Social nicotine dependence in Australian dental undergraduate students

Objectives: This study aimed to investigate dental undergraduate students’ tobacco usage and social nicotine dependence in Australia. A special interest was to identify the role of factors such as age, gender, year of dental education and cohabitants’ smoking status for social nicotine dependence. Materials and methods: A sample of 252, first‐to‐fifth year undergraduate students in an Australian dental school was used. Each completed a self‐administered questionnaire. Results: The smoking rate was 4.8%. Current smokers displayed higher social nicotine dependence than those that had never smoked (t = 3.1, df = 244, P = 0.002). Dental undergraduate students that showed higher social nicotine dependence (P = 0.001, OR = 1.3, 95% CI: 1.1–1.6), or that had smoking cohabitants (P = 0.016, OR = 4.8, 95% CI: 1.3–17.0), were more likely to smoke. Students’ social nicotine dependence increased with year of dental study (P = 0.043, β = 0.4, t = 2.0). Social nicotine dependence enhanced tobacco usage among Year‐1‐to‐4 students (P = 0.005, OR = 1.4, 95% CI: 1.1–1.7) but not Year‐5 undergraduates (P = 0.432). Conclusions: Social nicotine dependence has become a developing issue in dental education. Tobacco control should be highlighted in the dental curriculum. Future investigations into the effects of dental education on social nocotine dependence and tobacco usage are indicated.     

Dental patients’ perceptions and motivation in smoking cessation activities

Objective The aim of the present study was to investigate smokers’ perceptions of and motivation for smoking cessation activities in dentistry. Materials and methods Patients who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists. Results The sample consisted of 167 adult patients (≥?20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR?=?3.0, 95% CI?=?1.03–8.55). Conclusions This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.     

Dental students' smoking behavior and their attitude towards smoking

This study investigated dental students' smoking behavior and their attitudes, in order to provide programs to patients for giving up smoking. A questionnaire survey was conducted on dental students from November 2003 to February 2004. The subjects were 69 third-grade and 80 fifth-grade students of Tokyo Medical and Dental University. The following results were obtained. (1) The smoking rate of dental students was 19.4% (Male: 31.3%, Female: 5.8%). (2) About forty-three percent of the students had started smoking before entering the university. However, most of the students who smoked had started after entering the university. The smoking rate and number of cigarettes smoked of fifth-grade students were significantly higher than those of third-grade students. (3) Dental students recognized the health risks of smoking more than the general public, especially concerning periodontal disease. (4) Only 5.4% of students answered that they would actively provide advice and instructions about the health hazards of tobacco to patients who smoked. (5) The rate of students who answered that they had enough knowledge to conduct smoking cessation programs for patients was 21.5%. (6) Students who smoked showed positive attitudes towards dentists' smoking behaviors and had passive attitudes towards smoking cessation programs conducted by dentists. These results show it is necessary to conduct smoking cessation programs soon after entering university and to provide more lectures on tobacco and health issues as well as practical training programs about giving up smoking in the dental education curriculum.     

Dental students'' attitude towards anti-smoking programmes: a study in Flanders, Belgium

OBJECTIVE: The aim of the study was to assess the dental students' attitude towards tobacco cessation counselling in the dental setting and to explore the influence of knowledge, belief in effectiveness, smoking status, gender and curriculum. MATERIAL AND METHODS: The study group consisted of all undergraduate students from the 2002-2003 classes of the Ghent University (n = 96). A validated questionnaire was administered to all students involving four different sections: demographic characteristics, attitude related to tobacco cessation programmes in the dental setting, belief in their effectiveness and knowledge concerning tobacco health effects. Statistical analysis included simple univariate nonparametric tests for evaluating differences in attitude towards tobacco cessation programmes, belief in effectiveness of tobacco cessation programmes in the dental setting and knowledge of students concerning tobacco health effects by year of graduation, smoking status and gender. Multiple logistic regression was chosen to calculate adjusted odds ratios and 95% confidence intervals. RESULTS: Students view willingness to advise individual patients to quit using tobacco. Yet only 51.3% are willing to co-operate in anti-tobacco programmes at the community level, and the perception of students of the effectiveness of smoking cessation counselling in the dental setting is low. The variance of attitude towards tobacco cessation programmes was significantly affected by knowledge and the belief in effectiveness of tobacco cessation programmes in the dental setting. Better knowledge and belief in effectiveness of tobacco cessation counselling was associated with an increasing positive attitude towards tobacco cessation programmes expressed by an odds ratio of 3.12 (95% CI 1.00-9.67) and 1.17 (95% CI 1.00-1.37) respectively. CONCLUSION: Belief in effectiveness and knowledge seem to influence the attitude of students towards tobacco cessation counselling. Practice implications: Besides imparting knowledge, the attitude of newly graduated dentists could be improved by stressing the effectiveness of smoking cessation activities during lectures and integrated training modules in the undergraduate education.     

