Making the most of a teachable moment: a smokeless-tobacco cessation intervention in the dental office.

Abstract

OBJECTIVES. Primary care medical clinics are good settings for smoking interventions. This study extends this strategy with a smokeless tobacco intervention delivered by dentists and dental hygienists in the course of routine dental care. METHODS. Male users of moist snuff and chewing tobacco (n = 518) were identified by questionnaire in clinic waiting rooms and then randomly assigned to either usual care or intervention. The intervention included a routine oral examination with special attention to the part of the mouth in which tobacco was kept and an explanation of the health risks of using smokeless tobacco. After receiving unequivocal advice to stop using tobacco, each patient viewed a 9-minute videotape, received a self-help manual, and was briefly counseled by the dental hygienist. RESULTS. Long-term success was defined as no smokeless tobacco use at both 3- and 12-month follow-ups, with those lost to follow-up counted as smokeless tobacco users. The intervention increased the proportion of patients who quit by about one half (12.5% vs 18.4%, P < .05). CONCLUSIONS. These results demonstrate the efficacy of a brief dental office intervention for the general population of smokeless tobacco users.

What Factors Need to be Addressed to Support Dental Hygienists to Assist Their Patients to Quit Smoking?

“…Smoking negatively affects outcomes of dental treatment such as oral surgery, implants, and the treatment of gum disease (Johnson & Bain, 2000;SanchezPerez, Moya-Villaescusa, & Caffesse, 2007;Strietzel, et al, 2007), and has an aesthetic impact such as stained teeth. All of the above may offer a 'teachable moment' where patient receptiveness to quitting smoking is likely to be high (Gordon, Lichtenstein, Severson, & Andrews, 2006;Hébert, 2005;Stevens, Severson, Lichtenstein, Little, & Leben, 1995). As a consequence, there is increased attention on the dental setting as an opportunity to encourage smoking cessation (Edwards, Freeman, & Roche, 2006;Gordon, Andrews, Crews, Payne, & Severson, 2007).…”

Change in smoking status after spiral chest computed tomography scan screening

“…For example, in a study of 518 male spit tobacco users, researchers found that although advice from a dentist improved tobacco abstinence rates, providing feedback on clinically apparent oral lesions did not impact spit tobacco use. 12 Similarly, in a sample of asymptomatic smokers, positive results from electron beam CT scans for coronary calcification impacted the subject's perceived cardiovascular risk, but did not appear to impact any smoking behavior change. 13 Therefore, we need to learn more about how to use disease biomarkers to enhance the success of nicotine dependence interventions.…”

Provider Fatalism Reduces the Likelihood of HIV-Prevention Counseling in Primary Care Settings

“…Providers have many reasons to expect success with their counseling. Research demonstrates that clinic-based behavioral interventions are effective at changing patients' health behaviors (Bolu et al, 2004;Calfas et al, 1996;Campbell et al, 1994;Cornuz et al, 1997;Fleming et al, 1997;Hartmann et al, 1996;Hollis et al, 1993;Ockene et al 1999;Richardson et al, 2004;Rost et al, 2000;Senft et al, 1997;Stevens et al, 1995). More specifically, recent trials of clinicbased HIV-prevention interventions indicate that providers are able to implement intervention protocols in most clinical encounters (Fisher et al, 2004) and that such programs can reduce HIV-infected patients' transmission risk behaviors (Richardson et al, 2004).…”