Treatment of Tobacco Use and Dependence: The Role of the Dental Professional

Efficacy of 5-aminolevulinic acid-mediated photodynamic therapy in patients with nicotine stomatitis

AIM

This study aimed to treat smoker's palate (SP) using 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy (PDT).

METHODS

A total of 24 patients with SP were divided into two groups: group-I (test group; n = 12); and group-II (control group; n = 12). Group-I patients were treated with 5-ALA-mediated PDT, while group-II patients were advised to cease the smoking habit during the entire duration of the study and later. PDT was repeated on days 3, 7, and 14 (i.e., a total of four sittings including day 0 [baseline]). Later, the participants were called for follow-up after week-4 (1st follow-up), week-6 (2nd follow-up), and week-8 (3rd follow-up) after the completion of the treatment. The SPSS version 22.0 was used for data analysis.

RESULTS

Group-I patients showed a statistically significant improvement when all three time points were assessed (p < 0.0001). Similarly, the same trend was observed in the group-II participants (p < 0.001), however, the difference between both groups (i.e., group-I [test group] and group-II [control group]) was larger.

CONCLUSION

The findings of this clinical trial indicated a promising and satisfactory decrease in the clinical features of the smoker's palate without any adverse impacts utilizing 5-aminolevulinic acid-mediated photodynamic therapy. Hence, 5-ALA-mediated PDT appeared to be a promising treatment option together with smoking cessation.

Dental Professionals' Engagement in Tobacco, Electronic Cigarette, and Cannabis Patient Counseling

OBJECTIVES

California features low smoking prevalence, cautionary electronic cigarette (e-cigarette) public messaging, and legal recreational cannabis: a unique landscape for dental professionals to navigate tobacco cessation promotion. This cross-sectional study assessed California dental professionals' self-reported tobacco patient counseling behaviors and the correlates of providing such assistance.

METHODS

Statewide surveys of dental hygienists (n = 701) and dentists (n = 725) were distributed electronically. The dentist survey was weighted for sampling and nonresponse. Prevalence of asking patients about use was compared for cigarette and noncigarette products (e.g., e-cigarettes, cannabis). Multivariable models identified independent correlates of providing cessation assistance to tobacco-using patients.

RESULTS

Respondents reported frequently (often/always) documenting patient tobacco use (hygienists: 80%; dentists: 73%) but less commonly provided forms of assistance (hygienists: 27%-49%; dentists: 10%-31%). Most respondents asked patients about cigarette smoking, but noncigarette product use (cigar, hookah, pipe, e-cigarette, or cannabis) was not commonly assessed. Greater confidence and willingness to assist were positively associated with providing assistance in multivariable models, but perceived barriers (e.g., lack of time and remuneration) were not. Results were robust to model specifications.

CONCLUSIONS

California dental professionals often ask about smoking but lag in providing cessation assistance and inquiring about noncigarette products. Successful efforts to encourage dental professionals' engagement in tobacco prevention and cessation must enhance providers' self-efficacy and motivation and likely will require system and organizational change.

KNOWLEDGE TRANSFER STATEMENT

Study findings identify substantial gaps in dental professionals' engagement in patient tobacco cessation. The results identify correlates of providing assistance and of dental professionals' willingness and confidence to do so, which could serve to inform interventions to support and enhance engagement.

Personalized periodontal treatment for the tobacco- and alcohol-using patient

The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco-cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco-using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e-cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco-cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.

The tobacco-using periodontal patient: role of the dental practitioner in tobacco cessation and periodontal disease management

Although the prevalence of tobacco use has declined in some parts of the world, tobacco use remains a persistent and, in some cases, growing problem that will continue to be a fundamental challenge facing dental practitioners in the decades ahead. Dental practitioners have a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. In this article, the current noninvasive, evidence-based approaches are presented for dental practitioners to help patients avoid initiating tobacco use, to encourage and assist patients in ceasing tobacco use and to address tobacco-induced damage to periodontal supporting tissues.

Attitude and practices among dentists and senior dental students in iran toward tobacco cessation as an effort to prevent oral cancer

BACKGROUND

Oral health professionals are responsible in Iran for providing a brief tobacco cessation program to smoker patients. The aim of this study was to assess Iranian dental student and dentist practice, knowledge and attitudes toward smoking cessation programs.

MATERIALS AND METHODS

A valid and reliable self-administered questionnaire was designed and distributed to 150 dentists working in Isfahan-Iran and 60 dental students. Some questions were developed based on the expected 5A tobacco cessation protocol. Statements on attitudes focused on professional responsibility towards smoking cessation and its effectiveness. Chi-square, ANOVA, and t test were used for statistical analysis.