Prevalence and correlates of musculoskeletal disorders among Australian dental hygiene students

Abstract: Introduction: Although musculoskeletal disorders (MSD) have been identified as a significant occupational health issue for dental hygienists, few studies have explored this problem among the dental hygiene student population. Aim: The aim of this study was to investigate the prevalence and correlates of MSD among a selection of undergraduate dental hygiene students in Australia. Methodology: A self‐reporting questionnaire was distributed to dental hygiene students at an Australian university during 2008, from which a response rate of approximately 72% was achieved. Results: Musculoskeletal disorders were most commonly reported by students at the neck (64.29%), lower back (57.94%) and shoulder (48.41%) regions. Logistic regression indicated various correlations with MSD. Students who did not undertake regular exercise every week experienced an increased risk of lower back pain [Odds Ratio (OR): 4.88, 95% Confidence Interval (CI): 1.75–14.9]. Students undertaking 16–20 h of desk‐based study per week were much more likely to report neck pain (OR: 19.7, 95% CI: 1.34–378.94). Working 6–10 h on a computer each week was a risk factor for shoulder (OR: 7.03, 95% CI: 1.42–39.49) and upper back pain (OR: 5.29, 95% CI: 1.21–25.56). Conclusions: Overall, this study suggests that MSD are a reasonably common problem for dental hygiene students in Australia. As such, further studies are required to establish epidemiological patterns of MSD, and our profession will need to carefully consider preventive strategies to help minimize the impact of this important occupational health issue on the next generation of dental hygienists.     

Impact of shortened dental arches on oral health‐related quality of life

This study described the prevalence of adults with shortened dental arches (SDA) in Brazil, specifically assessing the differences of oral health‐related quality of life [the prevalence and severity of oral impacts on daily performance (OIDP)] by dentition status. We analysed data from the 2010 National Survey of Oral Health in Brazil, including home interviews and oral examinations. The assessment of SDA used two alternative definitions: having 3–5 natural occlusal units (OUs) in posterior teeth or having 4 OUs in posterior teeth. Both definitions included having intact anterior region and no dental prosthesis. The analysis was weighted, and a complex sampling design was used. Negative binomial regression models assessed associations as adjusted for socio‐demographic conditions and dental outcomes. A total of 9779 adults (35–44 years old) participated in the study. A non‐negligible proportion had SDA: 9·9% and 3·8% for the first and second definition, respectively. Individuals with SDA (first definition) ranked higher in OIDP prevalence [count ratio (CR) 1·22; 1·09–1·36, 95% confidence interval (CI)] and severity (CR = 1·43; 1·19–1·72, 95% CI) than those with more natural teeth. This difference was not statistically significant when adjusted for socio‐demographic and dental covariates: OIDP prevalence (CR = 1·04; 0·92–1·17, 95% CI) and severity (CR = 1·09; 0·91–1·30, 95% CI). Analogous results were obtained when the second definition of SDA was adopted. These findings suggest that a considerable contingent of adults may function well without dental prostheses, despite having several missing teeth. This conclusion challenges the traditional approach of replacing any missing tooth and instructs the allocation of more dental resources to preventive, diagnostic and restorative services.     

