Dentists' perspective on tobacco cessation and counseling in Jeddah

Shanthi Vanka; Dalya Nabil Afandi; Rana Hassan Otaif; Anan Adel Sharbatly; Raghad Emad Hejazi; Raghad Sultan Aljohani; Othman Wali; Amit Vanka

doi:10.4103/ajprhc.ajprhc_10_23

ORIGINAL ARTICLE

Year : 2023 | Volume : 15 | Issue : 1 | Page : 91-96

Dentists' perspective on tobacco cessation and counseling in Jeddah

Shanthi Vanka¹, Dalya Nabil Afandi¹, Rana Hassan Otaif¹, Anan Adel Sharbatly¹, Raghad Emad Hejazi¹, Raghad Sultan Aljohani¹, Othman Wali², Amit Vanka¹
¹ Department Preventive Dental Sciences, Dentistry Program, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia
² Department Oral Basic and Clinical Sciences, Dentistry Program, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia

Date of Submission	23-Jan-2023
Date of Decision	26-Feb-2023
Date of Acceptance	06-Mar-2023
Date of Web Publication	31-Mar-2023

Correspondence Address:
Shanthi Vanka
Department Preventive Dental Sciences, Ibn Sina National College for Medical Studies, Jeddah
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajprhc.ajprhc_10_23

Abstract

Introduction: A major cause of death on a global scale is tobacco and in fact the biggest preventable cause of mortality and illness worldwide. The World Health Organization estimates that there are 1100 million regular smokers worldwide and they are increasing alarmingly. Dentists play a pivotal role in the prevention of tobacco use as patients approach dentists for cosmetic reasons. We planned this study to find the experience of dentists on tobacco cessation and counseling. Methods: We designed the study as an analytical cross-sectional study. The data were collected through a questionnaire using Google Forms targeting all the dentists in Jeddah. The questionnaire Google link was sent to their WhatsApp and other electronic means. Consent from the dentists was obtained prior to collecting information from the dentists. Results: 89.9% of dentists agreed that it is the duty of every dentist to advise the patient on tobacco cessation and 10.1% disagreed. 81.7% of dentists agreed that all dentists have the capability of doing tobacco cessation practices. Seventy-eight percent of dentists agreed that dentists are not presently well prepared to assist patients with tobacco cessation in contrast with 22% who disagree. The scientific evidence relating to the burden of oral diseases has always been attributable to tobacco use, and a well-structured dental teaching curriculum for the dentists and the auxiliaries concentrating on oral cancer education and tobacco cessation interventions has to be emphasized in the Kingdom for the dentists (28). Dentists require formal training to do tobacco cessation successfully to reach a major goal of a “tobacco-free society.” Conclusion: There should be an emphasis on formal training being an effective tool to provide guidelines to the dentist and auxiliaries in tobacco cessation and counseling of the patients in the dental clinic.

Keywords: Analytical study, Jeddah, tobacco cessation and counseling, tobacco

How to cite this article:
Vanka S, Afandi DN, Otaif RH, Sharbatly AA, Hejazi RE, Aljohani RS, Wali O, Vanka A. Dentists' perspective on tobacco cessation and counseling in Jeddah. Asian J Pharm Res Health Care 2023;15:91-6

How to cite this URL:
Vanka S, Afandi DN, Otaif RH, Sharbatly AA, Hejazi RE, Aljohani RS, Wali O, Vanka A. Dentists' perspective on tobacco cessation and counseling in Jeddah. Asian J Pharm Res Health Care [serial online] 2023 [cited 2023 Jun 8];15:91-6. Available from: http://www.ajprhc.com/text.asp?2023/15/1/91/373367

Introduction

A major cause of death on a global scale is tobacco.^[1],[2] Smoking is a major cause of death and has severe negative impacts on oral health.^[2],[3] Tobacco products can lead to gum disease, oral cancer, and other issues with oral health.^[4] The use of tobacco products kills a third to half of users on average 15 years earlier and is the biggest preventable cause of illness and death in the developed world.^[1],[5] The biggest preventable cause of mortality and illness worldwide is tobacco use.^[6],[7]