RESULTS

The cessation program in dental settings covers a small group of patients (18%). Some 69.1% (n=96) of dentists reported asking their patients about tobacco use, 64% (n=83) advising their patients to quit, 33.8% (n=47) assessing their patients willingness to quit and 20% (n=28) reported helping their patients in changing their behavior. A far lower percentage reported active involvement in arranging assistance for smokers to quit (4.3%, n=5). Some 22% of students and 26% of dentists disagreed that the tobacco cessation programs should be as part of dentists' professional responsibility and 70% of them were willing to follow the protocol of tobacco cessation for patients.

CONCLUSIONS

Iranian dentist performance regarding tobacco cessation is weak. Dentists and students indicated their lack of knowledge as the major reason for non-adherence to the protocol. Therefore, planning to encourage dentist to follow the protocol needs continuous educational programs.

Guidelines for Motivating and Assisting Patients With Smoking Cessation in Dental Settings

Focused Clinical Question: Periodontal disease is related to use of tobacco, particularly cigarettes. Cigarette smoking is the leading cause of preventable death in the United States, with 20% of annual deaths attributable to smoking-related illness. How does motivating patients to quit smoking challenge periodontists and other providers to improve clinical management? Summary: Four patient cases from the author's (CED) clinical practice in behavioral medicine illustrate key points in management of two patients who were successful in quitting smoking and two who were unsuccessful quitting. Conclusion: These cases illustrate some of the characteristics of patients and factors that contribute to successful smoking cessation and provide examples and practical information for use in the dental office for helping patients with smoking cessation.

Health Professionals’ Role in Helping Patients Quit Tobacco Use: Attitudes among Iranian Dental Students

Background. Health professionals play an essential role in tobacco control. Our objective was to assess Iranian dental students' attitudes towards tobacco control. Methods. Eight dental schools were randomly selected, and a survey using Global Health Professions Student Survey (GHPSS) instrument was conducted among dental students in 2010 in Iran. The chi-square test served for statistical analyses. Results. Of the participants (325 students, 66% female), about one-fifth (21%) were current tobacco (including cigarettes and waterpipe) users. A clear majority (over 80%) of the students agreed as to the responsibility of health professionals on serving as role models for patients and the public, routinely advising patients using tobacco to quit, and giving patients advice about smoking cessation. Over 75% believed that cigarette-smoking health professionals are less likely to advise their patients to stop smoking. Current tobacco users were significantly less likely to agree with these beliefs (P<0.05). Conclusion. Future oral health professionals have generally positive attitudes towards tobacco control. However, their own current tobacco use has a significant negative impact on these attitudes, an impact which ought to be taken into account in tobacco control.

A video feedback-based tobacco cessation counselling course for undergraduates-preliminary results

BACKGROUND

Hungary has one of the highest rates of tobacco use and decayed, missing and filled teeth in Europe, and the number of lung cancer-related deaths per annum is amongst the highest globally. As it is estimated that the rate of smokers who see their dentist or physician annually is about 70%, to involve all healthcare providers in tobacco intervention seems to be a promising strategy to reduce tobacco use in countries like Hungary. Such an intervention should obviously include the dental health team. It has already been suggested by experts on this topic that instruction in tobacco use prevention and cessation counselling for dental professionals and students of dentistry should be included in under- and postgraduate curricula.

OBJECTIVES

To present a novel, video feedback-based undergraduate cessation counselling programme, which has recently been introduced to the dental curriculum at the Faculty of Dentistry, Szeged, Hungary.

METHODS

Applying a problem-based learning approach, the programme consists of three main activities: a small-group interactive training session led by a faculty member, where students learn about the basic science and clinical aspects of tobacco use, including counselling skills; student interactions with professional actors (i.e. standardised patients) simulating real-life dental situations, which are recorded for post hoc evaluation; and finally an evaluation of the recorded performance of each student, with the participation of the actor, the student and a faculty member.

RESULTS

With the help of this new approach, students had the chance to learn about and develop a deeper understanding of tobacco-related professional dental communication in realistic, case-based dental scenarios. Students have reported increased confidence in tobacco counselling after having participated in this programme. Furthermore, this method appears to be an ideal tool for the evaluation of both verbal and non-verbal tobacco counselling skills.

CONCLUSION

To our knowledge, we are the first to have applied video feedback combined with behavioural modification methods in the teaching of tobacco cessation counselling. We conclude that teaching method can help dentists better understand smokers, gain confidence in tobacco cessation counselling and become more effective promoters of a smoke-free lifestyle. In addition, this method can be easily adapted to other healthcare educational settings, including other oral health training programmes.