Oral health attitudes and behaviours of final‐year dental students

Objectives: The objectives of this study of final‐year dental students in 10 classes (1997, 2001—2009) were to examine their self‐reported oral health attitudes and behaviours and describe any trends in these attributes. Participants and methods: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude–behaviour associations were examined. Results: Of 583 students, 459 responded (79%). All tooth‐brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1—2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1—3/year. Between‐meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. Conclusions: Final‐year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.     

Periodontal attachment loss attributable to cigarette smoking in an urban Brazilian population

AIMS: The present study estimated the percentages of cases with severe periodontal attachment loss (PAL) attributable to cigarette smoking in a representative adult urban population in southern Brazil. METHODS: A representative sample comprising 853 dentate individuals (age: 30-103 years) was selected by a multistage, probability sampling method. A full-mouth clinical examination of six sites per tooth was performed and an interview using a structured written questionnaire was undertaken. Cases were defined as individuals with > or =30% teeth with PAL > or =5 mm. A multivariate logistic regression analysis for complex surveys was performed, and adjusted for age, gender, race, socioeconomic status and dental calculus. RESULTS: The prevalence of cases in this population was 49.7%, or 739,000 subjects. Overall, 50.9% of this adult population, or approximately 757,000 subjects have had a lifetime exposure to cigarette smoking. Multivariate analysis showed that heavy and moderate smokers had a significantly higher risk for PAL > or =5 mm than non-smokers (odds ratio=3.6, 2.0, respectively) after adjusting for the above covariates. We estimated that the number of moderate and heavy smokers with > or =30% teeth with PAL > or =5 mm might be reduced by approximately 28% and 48%, respectively, had they not smoked cigarettes. We project that a smoking cessation program could result in a reduction in the number of cases by up to 12% in this population, or approximately 90,000 potential cases. CONCLUSION: Cigarette smoking was strongly associated with severe attachment loss in this population. A significant percentage of cases may have been prevented if smoking cessation interventions had been implemented. The results support the implementation of population-based smoking cessation programs to reduce the prevalence of severe attachment loss in populations with high level of smoking exposure.     

Trends in dental caries among Brazilian schoolchildren: 40 years of monitoring (1971–2011)

The study aimed to estimate the prevalence, severity, and inequality in the distribution of dental caries in schoolchildren from Florianópolis, Santa Catarina, Brazil, in 2011, and to compare the results with data from previous studies carried out since 1971. All 12‐ and 13‐year‐old schoolchildren enrolled in a public school were eligible. Dental caries were assessed according to the World Health Organisation diagnostic criteria. Decayed, missing and filled surfaces and teeth (DMFS/DMFT) indexes, the Significant Caries Index (SiC) and the Gini coefficient (to assess inequalities in the distribution of dental caries) were estimated. The response rate was 82.3% (n = 130). The prevalence of dental caries decreased from 98.0% (95% CI 96.0–100.0) in 1971 to 36.9% (95% CI 28.5–45.3) in 2011. The mean DMFT ranged from 9.2 in 1971 to 0.7 in 2011. The mean DMFS index was 1.2 (95% CI 0.8–1.6) in 2011. The Gini coefficient was 0.624 in 2002 but increased to 0.725 in 2011; the Lorenz curve showed that 70–75% of dental caries attacks was restricted to 20% of the population in 2011. A reduction of 41.2% in the mean SiC index was observed between 2002 (3.4, 95% CI 3.0–3.8) and 2011 (1.9, 95% CI 1.6–2.1). An effective decline in the prevalence and severity of dental caries in schoolchildren was observed throughout 40 years of monitoring. However, a small proportion of the population has experienced most of the caries burden in the recent years studied.     

