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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 3  |  Page : 209-212

Dental professionals as a counsellor for tobacco cessation: A survey


1 Department of Oral Medicine and Radiology, Faculty of Dental Sciences, SGT University, Gurgaon, Haryana, India
2 Department of Oral Medicine and Radiology, Lenora Institute of Dental Sciences, Rajanagaram, Andhra Pradesh, India

Date of Submission28-Jan-2017
Date of Acceptance05-Nov-2017
Date of Web Publication20-Nov-2017

Correspondence Address:
Lavina Taneja
A 150 Second Floor, Lok Vihar Pitampura, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.JIAOMR_44_16

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   Abstract 

Aim: To evaluate the role of oral physicians as a counsellor in tobacco cessation. Material and Methods: A questionnaire was designed and distributed among 110 randomly selected participants, i.e., students (interns) and dental professionals. The questions were meant to assess the level of the knowledge, attitude, and effectiveness of dental students and professionals towards tobacco cessation. Result: A total of 100 participants responded to the survey, thus the response rate was 90.9%. A total of 77.4% were comfortable handling patients with tobacco dependence, 78.6% stressed on history pertaining to tobacco, and 87.6% did counselling habitually. Only 5.4% had received additional training for the same and only 5% thought training received was sufficient. Majority of dentists were doing counselling by asking and advising, and limited participants were using nicotine replacement therapy and other pharmacological and behavioural therapies, and only 24.7% were referring patients of high dependence to psychiatrists. Conclusion: The present study concluded that though dentists had a positive attitude towards tobacco cessation and were stressing on history and warning and advising to quit, more emphasis on pharmacological and behavioral therapies should be given. This can be achieved through alteration in the curriculum and attending more continuing dental education (CDE) programmes to update the knowledge regarding tobacco cessation intervention means and referring patients with heavy dependence to psychiatrists.

Keywords: Cessation, counsellor, dentist, dependence


How to cite this article:
Vinod VC, Taneja L, Mehta P, Koduri S. Dental professionals as a counsellor for tobacco cessation: A survey. J Indian Acad Oral Med Radiol 2017;29:209-12

How to cite this URL:
Vinod VC, Taneja L, Mehta P, Koduri S. Dental professionals as a counsellor for tobacco cessation: A survey. J Indian Acad Oral Med Radiol [serial online] 2017 [cited 2019 Oct 23];29:209-12. Available from: http://www.jiaomr.in/text.asp?2017/29/3/209/218720


   Introduction Top


Globally, one of the greatest health challenges of today is tobacco epidemic. Tobacco-related mortality in India alone is among the highest in the world, with about 700,000 annual deaths attributable to smoking alone.[1] Data from the global adult tobacco survey (GATS) India (2010) revealed that more than one out of three adults in India (35%) use tobacco in one form or the other.[2] India's tobacco-related problem is unique in its own way due to its acceptance both culturally and traditionally. Moreover, use of smokeless tobacco is typically high in India and South East Asian countries. Both smoked and smokeless forms of tobacco contain nicotine, a highly addictive chemical, making it difficult for habituated tobacco users to quit.[3],[4] Over time, users become dependent on nicotine and suddenly stopping produces physical as well as psychological withdrawal symptoms.[5–7]

Tobacco dependence is a chronic condition that often requires repeated interventions.[8],[9] Involvement of health professionals in the tobacco epidemic is an essential way to combat it. Since oral physicians are the first to note any changes that can occur in the oral cavity, they can play a major role in prevention and intervention of this deleterious habit. Hence, the present study was designed to evaluate the role of dental professionals towards motivation for tobacco cessation. The objectives of the study were to assess if the dental practitioner is able to educate, motivate, and counsel the patient with tobacco dependence and to assess the level of the knowledge, attitude, and effectiveness of dental students and professionals towards tobacco cessation.


   Materials and Methods Top


A printed survey proforma was distributed to a total 110 dental students and professionals including interns, postgraduate students, and faculty members of SGT Dental College. Participants were randomly selected for a questionnaire survey to find out the ways and ease in handling the patients with tobacco dependence. The questionnaire comprised 10 questions to evaluate the attitude, awareness of smoking cessation, willingness to provide tobacco cessation services [Table 1], which had to be answered by each respondent. The data obtained was then entered in Microsoft Excel and descriptive analysis was done.
Table 1: The questionnaire for the study

