Abstract

In the United States, tobacco use is the leading preventable cause of illness and death, and Kentucky maintains the highest smoking rate in the country (32%). Dentists could play an influential role in assisting patients to quit using tobacco since approximately half of all smokers have annual dental checkups. The American Dental Association’s position is that all members are urged to become “fully informed” about tobacco cessation intervention techniques. The current study surveyed professional practices of Kentucky dentists (n= 266) to determine if they consistently identify patients that use tobacco, advise them to quit, and offer assistance to overcome nicotine dependence. Kentucky dentists were asked to complete the survey as part of a free continuing education program, Providers Practice Prevention: Treating Tobacco Use and Dependence, which reflects the United States Public Health Service Clinical Practice Guideline’s five A’s (Ask, Advise, Assess, Assist, Arrange). The majority of the dentists worked in rural (44%) or suburban (36%) areas and two-thirds were male. The evidence from the current study indicates that dentists do not routinely intervene to assist patients in tobacco cessation. Although a majority of dentists agree that it is a professional responsibility to educate patients about the oral health hazards of tobacco use and that tobacco cessation should be discussed with patients during dental visits, few dentists actually comply with this belief. Remarkably, 63% of dentists surveyed reported that they either “rarely” or “never” assist patients with a tobacco cessation plan. One possible reason for this discrepancy is that almost one-third of the dentists indicated they did not have sufficient skills and knowledge to treat nicotine dependence, and half felt uncomfortable discussing tobacco cessation with patients. Another troubling discovery was that less than 30% of dentists indicated strong agreement that a brief intervention with patients could be effective. Most dental schools have not yet systematically incorporated tobacco cessation into the curriculum. To help integrate tobacco cessation interventions as part of routine dental care, it would be optimal for dental schools to amend the curriculum to offer students educational training and to develop continuing education programs for practicing dentists.

Introduction

More than 30 percent of all cancer deaths can be attributed to smoking (American Cancer Society, 2004). Dentists could play an influential role in assisting patients to quit using tobacco since approximately half of all smokers have annual dental checkups (Tomar, Husten, & Manley, 1996). However, past research indicates that majority of dentists do not routinely assist patients with smoking cessation (Tomar, 2001; Dolan, McGorray, Grinstead-Skigen, Mecklenburg, 1997; Tomar, Husten, & Manley, 1996). This practice is not in compliance with the recommendations set forth by the American Dental Association which stipulates that dentists should “become fully informed in smoking cessation techniques” to assist patients who are nicotine dependent (ADA, 2004). Recent research indicates that even brief interventions can be effective in assisting patients with tobacco cessation management (USDHHS, 1996). Dentists are in a unique position as they may deliver an oral health message as they are performing routine duties and would not require additional time.

Purpose and Hypotheses

• The purpose of this study is to examine the routine professional practices of dentists in regards to smoking cessation management. Specifically examined were the rate at which dentists evaluate patients as tobacco users and the rate that dentists offered assistance with tobacco cessation once a patient had been identified as a tobacco user.
• The current study hypothesizes that dentists do ask patients about smoking practices and subsequently assist patients with smoking cessation management as part of routine oral health care.

Method

Sample Description

Participants were Kentucky Dentists (n=266)

Gender of Dentist:
Male (67.9%)
Female (32.1)

Patient Population:
Rural (45.8)
Suburb (38.2%)
Urban (16%)

Area of Practice:
General (88.2%)
Family (1.1%)
Pediatric (1.1%)
Other (9.5%)

Years in Practice:
Range 0-44
Mean 17.24
Standard Deviation 10.775

Procedure

Kentucky dentists completed a questionnaire as part of a free continuing education program, Providers Practice Prevention: Treating Tobacco Use and Dependence, based on the recently published United States Public Health Service Clinical Practice Guideline

Measures

• Participants completed a questionnaire that inquired about their routine practices for implementing tobacco cessation management.
  
• The questionnaire was composed of questions that implemented the Tobacco Guidelines Five A’s:
  
• Asses: Do you identify every patient who uses tobacco?
  
• Ask: Do you ask every patient about tobacco use?
  
• Advise: Do you advise every patient about cessation?
  
• Assist: Do you assist with tobacco management?
  
• Arrange: Do you arrange for external help with management?
  
• Items were included that assessed Extended Parallel Processing Model variables (i.e., perception of susceptibility, perception of seriousness, perception of self-efficacy, and perception of response-efficacy.
  
• Items were also included that measured participants’ knowledge of tobacco cessation.
  

Results

• 87.8% “Strongly Agreed” that it is important for dentists to discuss tobacco use with patients
  
• 32.8% either “Somewhat Disagreed” or “Strongly Disagreed” that they have sufficient skills/knowledge to treat nicotine dependence
  
• 51% indicated the primary reason they do not counsel patients is due to lack of time
  
• 63% reportedly identified every patient that smokes
  
• 7.8% “Always” assisted the patient develop a tobacco cessation plan
  
• 29.7 “Strongly Agreed” and 51.6% “Somewhat Agreed” that a brief intervention for tobacco cessation would be effective
  

Conclusions

• Every dentist agreed that smoking poses serious health risks and almost all agreed that it is a professional duty to assist patients with smoking cessation management. While two-thirds of the dentists routinely identified patients who use tobacco, most dentists did not reportedly implement smoking cessation techniques with those patients. The majority of the dentists indicated that they felt that they lack skills and knowledge in facilitating tobacco cessation with patients.
  
• Past research indicates that even brief interventions can facilitate changes in smoking that lead to health benefits. Additional tobacco cessation training for dentists would benefit patients who use tobacco. Most dental schools have not yet systematically incorporated tobacco cessation into the curriculum (Tomar, 2001). To help integrate tobacco cessation interventions as part of routine dental care, it would be optimal for dental schools to amend the curriculum to offer students additional training and to develop continuing education programs for practicing dentists. With an increased knowledge of tobacco management techniques, dentists would likely experience increased confidence in their ability to help patients quit smoking. Dentists who feel competent with cessation techniques are more likely to offer their patients assistance with tobacco management.
  
• Over half of the dentists indicated that a primary reason for not counseling patients about tobacco use cessation is due to lack of time. However, the majority also agreed that a brief three-minute intervention could facilitate tobacco cessation. Again, additional training may foster confidence in dentists and lead to an increase in tobacco cessation efforts.
  

Limitations

• These results many not reflect the tobacco-related clinical practices of dentists throughout the United States for the following reasons:
  
• Higher than average interest: Dentists in the current study may have a predisposed interest in assisting patients with smoking cessation. Participants were Kentucky dentists who volunteered to complete the questionnaire and were awarded continuing education credits for their participation.
  
• Lower than average interest: Alternatively, consideration should be given to the fact that participating dentists practice in Kentucky-- a state that is known to have a higher percentage of tobacco users as compared to national rates and a cultural context that promotes tobacco use.