|Year : 2015 | Volume
| Issue : 3 | Page : 254-258
Awareness on smoking cessation counseling among dentists in Kerala, India
Benley George1, Vinod Mathew Mulamoottil1, Sunu Alice Cherian1, Jacob John2, T Aby Mathew3, Shibu Thomas Sebastian1
1 Department of Public Health Dentistry, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
2 Department of Orthodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
3 Department of Prosthodontics, Pushpagiri College of Dental Sciences, Thiruvalla, Kerala, India
|Date of Web Publication||14-Sep-2015|
Department of Public Health Dentistry, Pushpagiri College of Dental Sciences, Medicity, Perumthuruthy, Thiruvalla - 689 107, Kerala
Source of Support: None, Conflict of Interest: None
Introduction: Although dentists are ideally placed to deliver smoking cessation advice and assistance to their patients, smoking cessation interventions are not often incorporated as a routine part of dental care. Aim: To assess the awareness on smoking cessation counseling among dental practitioners in Kerala. Materials and Methods: A pretested questionnaire was used for the study. Four hundred and sixteen registered dentists practicing all over Kerala participated in the survey. Results: Dentists are willing to ask and advise patients about smoking, but are less inclined to assist patients to quit or arrange follow-up. Dentists are more likely to implement one-off, opportunistic interventions rather than take a systematic preventive approach. Dentists are interested in attending further education and say they require training to be relevant to the context of their day-to-day running of the dental practice. Conclusions: Training should aim to legitimize the dentist's role in smoking cessation and provide strategies and resources so that dentists can practice interventions as part of their day-to-day work.
Keywords: Counseling, dentist, smoking, tobacco products
|How to cite this article:|
George B, Mulamoottil VM, Cherian SA, John J, Mathew T A, Sebastian ST. Awareness on smoking cessation counseling among dentists in Kerala, India. J Indian Assoc Public Health Dent 2015;13:254-8
|How to cite this URL:|
George B, Mulamoottil VM, Cherian SA, John J, Mathew T A, Sebastian ST. Awareness on smoking cessation counseling among dentists in Kerala, India. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2021 Jun 15];13:254-8. Available from: https://www.jiaphd.org/text.asp?2015/13/3/254/165245
| Introduction|| |
Smoking is the single greatest cause of avoidable morbidity and mortality in the United States and represents a significant public health concern. Over 400,000 people die each year from tobacco-related diseases.  The deleterious effects of tobacco use on oral and overall health are well known.  It has been projected that if the current trend in the use of tobacco is left unabated, it will cause about 450 million deaths worldwide in the next 50 years.  Smoking has been established as a risk factor for death from several systemic diseases including lung cancer, respiratory diseases, and cardiovascular diseases. , It also causes premature hair graying, hair loss, and skin aging. ,,, Moreover, smoking is associated significantly with oral cancer,  periodontal diseases, , failure of periodontal therapy,  failure of dental implants, , impaired oral wound healing, , oral pain,  and dental caries. 
Southeast Asia, especially, India, has one of the highest age-adjusted incidence rates of oral cancer and upper aerodigestive tract cancers in the world.  According to World Health Organization, the prevalence of tobacco habits in India is high, with 34% using bidis, 31% cigarettes, 19% chewing tobacco, 9% hookah, and 7% other forms. 
Dentists have been recognized as "ideally positioned to counsel against the use of cigarettes and smokeless tobacco products." , They are one of the health professionals more frequently in contact with the general population and are first to see the effects of tobacco in mouth. They are as effective in providing smoking cessation counseling as any other health-care professional. ,, Dentists play a significant role in the identification of precancerous lesions in the oral cavity of tobacco users. The evidence is clear that smokers who receive assistance from health-care workers are more successful at quitting than those without any support. ,, Although dental professionals have the opportunity to play an important role in motivating and assisting their patients to quit tobacco use, tobacco cessation often is not included routinely in dental care. ,,, Presently, there is a dearth of information on awareness on smoking cessation counseling among dentists in Kerala. This study would provide a baseline data on the awareness on smoking cessation counseling among dentists in Kerala.
| Materials and methods|| |
The survey was conducted during the period of May 2013 to October 2014. The institutional ethical approval was obtained prior to the start of the study. The calculated sample size was 371 at 95% confidence level and 5% confidence interval.  Four hundred and fifty registered dentists practicing across the 14 districts in Kerala were included to meet the prior determined sample size. A systematic random sampling method was employed to select the sample size for the study. The lists of dentists were obtained from the directory of the Indian Dental Association, Kerala state. The questionnaires along with the informed consent sheet were sent to the dentists by post and the duly filled forms along with the signed consent form were obtained through return post. The participants were reminded about the return of the filled forms through SMS and emails. Four hundred and sixteen dentists returned the completely filled forms and were included in the survey. There were 22 incompletely filled forms which were eliminated from the study.