Prevalence and association of dental injuries with socioeconomic conditions and alcohol/drug use in adolescents between 15 and 19 years of age

Abstract –  Background: The aim of the present study was to investigate the prevalence of dental trauma, etiological factors, predisposing factors, and associations with socioeconomic status and the risk of alcohol and illicit drug use among adolescents in the city of Belo Horizonte, Brazil. Methods: A cross‐sectional study was carried out that included clinical examinations and self‐administered questionnaires. The sample population was composed of 891 adolescents from public and private schools. The Social Vulnerability Index (SVI) was used for socioeconomic classification. Information on alcohol and illicit drug use was obtained using two questionnaires: the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Results: The prevalence of traumatic dental injury (TDI) was 24.7%. Falls (17.7%) was the most frequently cited etiological factor in dental injury. Among the participants with TDI, 32.8% were students in the private school system (P = 0.006). A total of 56.8% of individuals with accentuated overjet had some type of TDI (P = 0.000). There was a high prevalence of adolescents who consumed alcoholic beverages (50.3%) and used illicit substances (15.2%). However, no statistically significant associations were found between these variables and the presence of TDI. The results of the analysis demonstrate that individuals in a private school system [prevalence ratio (PR) = 1.11; 95% confidence interval (CI): 1.03–1.20] and those with accentuated overjet (>3 mm) (PR = 1.17; 95% CI: 1.10–1.25) had a 1.11‐ and 1.17‐fold greater chance of belonging to the group of individuals diagnosed with some type of TDI. Conclusions: The prevalence of dental trauma in the study population was high. The same was true regarding alcohol and illicit drug use among the adolescents examined, although no statistically significant associations were found between these variables and a history of TDI. Private school system and accentuated overjet were significantly associated with dental trauma.     

Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil

Oral Diseases (2011) 17 , 171–179 Objective: The objective of the study was to assess the prevalence of oral mucosal lesions (OML) and to perform a multivariable risk assessment of demographic, socioeconomic, behavioral, and oral risk indicators for its occurrence in an urban population in South Brazil. Methods: This cross‐sectional study selected 1586 subjects (719M/867F, age: 14–104 years) using a multistage probability sampling strategy (65.1% response rate). Prevalence, odds ratios (OR), and confidence intervals (95% CI) were calculated accounting for the survey design. Results: Leukoplakia and lichen planus were observed in 1.01% and 1.02% of subjects, respectively. In the multivariable analysis, these lesions were significantly associated with moderate/heavy smoking (OR = 9.0, 95% CI = 2.1–39.1) and heavy drinking (OR = 2.0, 95% CI = 1.1–3.7). Candidiasis and proliferative lesions were observed in 14.09% and 3.80% of the subjects, respectively. These lesions were significantly associated with female gender (OR = 2.2, 95% CI = 1.5–3.2 and OR = 1.7, 95% CI = 1.0–2.8), older age (OR = 22, 95% CI = 8.0–60.8 and OR = 8.9, 95% CI = 3.4–23.7), and low socioeconomic status (OR = 1.9, 95% CI = 1.0–3.5 and OR = 3.0, 95% CI = 1.2–7.2). Conclusions: This population is in need of OML prevention and treatment. Future studies should validate the findings that premalignant lesions are causally related to smoking and alcohol consumption, and that other OML are associated with socioeconomic‐demographic disparities in this and similar populations.     

Exploring factors associated with traumatic dental injuries in preschool children: a Poisson regression analysis

Abstract – Objective: This cross‐sectional study aimed to investigate the factors associated with dental trauma in preschool children using Poisson regression analysis with robust variance. Subjects and methods: The study population comprised 888 children aged 3‐ to 5‐year‐old attending public nurseries in Canoas, southern Brazil. Questionnaires assessing information related to the independent variables (age, gender, race, mother’s educational level and family income) were completed by the parents. Clinical examinations were carried out by five trained examiners in order to assess traumatic dental injuries (TDI) according to Andreasen’s classification. One of the five examiners was calibrated to assess orthodontic characteristics (open bite and overjet). Multivariable Poisson regression analysis with robust variance was used to determine the factors associated with dental trauma as well as the strengths of association. Traditional logistic regression was also performed in order to compare the estimates obtained by both methods of statistical analysis. Results: 36.4% (323/888) of the children suffered dental trauma and there was no difference in prevalence rates from 3 to 5 years of age. Poisson regression analysis showed that the probability of the outcome was almost 30% higher for children whose mothers had more than 8 years of education (Prevalence Ratio = 1.28; 95% CI = 1.03–1.60) and 63% higher for children with an overjet greater than 2 mm (Prevalence Ratio = 1.63; 95% CI = 1.31–2.03). Odds ratios clearly overestimated the size of the effect when compared with prevalence ratios. Conclusions: These findings indicate the need for preventive orientation regarding TDI, in order to educate parents and caregivers about supervising infants, particularly those with increased overjet and whose mothers have a higher level of education. Poisson regression with robust variance represents a better alternative than logistic regression to estimate the risk of dental trauma in preschool children.     