The World Health Organization (WHO) estimates that there are 1100 million regular smokers worldwide. There are nearly 5 million individuals who die each year from tobacco-related diseases worldwide, with 2.41 million of those deaths occurring in developing countries and 2.43 million in developed countries.^[8] Additionally, it is also believed that about one-third of adults regularly come into contact with second-hand smoke.^[9]

The International Agency for Research on Cancer stated that there is sufficient evidence that tobacco smoking causes oral cavity cancers.^[3] Tobacco is one of the major causes of oral and other types of carcinomas and is the foremost cause of preventable death in the world.^{[10],[11],[12]} A study by Winn demonstrates that there is a strong correlation between prevalence of smoking in relation to sex differences.^[4] Majority of deaths happen as a result of an addiction developed in youth.^[12],[13]

Saudi Arabian scenario

The number of smokers and deaths due to smoking in the Kingdom is rising rapidly. The tobacco use epidemic is one of the major global public health challenges in Saudi Arabia as it causes >7 million deaths each year, including around 70,000 Saudis who die from smoking-related diseases.^[14]

The “gold standard” of health-care cost-effectiveness is frequently cited as being smoking cessation programs since they result in more life years gained for fewer resources than many other medical and preventive health initiatives.^[15] Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decade of life.^[16] The WHO recommended that dentists and other oral health professionals should be involved in helping patients to quit smoking and that tobacco cessation should be part of the practice of dentistry.^[17] The role of the dentist and dental offices in promoting and assisting tobacco cessation is crucial.^[12]

Increased cigarette abstinence rates among tobacco users present a great opportunity for oral health practitioners working in dentist offices or community settings.^[3] Dentists play an important role in helping people quit the habit.^[18] Hence, this study has been planned to be aimed at assessing the role, knowledge, current practices, different barriers, and tools to overcome tobacco cessation and counseling as perceived by dentists in Jeddah.

Methods

This was an analytical cross-sectional study. We obtained ethical committee approval from Ibn Sina National College for Medical Studies. The protocol identification number is 004SRCDP03082022. The required sample size was calculated to be 93 and a margin of error of 10% at a 95% confidence interval. The dentists have been chosen based on a convenience sample from the four regions of Jeddah.

The data were collected through a questionnaire using Google Forms targeting all the dentists in Jeddah. The questionnaire Google link was sent to their WhatsApp and other electronic means. Consent from the dentists was obtained prior to collecting information from the dentists on tobacco cessation and counseling.

Data were collected from all dentists in Ibn Sina National College for Medical Studies in Jeddah via the survey instrument, which consisted of 18 closed-ended questions. A close-ended questionnaire was created because there was no validated questionnaire for the group of faculty members based on the various replies supplied by the faculty members. Two faculty members proofread the completed questionnaire to ensure that the statements were clear and meaningful. For the questions, the test–retest correlation coefficients varied from 0.95 to 0.99. The alpha value of Cronbach's alpha was 0.8.

Questions collected data on sociodemographic factors including age, sex, education, occupation, and nationality. It also assessed dentist perspectives regarding tobacco cessation and counseling. The outcome measures collected from the questionnaire will include knowledge, attitude, and practices of dentists on tobacco cessation and counseling. The sample of dentists was a convenience sample from the private dental school and private dental practitioners in Jeddah.

The SPSS package version 23, manufactured by (IBM, USA). The responses have been represented as descriptive statistics in numbers and percentages. The association between the variables was calculated using Chi-square test. The level of significance was considered P < 0.05 for a statistically significant value.

Results

Out of 120 dentists to whom the questionnaire was administered, 109 responded within a week's time resulting in a high response rate of 90.83%. The demographic details of the respondents are tabulated in [Table 1]. Seventy-six percent of the dentists agreed that they advocate tobacco cessation practices actively and 24% disagreed about tobacco cessation advocation.The perceived role of the dental fraternity in tobacco cessation and counseling at clinical level was 28 (26%), community level 30 (27%), state and national level 3 (3%), and all of the levels 48 (44%) [Table 1].

