|Year : 2011 | Volume
| Issue : 3 | Page : 400-403
|Tobacco cessation and counseling: A dentists' perspective in Bhopal city, Madhya Pradesh
Shanthi Amit, Ajay Bhambal, Vrinda Saxena, Sakeena Basha, Sudhanshu Saxena, Amit Vanka
Department of Pedodontics & Preventive Dentistry, People's Dental Academy, Bhopal Madhya Pradesh, India
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|Date of Submission||09-Jan-2010|
|Date of Decision||24-Apr-2010|
|Date of Acceptance||27-Oct-2010|
|Date of Web Publication||3-Nov-2011|
| Abstract|| |
Introduction: Dental team has high potential to help smokers to better oral/general health but to achieve this; they need to be clear about their role. Considering the importance of tobacco cessation, the authors carried out this study aimed at assessing the role, knowledge, current practices, different barriers, and tools to overcome the same as perceived by dentists in Bhopal city.
Materials and Methods: A self-administered structured, coded questionnaire was distributed to 200 private practitioners and the teaching staff in all the dental colleges in Bhopal city.
Results: Out of 200 dentists to whom questionnaire was administered, 168 responded within a week's time resulting in a high response rate of 84%. A total of 97% of the dentists agreed that it is the duty of every dentist to advice patients about tobacco cessation. A total of 58% strongly agree that formal training will be an effective tool to provide the guidelines to dentists in tobacco cessation and counseling.
Conclusion: Monitoring of effective planning and execution of these programs by appropriate authorities at regular intervals is vital for successful achievement of the goal of "Tobacco Free Society."
Keywords: Dentist, tobacco cessation, tobacco
|How to cite this article:|
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
Tobacco has become a global agent of death. Tobacco kills a third to half of the people who use it, on average 15 years prematurely. Although tobacco deaths rarely make headlines, tobacco kills one person every 6 seconds. Today, tobacco use causes one in 10 deaths among adults' worldwide-more than 5 million people a year. By 2030, unless urgent action is taken, tobacco's annual death toll will rise to more than 8 million.  Tobacco is the only legally available consumer product which kills people when it is used entirely as intended. 
|How to cite this URL:|
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 [serial online] 2011 [cited 2019 Jul 18];22:400-3. Available from: http://www.ijdr.in/text.asp?2011/22/3/400/87061
Tobacco toll in India currently has one-fifth of all world wide deaths attributed to tobacco. There are 700,000 deaths per year due to smoking and 800,000-900,000 per year due to all forms of tobacco use/exposure in India. For the next 20 years there will be fastest trajectory of rise in tobacco-related deaths. Many of the deaths occur during middle age of 35-66 years.  Satyanarayana et al. compared the cumulative risk of tobacco-related cancers in various cities in India and found Bhopal city in Madhya Pradesh to have the highest tobacco-related cancers at 56.9% in males. The cumulative risk of tobacco-related cancers among males was 3.82% and that in females was 1.15%. So the risk of developing tobacco-related cancer is 1 out of 26 males and 1 out of 87 females in the Bhopal city. 
"Giving up smoking is easy I have done it a thousand times" - by Mark Twain is the adage that puts in perspective the difficulties of tobacco cessation. Bates et al. suggest that although 70% of patients who smoke say that they would like to quit, only 7.9% are able to do so without help.  The physician/dentist and their staff can contribute significantly to increase rates of tobacco cessation with training and brief office-based programs. In a study conducted by Wood and associates, using participants' estimates taken at 3 months after training had evaluated that an average of two patients per office had stopped using tobacco.  Stacey et al. in 2006 concluded that dentists with further training and appropriate remuneration could guide many of their patients who smoke to successful quit attempts. 
How does tobacco cessation best fit the role of the dental team?
In simple terms dentists diagnose, advise and treat, or refer patients. The American Dental Association summarized that tobacco use is the root of many oral health problems, including tooth-loss, jawbone loss, and periodontal diseases. Half the cases of adult periodontitis are attributable to smoking. Moreover, tobacco use impedes the effectiveness of periodontal therapy, dental implants, and wound healing. Worst of all, smoking a pack of cigarettes a day or using smokeless tobacco quadruples the risk of developing oral cavity or oropharyngeal cancer, which kills 49% of its victims within 5 years of diagnosis. Recently tobacco cessation advice has been proposed to be a part of the oral health assessment.  Dental team has high potential to help smokers to better oral/general health but to achieve this; they need to be clear about their role. 
Considering the importance of tobacco cessation, the authors carried out this study aimed at assessing the role, knowledge, current practices, different barriers, and tools to overcome the same as perceived by dentists in the Bhopal city.
| Materials and Methods|| |
Self-administered structured, coded questionnaire was distributed to 200 private practitioners and teaching staff in all the dental colleges in Bhopal city. The 200 dentists to whom the questionnaire was sent included the dentists working in the dental colleges, those having private practice, and those registered in the IDA, Bhopal branch. The study covers the entire population of dentists in the city. All sections of dentists including graduates, postgraduates and the private practitioners, and those associated with institutes were included in the study.