A self-administered questionnaire by Ibrahim and Norkhafizah previously in a similar study  was adapted and utilized in the present survey. The structured questionnaire consisted of questions pertaining to attitudes toward smoking cessation, practices in smoking cessation, and barriers to smoking cessation. A four-point Likert scale of "not at all," "to some extent," "considerable extent," and "great extent" was used to indicate their degree of agreement and involvement in smoking cessation attitudes and practices, respectively. Four main barriers to smoking cessation as identified in previous studies - lack of training, lack of remuneration, lack of time, and fear of losing patients - were listed and the dentists were asked about their degree of agreement or disagreement. The dentists were also asked to specify other barriers that they perceived in their practice. The questionnaire was pretested in a group of dentists who were not included in the main study. The reliability of the questionnaire was found to be kappa = 0.86.
The response rate was 92.4%. Data were manually entered into the computer, tabulated, and analyzed. Data analysis was performed using the software IBM SPSS Inc., Chicago, USA version no.17. Pearson's Chi-square test was employed in the survey. The level of significance was set to be P < 0.05.
| Results|| |
[Table 1] shows the sociodemographic profile of the respondents. Out of the 416 respondents, the majority of them were males (66.6%). [Table 2] demonstrates the distribution of dentists according to the duration of practice. The present study revealed that majority of dentists had a clinical practice of about <30 years (34.1%). The study showed that 94 female dentists (67.6%) and 188 male dentists (67.8%) had received training on smoking cessation. The difference observed was found to be not significant (P = 0.34) [Table 3].
Most of the dentists agreed that they have the responsibility in providing smoking cessation counseling to their patients (89.9%). Only 42.8% of the dentists considered to a great extent it is the responsibility of dentist to provide smoking cessation counseling to their patients [Table 4].
|Table 4: Responsibility of dentists to provide smoking cessation counseling based on duration of clinical practice |
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The majority of the male dentists 204 (73.6%) discussed the effects of smoking on oral health with their patients when compared to 99 (71.2%) female dentists. The difference found was not statistically significant (P = 0.543) [Table 5].
Sixty dentists (14.4%) considered that to a great extent lack of patients motivation was the barrier in providing smoking cessation counseling. The difference observed was not significant. One hundred and eight female dentists and two hundred and twenty-three male dentists considered lack of time in consultation as a barrier in providing smoking cessation counseling to their patients. The difference observed was not statistically significant (P = 0.255). Majority of the female dentists (105; 75.5%) and male dentists (206; 74.3%) considered lack of financial incentives as a barrier in providing smoking cessation counseling. The difference found was not statistically significant. About 129 dentists (31%) considered to a considerable extent that the fear of damaging dentist-patient relationship was the barrier in providing smoking cessation counseling. The difference was found to be statistically significant (P = 0.01) [Table 6].
|Table 6: Perceived barriers of dentists in conducting smoking cessation counseling |
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| Discussion|| |
Dentists believe that they have a big role in smoking cessation counseling. The present study showed that a greater proportion of all dentists in Kerala (89%) agreed about their role in smoking cessation counseling. There is an agreement with results of other studies done in Malaysia,  United States,  the United Kingdom, , Australia,  Saudi Arabia,  and India  that dentists generally believed that it was part of their responsibility to help patients in smoking cessation.
A large proportion (74.6%) of the dentists in Kerala counseled their patients on the adverse effects of smoking on oral health. This was in agreement with a study conducted in Rajasthan, India.  The current study shows that 79.8% of the dentists considered lack of patient's motivation as a barrier in providing smoking cessation counseling. The study showed that 79.5% of the dentists considered lack of time as a barrier in providing smoking cessation counseling. This was similar (88.9%) to a study conducted in Nigeria.  This was in contrary (32%) to a study conducted in the USA.  The study showed that 74.7% of the dentists considered lack of financial incentives as a barrier in providing smoking cessation counseling. This was in contrary (30.1%) to a study conducted in Malaysia  and (56%) in a study conducted in the USA.  The study showed that 81.4% of the dentists believed that there would be damage in dentist-patient relationship if smoking cessation counseling was provided to their patients. This was in contrary to a study conducted in Malaysia  (52.4%) and Rajasthan  (35.8%).