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   Results Top


Out of the total 110 survey forms distributed, 100 responded back with overall response rate of 90.9%. The dental practitioners generally had positive attitude towards the role of oral physician in tobacco control. The response to questionnaire is depicted in [Figure 1]. In our survey, 77.4% of participants thought that they are comfortable in handling patients with tobacco dependence. A total of 78.6% of respondents routinely stress on their patients about habit history pertaining to tobacco usage. Majority (87.6%) of the practitioners do habit counselling of the patients with tobacco usage. Only 5.4% of the dental practitioners have taken additional training pertaining to tobacco cessation. Only 5% felt training received was sufficient.
Figure 1: Graph showing responses to the questionnaire

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About 55.5% of practitioners were advising the patients for tobacco cessation, 29.09% were warning, 9.09% were using nicotine replacement therapy (NRT), and 5.45% were using combination. Almost 59.6% of the respondents felt that chances of quitting habit have increased after advising the patients about tobacco cessation. A total of 63.9% of practitioners got positive feedback from the patients after counseling. Only 24.7% of practitioners thought of referring the patients with heavy dependence to psychiatrists for counseling. A total of 65.7% of practitioners observed change in tobacco usage pattern of patients. In response to the question regarding steps taken about habit cessation a total 29.09% of the respondents were warning, 55.45% were advising, 9.09% were using NRT, and 5.45% were using combinations, and only 0.91% responded positive of using other pharmacological and behavioral therapies [Figure 2].
Figure 2: Pie chart depicting response to question 4 regarding steps taken to help patients quit tobacco

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   Discussion Top


Tobacco dependence is defined as “cluster of behavioral, cognitive, and physiological phenomenon that develops after repeated tobacco use and typically includes a strong desire to use tobacco difficulties in controlling its use, persistence in tobacco use despite harmful consequences, a higher priority given to tobacco use than other activities and obligations, increased tolerance, and sometimes a physical withdrawal state.” According to various studies, a variety of behavior therapies, ranging in complexity from simple advice offered by a physician or other healthcare providers or much more extensive therapy offered by counsellors, have been shown to be efficacious for tobacco cessation. Basic knowledge of certain skills are required to provide effective counselling for tobacco cessation.[10]

Health professionals' involvement in the tobacco control is an essential way of dealing with this man-made epidemic.[11] Dental professionals can play a pivotal role in diagnosing and effectively managing tobacco dependence as they can easily recognize patient's tobacco status owing to the oral implications such as staining, habit-related lesions, oral cancer. Tobacco cessation is a multidisciplinary approach. There are 5 major steps (the “5 As”) in tobacco cessation services. It is important for the dental practitioner to “Ask” the patient if he or she uses tobacco, “Advice” him or her to quit, “Assess” willingness to make a quit attempt, “Assist” the patient in making a quit attempt, and “Arrange” for follow-up contacts to prevent relapse.[12] Our study investigated the attitude, knowledge, and awareness of dental practitioners regarding tobacco cessation. A total of 77.4% of participants were comfortable in handling the patients with tobacco usage, and 78.6% were routinely asking their patients about habit history pertaining to tobacco, thus suggesting awareness about ill effects of tobacco and positive attitude about cessation.

A total of 87.6% of dentists positively replied about counselling the patients about habit cessation, thus fulfilling their moral and professional obligations and playing an important role in tobacco cessation. When enquired about various modalities used, 55.45% of practitioners were advising the patients for tobacco cessation, 29.09% were warning, 9.09% were using NRTs, and 5.45% were using combination, and only 0.91% were using other pharmacological and behavioral intervention, thus implying the need for inclusion of more tobacco cessation intervention strategies including behavioural and pharmacological interventions for the same. As established in a study done by Goswami et al., there is still a great deal of work which needs to be done in the field of educating and counseling the patients for habit cessation.[13]

According to a study conducted by Ibrahim and Norkhafizah to determine the attitudes and practices in smoking cessation counselling among dentists in Kelantano and to identify the barriers that prevent them from doing so, they found that majority of dental practitioners have role in smoking cessation counselling but the main barrier was lack of training in their practices.[14] Similarly, in our study we found that only 5.4% of dental practitioners had taken additional training pertaining to tobacco cessation so there was a strong need for more training sessions regarding tobacco cessation. More courses on regular and distant learning programmes should be designed by established institutions and organisations like Indian Dental Association along with regular continuing dental education (CDE) programmes with wider coverage and emphasis on pivotal role played by dental professionals on regular basis.

Dental professionals can immediately recognize visible changes as they are trained and our study had confirmed that counselling and advice by dental professional had a great impact in patient habit profile as confirmed in our study with 59.6% of the dentists reporting change in the habit pattern of the patients along with 63.9% reporting positive feedback from their patients. In our study, we found out that only some (24.7%) dentists were referring the patients with heavy dependence of tobacco to psychiatrists for further evaluation so there should be increased awareness of referring especially patients with high dependence to psychiatrists as this is a multidisciplinary approach with active participation from family members, social workers, and healthcare professionals.

