitioners (69·8%) than specialists (89·3%) (P < 0·05). The possible risk factors, signs and symptoms, and consequences of OSA were overall well recognised regardless the years in dental profession, but specialists saw more often that nocturnal sweating (P < 0·01) and snoring (P < 0·05) may signify OSA. Dentists could play an important role in suspecting OSA, but they may need more education to cope with that.     

Reimbursement rates and policies for primary molar pit-and-fissure sealants across state Medicaid programs

BackgroundLittle is known about Medicaid policies regarding reimbursement for placement of sealants on primary molars. The authors identified Medicaid programs that reimbursed dentists for placing primary molar sealants and hypothesized that these programs had higher reimbursement rates than did state programs that did not reimburse for primary molar sealants.MethodsThe authors obtained Medicaid reimbursement data from online fee schedules and determined whether each state Medicaid program reimbursed for primary molar sealants (no or yes). The outcome measure was the reimbursement rate for permanent tooth sealants (calculated in 2012 U.S. dollars). The authors compared mean reimbursement rates by using the t test (α = .05).ResultsSeventeen Medicaid programs reimbursed dentists for placing primary molar sealants (34 percent), and the mean reimbursement rate was $27.57 (range, $16.00 [Maine] to $49.68 [Alaska]). All 50 programs reimbursed dentists for placement of sealants on permanent teeth. The mean reimbursement for permanent tooth sealants was significantly higher in programs that reimbursed for primary molar sealants than in programs that did not ($28.51 and $23.67, respectively; P = .03).ConclusionsMost state Medicaid programs do not reimburse dentists for placing sealants on primary molars, but programs that do so have significantly higher reimbursement rates.Practical ImplicationsMedicaid reimbursement rates are related to dentists' participation in Medicaid and children's dental care use. Reimbursement for placement of sealants on primary molars is a proxy for Medicaid program generosity.     

Dental students' attitudes toward smoking cessation guidelines

Dentists can be effective in helping their patients achieve smoking cessation. To plan a didactic program, we explored the smoking cessation attitudes and practices of dental students and identified barriers to service provision in the dental setting. We assessed 244 fourth-year dental students at New York University College of Dentistry through a self-report survey. The instrument included a twenty-nine-item measure assessing attitudes towards tobacco-use counseling and adherence to National Cancer Institute tobacco cessation guidelines. The survey also assessed demographics, tobacco use history, and level of preparation to provide services. Generally, students endorsed tobacco prevention practices, but perceived barriers to service provision. Students provided counseling inconsistently, with 69 percent asking about smoking, 58 percent advising cessation, 24 percent offering assistance, and 22 percent providing followup on a routine basis. Those who provided more counseling were more likely to have undergone formal training in smoking cessation, did not feel time was a barrier to counseling, and had more favorable beliefs about dentists' role in promoting smoking cessation. Study findings indicate great receptivity among students as well as a critical need and opportunity to include comprehensive cessation counseling training in the dental curriculum.     

Dentists' attitudes toward discussing Internet health information with their patients – does professional self‐efficacy matter?

Objective: The present study explored the relation between professional self‐efficacy and the attitudes of dentists toward discussing Internet dental health information with their patients. Methods: Fifty‐seven dentists answered a questionnaire examining professional self‐efficacy and attitudes toward patients wishing to discuss dental health information obtained through the Internet. Results: A correlation was found between professional experience (in years) and professional self‐efficacy [r point by serial (rpb) = 0.27, P < 0.05]. No statistically significant correlation was found between specialty and professional self‐efficacy (rpb = 0.11, P < 0.4), and between professional self‐efficacy and attitudes toward patients who wish to discuss dental health information (rpb = 0.22, P > 0.1). Specialists were more willing to converse with their patients than nonspecialists. Most participants did not find discussing information from the Internet to be time‐consuming. Conclusions: This pilot study's results indicate that a) Specialists in dentistry were more willing to discuss Internet dental health information with their patients than nonspecialists; b) Dentists with high professional self‐efficacy had a positive attitude toward patients who wish to discuss Internet dental health information with them; and c) Further studies are needed to investigate and validate the results of the present study. Practice Implications: High professional self‐efficacy may improve general dentists' attitudes toward patients who wish to discuss Internet dental health information. The dental community should seek to expand the professional self‐efficacy of its members in order to enable them to adequately deal with patients' needs.     

Respect for Patients' Autonomy

BackgroundRespect for patients' autonomy is an ethical principle in health care highlighted in the ADA Principles of Ethics and Code of Professional Conduct. The author presents a case example to illustrate its importance in dentistry.MethodsUsing a clinical example of disrespect for patients' autonomy, the author underscores the importance of incorporating normative ethical principles in patient-dentist relationships.ConclusionsRespect for patients' autonomy sustains healthy boundaries between patients and the clinician. It underscores the importance of providing patient education and counsel without attempting to persuade or manipulate patients for dentists' benefit.Practice ImplicationsRespect for patients' autonomy is a fundamental principle of health care ethics that patients expect dentists to follow. The author encourages dentists to incorporate this principle into every patient encounter.     