Role of plasma membrane disruption in reference moist smokeless tobacco-induced cell death

An oral injury is thought to presage the development of mucosal lesions that are common in moist smokeless tobacco (MST) users. The abrasion or mechanical stress caused by direct contact of MST with the oral mucosa may contribute to this injury by causing transient disruptions in the cell membrane. In order to test this hypothesis, we developed an in vitro exposure system that directly exposes cells to reference MST on a rocking platform to simulate the abrasion that might be experienced in the oral cavity when using MST. Using this treatment paradigm, we monitored plasma membrane disruption as a measure of cell wounding caused by direct interaction of the tobacco material itself with monolayer cultures of Het-1A immortalized human esophageal cells as a potential contributor to the injury process. We found that a washed reference MST preparation, in which MST-associated chemicals were removed but the tobacco material retained, causes cell wounding as indicated by the uptake through plasma membrane disruptions of a fluorescent marker normally impermeable to the cell. Having established that non-chemical properties of MST cause cell wounding, subsequent experiments revealed that cell wounding during simultaneous exposure to an aqueous MST-extract result in greater than additive cell death when compared to treatment with washed MST or MST-extract alone. Furthermore, we found that the high levels of free calcium found in MST-extract appear to be playing an important role. Taken together, these results indicate that MST-induced oral injury may result from a combined interaction of physical disruption of the plasma membrane by the tobacco material itself and the adverse effects of MST chemical constituents, notably high levels of calcium, that gain entry to the cell by way of MST-induced cell wounding.

Smoking cessation advice: knowledge, attitude and practice among clinical dental students

OBJECTIVE

To examine knowledge, attitude and current practice among clinical dental students in giving smoking cessation advice (SCA) and to explore the barriers to this activity.

DESIGN AND SETTING

A self-administered questionnaire survey of clinical dental students at Cardiff University School of Dentistry.

MATERIALS AND METHODS

In 2008, clinical dental students were surveyed (n = 181). Information on smoking cessation practices, students' attitude, potential barriers and level of preparedness to deliver SCA, knowledge of association between tobacco use and various pathological conditions and demographics and tobacco use by clinical dental students were gathered.

RESULTS

One hundred and sixty-one (89%) students responded. All students enquired about patient smoking habits in the previous three months but were inconsistent in providing SCA--only one third of students gave SCA all or nearly all the time. Students had good knowledge of the associated health risks with tobacco use. A majority of students perceived barriers in providing patients with SCA. Those who provided advice were more likely to have positive attitudes and reported feeling adequately prepared.

CONCLUSIONS

Dental educators should address students' perceived barriers towards providing SCA when designing smoking cessation curricula in order to produce dentists who are confident and competent to provide this important health care intervention.

An international review of tobacco smoking among dental students in 19 countries

This study was conducted as a systematic review of all modern literature describing the prevalence of tobacco smoking among dental students. An electronic keyword search of appropriate terms was initially undertaken to identify relevant material, after which the reference lists of manuscripts were also examined to locate additional publications. A total of 27 studies from 19 countries were identified. The earliest manuscripts appeared in 1970, with the most recent being published in 2006. From a global perspective, our review suggests that tobacco smoking is relatively uncommon among contemporary dental students in Australia, Brazil, Canada, Great Britain and the United States. This is not surprising however, as it has previously been noted that dentists generally smoke at one of the lowest rates among all health professionals, and much lower than that of the communities in which they live. Somewhat discouragingly, we did find that smoking remains quite common among dental students in countries such as Greece, Serbia, Romania and Hungary. Given the fact that some of the student body continue to smoke tobacco, it is clear that more aggressive tobacco-specific measures should become a mandatory component of global dental education in future years.

Patient feedback as a motivating force to quit smoking

OBJECTIVES

The effectiveness of a brief intervention by dental professionals utilizing feedback of oral symptoms and dental treatments specifically relevant to smoking was examined in terms of it being a motivating factor to quit smoking.

METHODS

Information pertaining to the present study was mailed to 208 dental clinics and 45 dentists agreed to participate. Dental patients who currently smoked were assigned consecutively to either an intervention (IG) or nonintervention group (NG) in each clinic during the 6-month experimental period. In IG, dental professionals provided brief explanations regarding oral symptoms and dental treatments specifically relevant to smoking. The effectiveness of intervention was evaluated with respect to attempts to quit and progression through the stages of behavioral changes involved in quitting using the standardized questionnaire.

RESULTS

Dropout was considerable; 10 clinics terminated their participation. Questionnaires of 797 patients (IG, 416; NG, 381) were received from 35 clinics and the records of 497 patients (IG, 248; NG, 249) were analyzed. Among patients in IG and NG, 12.1% and 4.8% reported attempts to quit, respectively. Odds ratios of quitting attempts and progression and regression through the stages of behavioral changes adjusted for sex, age, and stage at the first visit were 2.2 (95% confidence interval: 1.04, 4.5), 1.7 (1.1, 2.8), and 0.28 (0.15, 0.53) for all patients, respectively, and 3.1 (1.3, 7.5), 2.1 (1.3, 3.4), and 0.21 (0.11, 0.44), respectively, for patients who were not ready to quit. Trends in the movement through stages differed because of the stage at the first visit.

CONCLUSIONS

As a result of the limitation imposed by the considerable dropout number, we concluded that a brief intervention by dental professionals potentially motivates smokers with respect to their attempts to quit smoking and promotes behavioral changes involved in quitting.