The present study included dentists from all districts across Kerala and hence a thorough representation of the state has been done. The survey has not determined the pattern of awareness on smoking cessation counseling among dentists across the various districts of Kerala.
- The Dental Council of India should implement compulsory attendance of smoking cessation training programs by dentists every year for renewal of registration
- Dental schools should provide mandatory tobacco cessation counseling to its students every year to reinforce them in providing tobacco cessation counseling to their patients
- Future studies should be conducted after providing a training program on smoking cessation counseling to dentists to determine its effectiveness on their patients. The study necessitates the need for encouraging and motivating dentists to undergo smoking cessation training and provide smoking cessation counseling in their dental practice so as to reduce the burden of this public health problem.
| Conclusion|| |
The present study concludes that dentists are aware that they play an important role in motivating smokers to quit smoking. Dentists should overcome all barriers which prevent them from providing smoking cessation counseling to their patients. Dentists can play an important role in primary prevention of adverse health effects by promoting cessation of tobacco use among patients to whom they provide care. Educational interventions are needed to increase smoking cessation activities by dentists. Smoking cessation training should be provided to the interns, post graduate students, and faculty in all dental colleges in the country by professionally qualified trainers. Adequate training will enhance the confidence of dentists in providing smoking cessation counseling to their patients in the dental settings. Successful smoking cessation counseling can help in creating a smoke-free environment, reduce the financial burden of treating cancer, and increase the productivity of our community.
The authors would like to gratefully acknowledge Nisha Kurien, Assistant Professor, Biostatistician, Pushpagiri Institute of Medical Sciences, Thiruvalla, for conducting the statistical analysis of the survey.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Centers for Disease Control and Prevention (CDC). Annual smoking-attributable mortality, years of potential life lost, and productivity losses - United States, 1997-2001. MMWR Morb Mortal Wkly Rep 2005;54:625-8.
Warnakulasuriya S, Dietrich T, Bornstein MM, Casals Peidró E, Preshaw PM, Walter C, et al.
Oral health risks of tobacco use and effects of cessation. Int Dent J 2010;60:7-30.
Peto R, Lopez AD. The future worldwide health effects of current smoking patterns. In: Koop CE, Pearson CE, Schwarz MR, editors. Critical Issues in Global Health. New York: Jossey-Bass; 2001.
Johnson NW, Bain CA. Tobacco and oral disease. EU-Working Group on Tobacco and Oral Health. Br Dent J 2000;189:200-6.
Fielding JE. Smoking: Health effects and control (1). N Engl J Med 1985;313:491-8.
Trüeb RM. Association between smoking and hair loss: Another opportunity for health education against smoking? Dermatology 2003;206:189-91.
Mosley JG, Gibbs AC. Premature grey hair and hair loss among smokers: A new opportunity for health education? BMJ 1996;313:1616.
Morita A. Tobacco smoke causes premature skin aging. J Dermatol Sci 2007;48:169-75.
Urbanska M, Nowak G, Florek E. Cigarette smoking and its influence on skin aging. Przegl Lek 2012;69:1111-4.
U.S. Department of Health and Human Services. The Health Consequences of Smoking a Report of the Surgeon General. Washington, DC: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2004.
Molloy J, Wolff LF, Lopez-Guzman A, Hodges JS. The association of periodontal disease parameters with systemic medical conditions and tobacco use. J Clin Periodontol 2004;31:625-32.
Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: Findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol 2000;71:743-51.
Bergström J, Eliasson S, Dock J. A 10-year prospective study of tobacco smoking and periodontal health. J Periodontol 2000;71:1338-47.
Chuang SK, Wei LJ, Douglass CW, Dodson TB. Risk factors for dental implant failure: A strategy for the analysis of clustered failure-time observations. J Dent Res 2002;81:572-7.
Position paper: Tobacco use and the periodontal patient. Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontol 1999;70:1419-27.