Table 1: Demographic details and dentist's perceived role in tobacco cessation and counseling according to the academician and/or private practitioners

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89.9% of dentists agreed that it is the duty of every dentist to advise the patient on tobacco cessation and 10.1% disagreed. 81.7% of dentists agreed that all dentists have the capability of doing tobacco cessation practices. Seventy-eight percent of dentists agreed that dentists are not presently well prepared to assist patients with tobacco cessation in contrast with 22% who disagree.

90.8% of dentists agree that dentists have to display patient education materials in the practice/reception areas and 9.2% disagree about this practice. 89.9% of dentists agree that the dentist should engage their auxiliary staff in the process of tobacco cessation and counseling. Eighty-nine percent of dentists agreed that formal training is an effective tool to provide guidelines to the dentist in tobacco cessation and counseling and 11% disagree with the same.

84.4% of dentists agreed that the future direction of tobacco cessation and counseling to the patients is the duty of the dentist and 15.6% disagree [Table 2].

Table 2: Dentists' perceived role in tobacco cessation and counseling evaluated on a 4-point Likert scale

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Around half of the dentists ask the patients about tobacco use, and most of them keep recording the details of the patients who have the habit of using tobacco. Furthermore, they ask them if they know about the importance of tobacco cessation. Always to never, dentists refer patients to a general practitioner if they have a habit of using tobacco in any form [Table 3].

Table 3: Dentists' perceived role in tobacco cessation and counseling evaluated on a 5-point Likert scale

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The most common barriers to successful tobacco cessation in our study are dentists not having time to do tobacco cessation and counseling, lack of printed materials available in the clinics, lack of persuasion on tobacco cessation, and fear that after the tobacco cessation counseling sessions, the patients may not come back to the clinic for treatment [Table 4].

Table 4: Common barriers the dentist perceives for successful tobacco cessation

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Discussion

The response rate of the current study is 90.83% which is almost similar to the study by Amit et al., 2011,^[1] where the response rate was 84%. The findings of the present study highlight the value of formal training for dentists as a means of advising patients on quitting smoking. In a dental clinic, patients should receive tobacco cessation and counselling from dental auxiliary staff.

97% of dentists in the study by Amit et al.^[1] believed that it is the responsibility of every dentist to counsel patients on quitting smoking. 90% of participants in our study believed that it is the responsibility of every dentist to counsel patients on quitting smoking. In our study, nearly 90% of dentists agreed that formal training is a useful tool for giving dentists direction on how to conduct tobacco cessation and counseling.

Tobacco cessation and counseling are very important, and dentists play a very important role in helping patients attempt to quit the habit.^[19],[20] Devaki Talluri in 2019^[21] has also supported the same in her study and concluded that health-care providers play a vital role in helping patients and that treatment of tobacco dependence may be included in the dental curriculum. The dental curriculum should have tobacco cessation and counseling as it is an integral part of the oral health-care delivery for the patients and the community.

Eight nine percent of the dentists agreed that they are not presently well prepared to assist the patients with tobacco cessation and also have the capability of practicing tobacco cessation and counseling during their dental practice. Albert et al., 2005,^[22] concluded that 27% of the dentists surveyed indicated that no tobacco cessation activities were being conducted in their offices and that there are barriers to acceptance of the dentists' role in tobacco cessation. The barriers that the dentist perceives for successful tobacco cessation are lack of time during their practice (55%), lack of persuasion on tobacco cessation (45.9%), lack of printed materials (43.1%), and fear that after the tobacco cessation counseling, the patients may not come back (26.6%). According to the 2011 study by Amit et al.^[1], dentists' lack of time (39%), lack of access to printed materials in the clinics (49%), inability to convince patients to quit smoking (64%) and worry that the patients might stop coming back for treatment (48%) are the most common barriers to successful tobacco cessation.

And these barriers could be addressed by the fact that dentists lack information related to tobacco cessation and counseling. Hence, it is recommended that there is formal training that is needed for dentists. Moreover, the formal training when given during the bachelor program would be effective in the following tobacco cessation and counseling practices in their clinical practice. The formal training addressing tobacco use and dependence in dental colleges is suggested by Gordon et al.^[23] as a good model in treating the patient comprehensively.

