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| LETTER TO EDITOR |
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| Year : 2017 | Volume
: 15
| Issue : 3 | Page : 263-264 |
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Dentists and tobacco cessation: Moving beyond the willingness
Rachana Shah1, Rupal Shah1, Upendra Bhojani2, Sujal Shah3
1 Department of Prosthodontics, Government Dental College and Hospital, Ahmedabad, Gujarat, India
2 Institute of Public Health, Bengaluru, Karnataka, India
3 Private Dental Practitioner, Ahmedabad, Gujarat, India
| Date of Web Publication | 18-Sep-2017 |
Correspondence Address:
Rachana Shah
301, Mithila 1, Opposite Tatanagar, Meghaninagar, Ahmedabad - 380 016, Gujarat
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jiaphd.jiaphd_100_17
How to cite this article:
Shah R, Shah R, Bhojani U, Shah S. Dentists and tobacco cessation: Moving beyond the willingness. J Indian Assoc Public Health Dent 2017;15:263-4 |
Sir,
The Global Adult Tobacco Survey (2016–2017) shows impressive 6% point reduction in tobacco use prevalence in the last 7 years.[1] It possibly testifies the positive impact of a series of policy reforms including the Cigarettes and Other Tobacco Products (Prohibition Of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 ban on gutka, and several states raising tobacco taxes. It also reveals a significant increase in awareness about tobacco harms.[1] While at least one in two tobacco users is planning to quit tobacco, there is very little cessation support available for them.[1]
The need to provide tobacco cessation as part of the primary health care is long acknowledged. There have been several studies in India exploring the role of dentists in tobacco cessation. These inquiries reveal that an overwhelming majority of dentists are willing to engage in tobacco cessation.[2],[3],[4],[5] However, these studies point that the willingness does not readily translate into practice. At least a quarter to a little less than a half of the dentists surveyed did not inquire tobacco use status of their patients. Even lesser engage in providing support and follow-up services.[2],[3],[4],[5]
Major barriers perceived by dentists hindering tobacco cessation in dental practice include lack of training,[2],[3],[4] lack of time,[2],[3],[4],[5] lack of financial incentives,[2],[5] and intriguingly, the fear of losing out on patients[2],[3],[4],[5] who might not appreciate their dentists bringing up tobacco-related matter with them.
If we need to bridge this gap between willingness and practice, we need to better understand “how to” integrate tobacco cessation services in varied forms (single-doctor clinics, multispecialty group practices, part of general hospitals, teaching hospitals, and outreach dental care) of dental practice. We need to go beyond surveys of individual dentists and use study designs/methods that provide deeper understanding of oral health-care systems as they operate today. We need to use a “system lens” and see tobacco cessation as not merely a technical intervention but how it might affect and in turn get shaped by various building blocks of oral health system.
One useful framework is the health systems building blocks proposed by the World Health Organization (i.e., Service Delivery, Workforce, Information Systems, Financing, Access to Medications, and Leadership and Governance).[6] The Dental Council of India in its role as a regulator can promote tobacco cessation training within dental curricula as well as cessation service delivery as part of the dental colleges. Advances in technology can be harnessed to optimize information systems. Limited access to medications (non-nicotine and nicotine-replacement agents) as they remain expensive and are not featured in the National List of Essential Medicines hinders support to people with severe tobacco addiction. Ironically, while most of the health insurance schemes charge higher premiums for tobacco users, they do not cover for tobacco cessation treatments. In fact, many hospitals (often at the request by their patients) are hesitant to record tobacco use status to avoid insurance companies creating issues in claim settlement. Hence, use of theoretical insights from the field of health systems and integration of vertical programs into general health services is very useful in understanding how we could enhance tobacco cessation practice within dental care settings.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | |
| 2. | Mitra DK, Pawar SD, Mandal A, Shah RA, Rodrigues SV, Desai AB, et al. Attitudes of dental professionals toward tobacco use. J Indian Soc Periodontol 2015;19:317-21.  [ PUBMED] [Full text] |
| 3. | Amit S, Bhambal A, Saxena V, Basha S, Saxena S, Vanka A. Tobacco cessation and counseling: A dentists' perspective in Bhopal city, Madhya Pradesh. Indian J Dent Res 2011;22:400-3. [ PUBMED] [Full text] |
| 4. | Parkar S, Pandya E, Sharma A. Attitudes, practices, and barriers in tobacco cessation counselling among dentists of Ahmedabad city, India. SRM J Res Dent Sci 2016;7:140-5. [Full text] |
| 5. | Aggarwal VP, Mathur A, Dileep CL, Batra M, Makkar DK. Health professional's perception towards tobacco cessation: A cross-sectional study. J Indian Assoc Public Health Dent 2015;13:438-43. [Full text] |
| 6. | World Health Organization. Everybody's business: Strengthening health systems to improve health outcomes: WHO's framework for action. Geneva: World Health Organization; 2007. |
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