Periodontists believe they should facilitate smoking cessation

Do you consider it your responsibility to help your patients quit smoking?

If you answered yes, then you are in good company. A recent study that surveyed 231 periodontists found 92% believe that tobacco-cessation interventions are a responsibility of the dental profession (Journal of Periodontology, March 2011, Vol. 82:3, pp. 367-376).

Tobacco use and dependence is an oral health problem and has a great impact on the development and progression of periodontal disease, said study author Laura Romito, DDS, an associate professor at the Indiana University School of Dentistry, in an interview with DrBicuspid.com.

"We believe tobacco-dependence treatment is a vital component of periodontal practice, and we were interested in evaluating the extent to which practices had incorporated tobacco-dependence treatment in their practice protocols," she said.

First study on periodontists

Although the use of tobacco cessation interventions by dental hygienists, general dentists, and oral maxillofacial surgeons has been reported in the literature, there are no comprehensive published studies about this topic specific to periodontists, Dr. Romito noted.

The study authors therefore felt this research was important because of the clear causal relationship between smoking and periodontal disease and the negative effects of smoking on wound healing.

They mailed surveys to 1,000 active members of the American Academy of Periodontology and received 231 responses. The survey assessed the periodontists' demographic information, educational and professional background, knowledge and attitudes about tobacco cessation, and use of interventions in the daily practice of periodontics.

Most (92%) of the surveyed periodontists believed that tobacco cessation is a responsibility of the dental profession, Dr. Romito noted.

"We were happily surprised by the large number of periodontists who believed that tobacco-dependence treatment is a responsibility of the dental profession," she said. "This implies that the message that tobacco use is an oral health problem has really been taken to heart by these oral health practitioners."

However, a pattern of declining levels of involvement was seen as the providers moved through the suggested "5 A's" (ask, advise, assess, assist, and arrange) -- a series of steps to be used in a healthcare setting to treat tobacco use and dependence -- for promoting tobacco cessation.

Younger periodontists and those who were recent graduates were more likely to have obtained tobacco-dependence treatment training and engage in the steps of the 5 A's, according to Dr. Romito.

Barriers and overcoming them

The primary perceived barriers to providing tobacco-cessation interventions were low patient acceptance of treatment, lack of time, and lack of training. The following were other barriers cited:

• Lack of reimbursement
• Believing that there was little chance of success in providing tobacco-cessation intervention
• Believing that patient acceptance of treatment is low
• Possibility of offending patients
• Lack of personal interest by the provider

"Although periodontists believe that there is a high amount of success in intervention, they also believe that acceptance of the treatment is low," Dr. Romito explained. "This may indicate that periodontists equate success with getting patients to quit, and they may not have had many such patients. It may also suggest a lack of communication between the patient and provider or incorrect assumptions about the patients' willingness to quit."

This barrier can be overcome with training in effective assessment and communication strategies, she added. For example, for patients who are unwilling to quit, the goal might simply be to engage in conversation, which helps increase their motivation to quit.

Training also can help practitioners overcome the "lack of time" issue.

The basic steps of a tobacco-dependence treatment protocol can be implemented in three minutes or less, according to Dr. Romito. If the dental office is familiar with community or state resources for tobacco-dependence treatment (such as the 1-800-QUIT NOW quit hot line), patients can be given information on these resources and referred for further assessment and assistance in quitting.

Finally, when it comes to lack of reimbursement, while many insurance plans do not provide coverage for cessation counseling, this seems to be changing.

"The ADA code for tobacco counseling in dental practice, D1320, should be applied when the service is rendered," Dr. Romito said. "If a service is utilized and visible to plan administrators, it may more likely to be considered the standard of care and become a covered service."

Comprehensive tobacco-dependence education should continue to grow as a part of the formal education of oral health providers, and should also be available through continuing education courses for those who have entered private practice, she noted.

Judith S. Gordon, PhD, an associate professor at the department of family and community medicine at the University of Arizona who has done similar research (Drug and Alcohol Review, January 2006, Vol. 25:1, pp. 27-37), said that these findings underscore that although dental practitioners can play a vital role in helping their patients to quit using tobacco, there is a great deal of room for improvement in this area.

"These findings reinforce those from previous research studies that training of oral health professionals is key to improving the treatment of tobacco dependence in dental settings," she said. "General and specialty dentists have a unique opportunity to motivate and assist their patients to quit using tobacco."

With proper training, dental professionals can be very effective in helping their patients to quit, Gordon concluded.