About 50% of smokers reported visiting the dentist annually, according to a study by Albert et al 2005^[22]. As a result, dentists can play a critical role in assisting their patients in quitting tobacco use. Nearly 90% of dentists have agreed that they are displaying patient education materials in their practice/reception areas. Hence, it is recommended that patient health education materials be displayed in the clinic reception areas for the patient information which could help tobacco users understand the importance of quitting the habit.

The future direction of tobacco cessation and counseling to the patients is that the duty of the dentist has been agreed upon by almost 89% of our study respondents. Deborah et al.^[12] also in their study concluded that the dental team (includes dentists and dental auxiliaries) plays a major role in the primary or the secondary prevention of tobacco addiction It is very important to achieve success in helping patient quit tobacco which could be achieved by the dental team as a whole. As evidence shows that dental practice has been identified as a potential location for smoking cessation activities. Dental auxiliaries have also proven to be more effective than dentists in providing tobacco cessation counseling to patients as per the studies by Severson et al. in 1990^[24] and Albert et al. in 2005.^[22] This has also been supported by 90% of our study respondents. Dentists and their auxiliaries have access to a large proportion of the smoking population and together hand in hand have many opportunities to help patients reduce tobacco use.

A study by Alajmi et al. in 2017^[25] shows that one in four dentists in Kuwait and Saudi Arabia is a smoker and dentists should show a favorable attitude toward initiating tobacco cessation activities. Hence, it is particularly important that dentists should be nonsmokers and older than 40 years. Practice what we preach is an important saying that is useful in this discussion point. Dentists who smoke are less likely to adopt smoking cessation campaigns in their practices, so they need to quit the habit before they are a part of the tobacco cessation campaigns.

In our study, 80% of the respondents inquired about their patients' tobacco usage, which is significantly more than in Albert et al.'s study in 2005,^[22] where only 50% did so. One explanation for this difference may be that smoking has been directly related to several disorders. In a study by Buczkowski et al. in 2013,^[26] the subject of smoking was infrequently brought up during visits. The study's participants also noted that general practitioners have little time for smoking cessation interventions in their everyday work and that patient and doctor collaboration in the effort to quit smoking was low. It is the dentist's responsibility to understand the significance of tobacco cessation and counseling at the clinical, community, state, and national levels because they are the first to detect any changes in the oral cavity that may result from tobacco use.

In our study, approximately 80% of participants supported smoke cessation strategies, compared to 94.8% by Madhu et al. in 2019.^[27] In contrast to research by Dolan et al. in 1997,^[28] which found that only 26% of dentists reported asking their patients to quit smoking, around 47% of dentists conducted tobacco cessation activities in their offices and recommended their tobacco-using patients to quit. Most participants said that they spend between 15 and 20 min per counseling session on average. According to the Maharani et al.^[29] study, dentists only employ a small portion of their clinical time for counseling and tobacco cessation. It is crucial that dentists and assistants regularly observe counseling and cigarette cessation programs in clinics.

In a study by Madhu et al. in 2019,^[27] about 53.2% keep a record of patients with habits of using tobacco which is very similar to our study. Keeping records and regular follow-up with the patients on tobacco cessation and counseling them periodically will be a very good way in helping them quit the habit.

The scientific evidence relating to the burden of oral diseases has always been attributable to tobacco use, and a well-structured dental teaching curriculum for the dentists and the auxiliaries concentrating on oral cancer education and tobacco cessation interventions has to be emphasized in the Kingdom for the dentists.^[30] Large multicentric studies should be conducted to evaluate the effectiveness of tobacco cessation and counselling among patients attending dental clinics/hospitals.

Conclusion

There should be an emphasis on formal training being an effective tool to provide guidelines to the dentist and auxiliaries in tobacco cessation and counseling, so that effective positive outcomes can be expected in a short span of time.

The governing organizations can motivate the universities and health-care settings to initiate such programs and formal to reach a major goal of a “tobacco-free society.”

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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