A study was conducted by Singla et al. in rural and urban areas of Modinagar to assess the attitude of dental professionals including the dentist and dental hygienist towards the tobacco cessation counselling and identify the possible barriers towards the implementation of these practices and they concluded that dental professionals must expand their horizon and armamentarium to include tobacco cessation counselling strategies inclusive of their regular preventive and therapeutic treatment modalities. Also, dental institutions should include tobacco cessation counselling into the curriculum, as in our study we also felt that there is a need for more CDE programmes to be conducted for awareness regarding tobacco cessation counselling;[15] and we further recommend inclusion of tobacco cessation strategy in the syllabus especially of Oral Medicine and Public Health dentistry with establishment of tobacco cessation clinic in dental as well as medical courses for thorough practical exposure during training period. More extensive exposure and usage of NRTs and other pharmacological agents will make dental students more confident. Limitations of our study included that it was a subjective study and respondents may not answer truthfully and accurately. Moreover, patient perspective of effectiveness of counselling was not done.


   Conclusion Top


As concluded in our study, majority of oral physicians are actively participating in recording the patient habit and counselling by means of warning and advising to quit the patients. There is limited stress on pharmacological and behavioural interventions and referral in case of high dependence and limited additional training regarding cessation. Thus, there is a need for alteration in the curriculum and more CDE programs to enhance the knowledge and effective role in cessation. Oral physicians can play a pivotal role in dealing with this tobacco epidemic by means of asking, advising, assessing, assisting, and arranging, thus justifying their role as a counsellor in habit cessation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Mohanty VR, Rajesh GR, Aruna DS. Role of dental institutions in tobacco cessation in India: Current status and future prospects. Asia Pacific J Cancer Prev 2013;14.2673-80.  Back to cited text no. 1
    
2.
Ram F. Global Adult Tobacco Survey 2009-10 Document. New Delhi, India, National Tobacco Control Programme, Ministry of Health and Family Welfare, Government of India, 2010.  Back to cited text no. 2
    
3.
Ronald D. The health consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General, US; 1988.  Back to cited text no. 3
    
4.
Moxham J. Nicotine addiction. BMJ 2000;320:391-2.  Back to cited text no. 4
[PUBMED]    
5.
Hatsukami DK, Hughes JR, Pickens RW, Svikis D. Tobacco withdrawal symptoms: An experimental analysis. Psychopharmacology 1984;84:231-6.  Back to cited text no. 5
[PUBMED]    
6.
Hatsukami DK, Gust SW, Keenan RM. Physiologic and subjective changes from smokeless tobacco withdrawal. Clin Pharmacol Ther 1987;41:103-7.  Back to cited text no. 6
    
7.
Hughes JR, Hatsukami D. Signs and symptoms of tobacco withdrawal. Arch Gen Phychiatry 1986;43:289-94.  Back to cited text no. 7
    
8.
Policy recommendations for smoking cessation and treatment of tobacco dependence, WHO, 2003.  Back to cited text no. 8
    
9.
Tomar SL. Dentistry role in tobacco control. J Am Dent Assoc 2001;132:30S-5S.  Back to cited text no. 9
    
10.
Hoonam K, Ahmad J, Mohammad RK, Jorma VI. Health professionals' role in helping patients quit tobacco use: Attitudes among Iranian dental students. ISRN Public Health 2013;10.1155/2013/706451.  Back to cited text no. 10
    
11.
World Health Organization, Framework Convention on Tobacco Control, World Health Organization, Geneva, Switzerland, 2003.  Back to cited text no. 11
    
12.
Prochaska J, Norcross J, Di Clemente CC. Changing for good: A revolutionary six-stage program for overcoming bad habits and moving your life positively forward. Avon Books NY; 1994.  Back to cited text no. 12
    
13.
Goswami A, Reddaiah VP, Kapoor SK, Singh B, Dwivedi SN, Kumar G. Tobacco and alcohol use in rural elderly Indian population. Indian J Psychiatry 2005;47:192-7.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Ibrahim H, Norkhafizah S. Attitudes and practices in smoking cessation counseling among dentists in Kelantan. Archives of Orofacial Sciences 2008;3:11-6.  Back to cited text no. 14
    
15.
Singla A, Patthi B, Singh K, Jain S, Vashishtha V, Kundu H, et al. Tobacco cessation counseling practices and attitude among the dentist and dental auxillaries of urban and rural areas of Modinagar, India. J Clin Diagn Res. 2014;8:ZC15–8.  Back to cited text no. 15
    


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