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M. Terrades, W. A. Coulter, H. Clarke, B. H. Mullally and M. Stevenson British Dental Journal 2009; 207: E22

Editor's summary

A previous paper published in the BDJ this year investigated the provision of smoking cessation advice by dental teams and factors that determined whether or not such advice was provided.1 The paper found that there was room for improvement in the provision of smoking cessation advice, particularly to patients without severe oral complaints, and the authors made various suggestions for how this improvement could be encouraged. This paper by Terrades et al. looks at the other side of the equation, by investigating patients' attitudes to smoking cessation advice provided by dentists. Their results make for interesting reading.

Two hundred and fifty-five patient questionnaires were analysed in they study, and the findings fall broadly into three areas: knowledge of the effects of smoking on general health, knowledge of the effects of smoking on oral health, and attitudes to dentists' role in smoking cessation. The study found that patients generally had a good knowledge of the effects of smoking on their general health, but that smokers in particular were significantly less aware of the effects of smoking on their mouths. Patient attitudes to dentists providing smoking cessation advice were very positive, with 69% of smokers indicating they would try to quit if their dentist suggested so and 81% indicating they would try to quit if their dentist showed them an effect of smoking on their mouth.

These results show why provision of smoking cessation advice by dentists is so important. Patients' knowledge of the effects of smoking on oral health appears to be patchy and patients are open to advice from dentists on this subject – indeed, they seem to expect it. This serves to underline the importance of the findings of Rosseel et al. in the earlier paper.1 With patients apparently so open to advice from dentists on the effects of smoking and the importance of quitting, there is a great opportunity for the profession to make a positive impact on the oral and general health of thousands of smokers who have yet to quit. Such an opportunity should not be passed up.

The full paper can be accessed from the BDJ website ( http://www.bdj.co.uk ), under 'Research' in the table of contents for Volume 207 issue 11.

Rowena Milan, Managing Editor

Author questions and answers

1. Why did you undertake this research?

The fight against smoking is a public health priority nowadays. This investigation was undertaken as a starting point for finding out more about smoking and dentistry. Its basic aim was to find out the current level of knowledge of patients regarding the effects of smoking on oral health and at the same time what they expected from their dentists. If we could show that there was a lack of knowledge but that patients were willing to follow their dentists' advice, it would be reasonable to ask all of the dental profession to participate in smoking cessation activities and thus be part of a worldwide strategy against tobacco.

2. What would you like to do next in this area to follow on from this work?

The ultimate objective of this work is to involve all of the dental profession in the fight against tobacco. For that reason, the next step we would like to take is to produce a leaflet for dentists and dental hygienists containing the results of this study to encourage them to participate in smoking cessation activities. Then it would be interesting to investigate any change in their attitudes to information about smoking. Apart from this, we would like to investigate in detail how oral tissues change after patients give up smoking. Although the effects of smoking are well described in the scientific literature, the effects of giving up the habit are not well documented yet.

Comment

None of us appreciates being preached at, but we do tend to be interested in new information about our own health. If that information comes from a respected source we are often motivated to act on it.

This article investigates these factors in relation to the dentist's role in smoking cessation. It identifies gaps in patients' knowledge and it assesses patients' attitudes to their dentists as advisers on smoking cessation and their stated willingness to follow such advice.

Smoking has well established effects on oral health – particularly through increased risk of oral cancer, increased prevalence and severity of periodontal disease, and slower and less successful wound healing after surgery.2 The study found that the association between smoking and these oral effects was less well understood than medical or aesthetic effects.

Smokers were less likely than non smokers to identify the link between smoking and oral health – especially the effects on periodontal disease and wound healing. This demonstrates the importance of assessing the smoking status of patients and ensuring that specific advice is given to smokers undergoing surgery or any form of periodontal intervention.

The majority of patients in this survey – both smokers and non-smokers – showed very positive attitudes to the role of the dentists in smoking cessation, agreeing that they would expect their dentist to be interested in their smoking status and to explain the effects of smoking on their oral health.

Almost all the smokers questioned stated that if the dentist showed them an effect of smoking in their mouth they would give up smoking. This reinforces the evidence that advice from primary care professionals – even very brief advice – is effective in reducing smoking levels in the population.3

The message is clear: assess your patients' smoking status and advise smokers on how this affects their oral health. They expect this advice and will act on it.