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.     

Knowledge and attitudes of Croatian Dentists Regarding Antibiotic Prescription in Endodontics: A Cross-sectional Questionnaire-based Study

ObjectivesTo assess dentists'' level of knowledge and practice concerning antibiotic usage in endodontics using the European Society of Endodontology position statement as a reference.Materials and MethodsA cross-sectional study was conducted in the form of an electronic questionnaire consisting of 23 questions, including dentists’ demographic and professional characteristics, attitudes as well as experiences regarding antibiotics in endodontics. Data were evaluated by the Mann-Whitney test or the Kruskal Wallis 1-way ANOVA, α = 5%.ResultsThe overall mean self-reported knowledge of antibiotics usage in endodontics was 11.7±2.5 points, out of a maximum possible score of 23. The factors associated with a higher knowledge were: age (P≤0.001), clinical experience (P≤0.001), specialist training (P=0.008), and adherence to the guidance on the use of systemic antibiotics in endodontics (P=0.006). Dentists who specialized in endodontics (16.1±2.2) achieved higher levels of knowledge.ConclusionKnowledge on antibiotic usage in endodontics among dentists in Croatia is insufficient. There is a need for continuing education on the use of antibiotics among general dentists.Key words: Antibiotics, Dentists, Endodontics, Knowledge, Questionnaire     

An analysis of dentists' incomes, 1996-2009

BackgroundThe U.S. economy is beginning to recover from the most significant contraction since the Great Depression. Several sectors, including dentistry, have experienced reduced consumer demand and reduced earnings. Focusing on general practitioners, the authors analyzed trends in various factors that drive dentists' income to identify which of these factors are most important in explaining the recent decline. They then offer their views on future trends in dentists' net income levels.MethodsThe authors used data from a nationally representative survey of dentists maintained by the American Dental Association (ADA) and data from the Agency for Healthcare Research and Quality's Medical Expenditure Panel Survey to analyze trends in real gross billings per visit, rates of collection of gross billings, number of visits to a dentist, percentage of the population who visited a dentist, population to dentist ratio and average real practice expenses.ResultsThe authors found that the recent decrease in dentists' net income levels was driven primarily by a decrease in utilization of dental care on the part of the population. Moreover, this decline in dental care use, although most pronounced during the economic downturn, appeared to have started before the downturn began. This suggests that more factors than solely the economic recession are affecting changes in dental care utilization patterns.ConclusionsThe authors' findings suggest that average real net income for dentists may not necessarily recover to prerecession levels once economic conditions in the United States improve. This finding, combined with the potential implications of health care reform for dentistry, causes the authors to believe the future prospects related to dentists' net income levels remain uncertain.     

Knowledge and Practice Regarding Oral Cancer: A Study Among Dentists in Jakarta,Indonesia

ObjectiveTo assess Indonesian dentists' knowledge of risk factors and diagnostic procedures related to oral cancer (OC) and to determine the factors that influenced their level of knowledge.MethodsA modified version of a questionnaire that had been used to assess dentists’ knowledge regarding OC in Canada was used. A total of 816 dentists were invited to participate in the study.ResultsThe total response rate was 49.2%; however, the number of dentists from 5 regions in Jakarta were equally represented. Use of tobacco or alcohol and history of previous OC were the top 3 risk factors that were answered correctly by dentists, but there was a high proportion of dentists who considered some without any evidence as risk factors. Almost half of the dentists did not know the early signs of OC and that erythroplakia and leukoplakia were associated with increased risks of developing OC. Only about 27% of dentists had a high level of knowledge of risk factors and fewer dentists demonstrated a good knowledge of diagnostic procedures. Dentists’ age group, year of graduation, and experience of continuing education significantly influenced the level of knowledge of diagnostic procedures (P < .05).ConclusionDentists in Jakarta had a considerable level of knowledge of major risk factors of OC, although some gaps in their knowledge, especially in diagnostic procedures, were present. Increasing these competencies may aid in the prevention and early detection of OC.     

Dangerousness and dentistry: an explanation of dentists' reactions and responses to the treatment of HIV-seropositive patients

Abstract Factors which influence health professionals' willingness to treat HIV seropositive patients have been explained in terms of the concept of dangerousness. Can this concept be used as a vehicle to explain dentists' responses? All dentists currently in practice in Northern Ireland (n= 664) were invited lo take part in the study. A final valid response rate of 73.3% was achieved. Altitudes and behavioural aspects of dental practice were examined in relation to whether they had or had not treated and HIV seropositive patients. In addition correlation and factor analyses were conducted. The results indicated that the concept of ‘dangerousness’ provides a useful framework to explain dentists' attitudes and behaviours with respect to the provision of dental care for this patient group.