Smoking prevalence and attitude toward anti-smoking activities among Korean dentists

Aims : To investigate the smoking habits and attitudes toward anti‐smoking activities of Korean dentists according to their smoking status. Methods : A questionnaire was mailed to a random sample of 2,500 currently active Korean dentists in 2008. After 20% of the 1,680 returned surveys (response rate 67.2%) were excluded due to missing data, 1,443 surveys were analysed. Results : Among the 1,443 respondents, most were male (81.8%) and age 40–49 was the most prevalent age group (41.6%). Approximately half of participating dentists were never‐smokers, 24.6% were current smokers, and 29% were ex‐smokers. Women (95.8%) were significantly more likely to have never smoked than men (35.4%). Prevalence of cigarette smoking of Korean male and female dentists was much lower than that of male and female Korean adults, respectively. Ex‐smokers were significantly more likely to show a positive attitude about anti‐smoking activities, compared to current smokers (p<.0001). Conclusions : A majority of respondents agreed dentists should encourage their patients to stop smoking. Further effort is needed to encourage smoking cessation among male Korean dentists who smoke so they benefit from a healthier lifestyle and will subsequently be more likely to provide recommendations for smoking prevention and cessation for their patients.     

Smoking cessation and the dental team

Dental teams are in an ideal position to help smokers stop smoking. In spite of this, smoking cessation interventions are not often incorporated as a routine part of dental care. Surveys have shown that most dentists believe that helping patients stop smoking is important, but they are reluctant to provide smoking cessation services for their patients. However, comparatively little research has been carried out to examine the views and activities of other members of the dental team, with respect to the provision of smoking cessation support as part of dental care.This paper describes a self-administered, questionnaire-based study to investigate attitudes and practices amongst staff in the Birmingham Personal Dental Service, with respect to helping patients to stop smoking. CLINICAL RELEVANCE: Dentists and their team members have an important role to play in smoking cessation.     

Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey

BACKGROUND: The principal objectives of this study were to examine the relationship between cigarette smoking and periodontitis and to estimate the proportion of periodontitis in the United States adult population that is attributable to cigarette smoking. METHODS: Data were derived from the Third National Health and Nutrition Examination Survey, a nationally representative multipurpose health survey conducted in 1988 to 1994. Participants were interviewed about tobacco use and examined by dentists trained to use standardized clinical criteria. Analysis was limited to dentate persons aged > or =18 years with complete clinical periodontal data and information on tobacco use and important covariates (n = 12,329). Data were weighted to provide U.S. national estimates, and analyses accounted for the complex sample design. We defined periodontitis as the presence of > or =1 site with clinical periodontal attachment level > or =4 mm apical to the cemento-enamel junction and probing depth > or =4 mm. Current cigarette smokers were those who had smoked > or =100 cigarettes over their lifetime and smoked at the time of the interview; former smokers had smoked > or =100 cigarettes but did not currently smoke; and never smokers had not smoked > or =100 cigarettes in their lifetime. RESULTS: We found that 27.9% (95% confidence interval [CI]: +/-1.8%) of dentate adults were current smokers and 23.3% (95% CI: +/-1.2%) were former smokers. Overall, 9.2% (95% CI: +/-1.4%) of dentate adults met our case definition for periodontitis, which projects to about 15 million cases of periodontitis among U.S. adults. Modeling with multiple logistic regression revealed that current smokers were about 4 times as likely as persons who had never smoked to have periodontitis (prevalence odds ratio [ORp] = 3.97; 95% CI, 3.20-4.93), after adjusting for age, gender, race/ethnicity, education, and income:poverty ratio. Former smokers were more likely than persons who had never smoked to have periodontitis (ORp = 1.68; 95% CI, 1.31-2.17). Among current smokers, there was a dose-response relationship between cigarettes smoked per day and the odds of periodontitis (P <0.000001), ranging from ORp = 2.79 (95% CI, 1.90-4.10) for < or =9 cigarettes per day to ORp = 5.88 (95% CI, 4.03-8.58) for > or =31 cigarettes per day. Among former smokers, the odds of periodontitis declined with the number of years since quitting, from ORp = 3.22 (95% CI, 2.18-4.76) for 0 to 2 years to ORp = 1.15 (95% CI, 0.83-1.60) for > or =11 years. Applying standard epidemiologic formulas for the attributable fraction for the population, we calculated that 41.9% of periodontitis cases (6.4 million cases) in the U.S. adult population were attributable to current cigarette smoking and 10.9% (1.7 million cases) to former smoking. Among current smokers, 74.8% of their periodontitis was attributable to smoking. CONCLUSIONS: Based on findings from this study and numerous other reports, we conclude that smoking is a major risk factor for periodontitis and may be responsible for more than half of periodontitis cases among adults in the United States. A large proportion of adult periodontitis may be preventable through prevention and cessation of cigarette smoking.     

