Tobacco chewers quit after "teachable moment" in dental chair

June 29, 1999

Dental hygienists can take an active part in helping their patients quit chewing tobacco, a new study conducted by Oregon Research Institute scientists shows.

In the study, quit rates tripled among the snuff and chewing tobacco users who received cessation intervention from their dental hygienists compared to patients who got only usual care.

"More than half of all tobacco users see a dentist at least once a year, and this visit represents a 'teachable moment' that dental hygienists can use to connect the patient's oral health problems to tobacco use," says Judy A. Andrews, Ph.D., a co-investigator of the study. "Patients are more receptive to getting tobacco cessation advice as they face up to the mouth sores, bleeding gums and receding gums that are typically associated with smokeless tobacco use."

Smokeless tobacco has been strongly linked with cancer of the mouth and increased risk of cancer of the vocal chords, "windpipe" and upper parts of the digestive canal (i.e., larynx and esophagus) and the stomach.

"This study shows that giving patients something tangible that reinforces the hygienist's message that smokeless tobacco use has harmful oral effects gives them the means to follow through with their quit attempt," says Andrews. The results of the study appear in the current issue of the Annals of Behavioral Medicine.

The scientists developed a three-hour workshop for dental hygienists to help their patients who use smokeless tobacco quit their habit. The workshop also trains them in step-by-step counseling techniques for talking with patients about quitting tobacco. As part of the protocol, smokeless tobacco users are given a manual and a video for self-study.

The scientists enrolled 633 smokeless tobacco users for their study from an initial group of about 35,000 dental patients. Almost 99 percent were male and on average they were using chewing tobacco or snuff six days a week, consuming a tin in 4.5 days.

The researchers followed up by mail and phone with these patients at three months and 12 months after their session with the dental hygienist. Of the 469 patients who responded, 60 percent had been treated by hygienists using the intervention protocol and 40 percent were in usual practices.

"Giving brief advice and materials during the dental hygiene visit could reach almost half of all smokeless tobacco users -- and we can expect that from 10 to 20 percent of them would give up snuff and chewing tobacco," says Herbert S. Severson, Ph.D., head of the study.

"Quit rates would increase from two to six times nationwide if all dental practices implemented a smokeless tobacco cessation intervention," says Severson.

This study replicated an earlier study using HMO dental clinics and extended the intervention to 75 private practice clinics. The investigators are currently conducting a study to evaluate the feasibility of disseminating this effective intervention.

The research was supported by a grant from the National Heart, Lung and Blood Institute of the National Institutes of Health.
Annals of Behavioral Medicine is the official peer-reviewed publication of The Society of Behavioral Medicine. For information about the journal, contact editor Arthur Stone, Ph.D., 516-632-8833.

Posted by the Center for the Advancement of Health For information about the Center, call Petrina Chong, 202-387-2829.

Center for Advancing Health

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