Implementation of Recommended Tobacco Cessation Systems in Dental Practices: A Qualitative Exploration in Northeastern North Carolina

Abstract

Every year, cigarettes and other tobacco products cause nearly one in five deaths in the U.S., but many smokers report not being advised to quit by their health care providers. Dentists have an important role to play in tobacco cessation, but more research is needed about the extent of and barriers to implementation in dental practices. The aims of this study were to assess the extent to which dental practices in northeastern North Carolina were implementing the recommended U.S. Public Health Service (PHS) Clinical Practice Guideline, to understand policies about smoking in dental practice settings, and to identify barriers to implementation of recommended systems. In the 252 telephone area code, which covers northeastern North Carolina, 75 general dentists were identified from the American Dental Association website and purposely selected for geographic, gender, race, and practice size diversity from the sampling frame. The 11 dentists who agreed to participate (seven male, four female) took part in 15-minute semi-structured interviews by phone in January-March 2017. The interview transcripts were thematically coded for adherence to the PHS guideline. The results showed that full implementation of the guideline and the 5As was limited, although asking, advising, and assessing about tobacco use was consistently present in these dental practices. Other recommendations, particularly designation of a staff member as coordinator, were not implemented. In terms of barriers, interviewees reported very limited past or present training for themselves or their staff members. This study found meaningful levels of adherence to the tobacco cessation guideline in this area with high smoking prevalence; but the results suggest room for improvement in training through both dental curricula and continuing education.

When primary care providers and smokers meet: a systematic review and metasynthesis

“…Some patients explained that they were too ashamed to admit they were smoking and would not be able to raise the issue by themselves 49 . According to the patients, general practitioners (GPs) were at the best place to initiate the process—better than specialized clinics-, since they knew the patients the best and had an established ongoing relationship with them 41 , 46 , 51 , 52 .…”

“…What appeared predominantly was the importance of the relational aspects among patients and PCP. Many patients underlined the unique relation of trust they had with their GPs 51 , 52 . A long-term relationship, based on long acquaintance and familiarity 42 , and a genuine dialog between professionals and patients were seen as key factors and therapeutic levers to enhance smoking cessation 40 .…”

Intention to provide tobacco cessation counseling among Indonesian dental students and association with the theory of planned behavior

“…Adequate modifications in the dental education curriculum was recommended to improving dentist's involvement in smoking cessation [23]. Education and are needed for dentists to develop their knowledge and abilities [17,19] and foster positive attitudes toward tobacco cessation counseling (TCC) [24][25][26]. Most dental students are aware that TCC is within the scope of dentist services.…”

“Buckets”

“…Our first article in this section reports on a study, conducted by a team of dental and pharmacy faculty, of dental patients’ attitudes about disclosing their daily medications to their oral health care provider 1 . Previously published articles that we forced into existing sections at the time, but would fit more appropriately in this new section include those that addressed dental practitioners’ implementation of tobacco cessation with their patients, 2 racial/ethnic minority older adults’ perspectives on oral health care, 3 and dentists’ role in teaching hospitals in Brazil 4 …”