Jones JK, Triplett RG. The relationship of cigarette smoking to impaired intraoral wound healing: A review of evidence and implications for patient care. J Oral Maxillofac Surg 1992;50:237-9.
Preber H, Bergström J. Effect of cigarette smoking on periodontal healing following surgical therapy. J Clin Periodontol 1990;17:324-8.
Riley JL 3 rd
, Tomar SL, Gilbert GH. Smoking and smokeless tobacco: Increased risk for oral pain. J Pain 2004;5:218-25.
Tomar SL, Winn DM. Chewing tobacco use and dental caries among U.S. men. J Am Dent Assoc 1999;130:1601-10.
Shah MN. Health professionals in tobacco control: Evidence from global health professional survey (GHPS) of dental students in India. New Delhi, India: WHO; 2005.
WHO. Tobacco or Health: A Global Status Report. Geneva: WHO Publication; 1997.
Beaglehole R, Watt R. Helping Smokers Stop: A Guide for the Dental Team. London: Health Development Agency; 2004.
Block DE, Block LE, Hutton SJ, Johnson KM. Tobacco counseling practices of dentists compared to other health care providers in a midwestern region. J Dent Educ 1999;63:821-7.
Albert D, Ward A, Ahluwalia K, Sadowsky D. Addressing tobacco in managed care: A survey of dentists′ knowledge, attitudes, and behaviors. Am J Public Health 2002;92:997-1001.
Shimkhada R, Peabody JW. Tobacco control in India. Bull World Health Organ 2003;81:48-52.
Crail J, Lahtinen A, Beck-Mannagetta J, Benzian H, Enmarks B, Jenner T, et al.
Role and models for compensation of tobacco use prevention and cessation by oral health professionals. Int Dent J 2010;60:73-9.
Hu S, Pallonen U, McAlister AL, Howard B, Kaminski R, Stevenson G, et al.
Knowing how to help tobacco users. Dentists′ familiarity and compliance with the clinical practice guideline. J Am Dent Assoc 2006;137:170-9.
Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA. National survey of U.S. health professionals′ smoking prevalence, cessation practices, and beliefs. Nicotine Tob Res 2010;12:724-33.
Tremblay M, Cournoyer D, O′Loughlin J. Do the correlates of smoking cessation counseling differ across health professional groups? Nicotine Tob Res 2009;11:1330-8.
Watt RG, McGlone P, Dykes J, Smith M. Barriers limiting dentists′ active involvement in smoking cessation. Oral Health Prev Dent 2004;2:95-102.
Ibrahim H, Norkhafizah S. Attitudes and practices in smoking cessation counselling among dentists in Kelantan. Arch Orofac Sci 2008;3:11-6.
Logan H, Levy S, Ferguson K, Pomrehn P, Muldoon J. Tobacco-related attitudes and counseling practices of Iowa dentists. Clin Prev Dent 1992;14:19-22.
John JH, Yudkin P, Murphy M, Ziebland S, Fowler GH. Smoking cessation interventions for dental patients - Attitudes and reported practices of dentists in the Oxford region. Br Dent J 1997;183:359-64.
Stacey F, Heasman PA, Heasman L, Hepburn S, McCracken GI, Preshaw PM. Smoking cessation as a dental intervention - Views of the profession. Br Dent J 2006;201:109-13.
Clover K, Hazell T, Stanbridge V, Sanson-Fisher R. Dentists′ attitudes and practice regarding smoking. Aust Dent J 1999;44:46-50.
Wyne AH, Chohan AN, Al-Moneef MM, Al-Saad AS. Attitudes of general dentists about smoking cessation and prevention in child and adolescent patients in Riyadh, Saudi Arabia. J Contemp Dent Pract 2006;7:35-43.
Bhat N, Jyothirmai-Reddy J, Gohil M, Khatri M, Ladha M, Sharma M. Attitudes, practices and perceived barriers in smoking cessation among dentists of Udaipur City, Rajasthan, India. Addict Health 2014;6:73-80.
Uti OG, Sofola OO. Smoking cessation counseling in dentistry: Attitudes of Nigerian dentists and dental students. J Dent Educ 2011;75:406-12.
Prakash P, Belek MG, Grimes B, Silverstein S, Meckstroth R, Heckman B, et al.
Dentists′ attitudes, behaviors, and barriers related to tobacco-use cessation in the dental setting. J Public Health Dent 2013;73:94-102.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]