LEVELS OF SMOKING AND PERI‑IMPLANT MARGINAL BONE LOSS: A SYSTEMATIC REVIEW AND META-ANALYSIS

AimThis systematic review and meta-analysis sought to determine if there was a significantly enhanced risk of peri?implant marginal bone loss (MBL) due to the increased number of cigarettes smoked per day.Materials and MethodsSix databases, including Medline, Embase, Cochrane Library, Web of Science, Scopus, and ProQuest, were searched until February, 2021. The search terms “dental implant, oral implant, smoking, smoker, non-smoker, marginal bone loss and crestal bone loss” were used in combination to seek the articles providing data for MBL related to the smoking habit. Articles were excluded if the quantity of cigarettes smoked per day was not reported. Random-effects meta-analyses were used to pool the estimates of mean difference (MD) with 95% confidence intervals (CI).ResultsEight studies were included for qualitative and 5 for quantitative synthesis. The meta‐analyses revealed higher levels of MBL in patients who smoked <10 or >10 cigarettes/day than in non-smokers (<10: (MD -0.33, 95% CI -0.69-0.03 and >10: MD -0.58, 95% CI -0.96- -0.19). There was a significant risk of MBL between patients who smoked >10 and <10 cigarettes/day (MD -0.23, 95% CI -0.47-0.01).ConclusionIt seems the risk of MBL is steadily increasing as daily smoking increases.     

Preventive dentistry: what do Australian patients endorse and recall of smoking cessation advice by their dentists?

OBJECTIVE: To investigate patients' views regarding dentists' smoking cessation advice. DESIGN: Survey questionnaire. SETTING: One hundred and thirty five dental practices in Sydney Australia. Subjects Two thousand, four hundred and fifty one dental patients. RESULTS: One thousand, one hundred and sixty pre-consultation questionnaires were obtained (RR=80%), 302 (26%) were self-reported smokers. From these, 623 post-consultation questionnaires were returned (RR = 54%). Most patients expected dentists to be interested in their smoking status (n = 847/1160, 73%, 95% CI: 70% to 76%) and to discuss smoking with them (n = 713/1160, 61%, 95% CI: 59% to 64%), however, smokers were significantly less likely to respond as such compared with non-smokers (P < 0.001). Smokers and non-smokers equally would not change dentist even if asked about their smoking status opportunistically (59% versus 62%) (OR = 0.91, 95% CI: 0.67 to 1.22). Less than one third of all smokers would try to quit if their dentist suggested they do so (n = 90/302, 30%, 95% CI: 25% to 35%). Smokers' recall of quit advice from their recent consultation was low (n = 22/124, 18%). CONCLUSIONS : Smoking cessation advice by dentists is not self-evidently effective. These findings behove interventional research to ascertain efficacy of smoking cessation advice delivered by dentists before admonishing changes in routine clinical practice.