The survey instrument of the current study included questions that addressed (a) the "5A's" protocol, i.e., Ask, Advise, Assess, Assist, and Arrange behaviors in dental practices; (b) self-efficacy including knowledge, confidence, and success regarding tobacco cessation; (c) success of various tobacco cessation strategies; (d) barriers to tobacco cessation; and (e) demographics including gender, and race/ethnicity. This is in accordance with the methodology used by Albert et al.  in their study. Four-point Likert scale (strongly agree/agree/disagree/strongly disagree) was used to assess attitudinal variables and three-point Likert scale (always/nearly always, sometimes, rarely/never) was used to measure levels of reported activity. Data analysis has been done using statistical package.
| Results|| |
Out of 200 dentists to whom the questionnaire was administered, 168 responded within a week's time resulting in a high response rate of 84%. The demographic details of the respondents are given as under:
Age-wise numbers (%):
- 20-25 years: 37(22.1)
- 25-30 years: 33(19.6)
- 30-35 years: 65(38.7)
- Above 35 years: 33(19.6)
Gender-wise numbers (%):
- Males: 103(61.31)
- Females: 65(38.69)
Type of practice-wise numbers (%):
- Private practitioners: 44(26.2)
- Academicians: 45(26.8)
- Both: 79(47)
There was no difference in the results in terms of age, gender, or type of practice. The findings of the study are as follows:
- 97% of the dentists agreed that it is the duty of every dentist to advise patients about tobacco cessation [Figure 1].
|Figure 1: It is the duty of every dentist to advise the patient on tobacco cessation|
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- 47% are optimistic about the capability of dentists in tobacco cessation though 70% felt that the dentists are not presently well prepared to assist the patients.
- 49% dentists raise the topic of the importance of tobacco cessation.
- 60% display patient education materials in their practice/reception areas and 43% engage even their staff in the process of tobacco cessation and counseling.
- 52% refer their patients to a general practitioner and rarely or even never recommend over-the-counter nicotine replacement therapy.
- As regards the most common barriers for successful tobacco cessation [Figure 2].
- 39% dentists attribute to lack of time,
- 49% to lack of printed resources,
- 64% to lack of persuasion on tobacco cessation,
- 48% dentists fear that the patients may not come back to them.
A total of 48% disagree that time consumption factor is a deterrent due to less chances of success.
- The perceived role of the dental fraternity in tobacco cessation and counseling at different levels is [Figure 3].
- 60% at clinical level,
- 64% at community level, and
- 44% at the state and national levels.
- 58% strongly agree that formal training will be an effective tool to provide the guidelines to dentists in tobacco cessation and counseling.
|Figure 3: The perceived of the dental fraternity in tobacco cessation and counseling|
Click here to view
| Discussion|| |
In the current study, 97% of the respondents feel that it is the duty of every dentist to encourage patients to stop smoking. This is in close agreement with the study of Raja et al.  in which 94% have agreed that it is the duty of every dentist to advise patients about tobacco cessation. The study also reveals that the dentists are capable of tobacco cessation if certain barriers on this noble path are removed.
The most common barriers for successful tobacco cessation as perceived by the dentists in the current study were, e.g., lack of time, lack of printed resources, lack of persuasion on tobacco cessation, lack of training, dentists' fear that the patients may not come back to them. The study by Raja et al.  found that the main barriers are lack of educational resources to give to the patients and lack of time. Johnson et al.  also in their study had mentioned the same common barriers as perceived in the current study, i.e., lack of time, lack of training, and lack of patient education materials but added another barrier as lack of reimbursement.
The current study is equivocal with the study by Johnson et al.  which mentions that around 70% of the respondents do not feel that they are well prepared to assist the patients for tobacco cessation and counseling. The important role of formal training to the dentists and their staff in achieving tobacco cessation has emphatically come out in both these studies though the percentage of the respondents on this aspect differs slightly. Christen  described various approaches to tobacco cessation and education that have been successfully employed in a University.
It is heartening to note from the current study that not withstanding various barriers on the path to achieve successful tobacco cessation, the dentists in Bhopal educate their patients about the vital importance of the subject and display patient education materials in their clinics and institutions. Some of them refer their patients to a general practitioner/other specialists wherever essential, for example, in cases where metastases is suspected.
The current study is limited to the dentists in the Bhopal city and for generalizing the findings at the National/Global level may require further research.
It has come out very clearly that the dentists require formal training for achieving successful tobacco cessation. Government has a very important role in this aspect. Presently, however, Government has taken several measures in this direction, providing formal training to the dentists and their teams and equipping them with promotional resources for giving wide publicity on the subject requires immediate attention of the Government. Further, Government may consider encouraging dentists who promote and achieve tobacco cessation through appropriate incentives including cash. Community-based programs should be planned and implemented at different levels of administration. Monitoring of effective planning and execution of these programs by appropriate Authorities at regular intervals are vital for successful achievement of the goal of "Tobacco Free Society."
In conclusion, dentists and their team feel that it is their duty to promote/encourage tobacco cessation since it will reduce the tobacco-related deaths. This perception of the dentists should be appreciated and further encouraged. This aspect due to its vital influence on the society should be taught at University level as a part of curriculum for the dentists.
Dentist plays very important role in tobacco cessation at both their clinical and community levels. It is therefore essential that the barriers on this path should be removed in order to achieve total success in this effort. At clinical level, the dentists should be encouraged to devote more time for counseling the patients toward tobacco cessation since it stops further aggravations of the disease and also results in speedy recovery. In the process of counseling, the dentists will find it easier to use printed resources such as pamphlets, posters and so on. Patients normally require lot of persuasion on the part of their doctors to stop tobacco use. The dentists have to realize that all these efforts toward tobacco cessation yield very good results not only at community level but also for them at clinical level. This effectiveness of the dentists in solving patients' problems and prevention of the diseases will certainly, through a word-of-mouth publicity, increase his/her practice and consequently income.
At the clinical level, counseling is limited only to the patients who approach the dentists for solving their problems related to oral health. Further, high-risk individuals such as children and pregnant women (tobacco results in low birth-weight babies with complications) require special attention. It is therefore essential that counseling should he carried out at community level so that prevention of the diseases is achieved. This is effective through community-based programs with the support of Government and NGOs.
| References|| |
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Department of Pedodontics & Preventive Dentistry, People's Dental Academy, Bhopal Madhya Pradesh
Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2], [Figure 3]
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