[Show abstract][Hide abstract] ABSTRACT: The objective is to explore the effectiveness of providing patient-reported feedback to stimulate dental professionals to adhere to guidelines for the treatment of tobacco addiction. We use three independent patient samples with intervals of 6 and 18 months. The study concerns twenty-three primary care general dental practices in the Netherlands. We use descriptive analyses and x 2 tests were carried out on data from
patient questionnaires administered at baseline and again 6 and 18 months later. Exploratory analyses were carried out on data from 425, 267 and 330 smoking patients to reveal factors influencing professional actions. Practices received a smoking cessation protocol intended to guide daily dental practice and facilitate discussion. On three occasions, patient perceptions of the smoking cessation education, advice and
support were reported to the practices. Patient perceptions were assessed via administration of a short questionnaire to all smoking patients visiting the practice during 1 week (i.e. baseline) and all smoking patients visiting the practice during 1 week 6 and 18 months later. We measured changes in patient-reported receipt of smoking cessation advice and support from dental professionals. Results are presented in the form of the provision of advice, support and patient education increased after 6 and 18 months. Motivational stage of the patients (i.e. contemplation and preparation), daily smoker status of patient and fewer assistants in the dental practice contributed to these changes. Feedback from patients stimulated dental professionals to adhere to national guidelines for tobacco addiction treatment. Nevertheless, no receipt of smoking cessation advice or support was still reported for about 50% of practice visits. Investigation of more long-term feedback is, therefore, recommended to gain insight into the sustainability of the observed changes and explore possibilities for raising levels of guideline adherence.
International Journal of Health Promotion and Education 01/2012; 50(3):101-110.
[Show abstract][Hide abstract] ABSTRACT: In a controlled study, primary care dental professionals in the intervention group were encouraged to provide smoking cessation advice and support for all smoking patients with the help of a stage-based motivational protocol. The barriers and facilitators reported by the dental professionals on two occasions for their efforts to incorporate smoking cessation advice and counselling into daily patient care are summarised here. Lack of practice time and anticipated resistance on the part of the patient were cited as barriers by over 50% of the dental professionals in the first interviews. Periodontal treatment and the presence of smoking-related diseases were mentioned as the most important stimuli. The experience-based interviews revealed key points for the implementation of smoking cessation advice and support in daily dental care. Education on the associations between smoking and oral health, vocational training on motivational interviewing and the offering of structured advice protocols were identified as promising components for an implementation strategy to promote the involvement of dental professionals in the primary and secondary prevention of tobacco addiction.
British dental journal official journal of the British Dental Association: BDJ online 04/2011; 210(7):E10. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Smoking influences oral health in several ways (such as the occurrence of periodontitis, teeth discolouration and oral cancer); therefore, smoking behaviour should be addressed in dental care. Dentists can play a role in primary and secondary prevention of tobacco dependence. They see their patients repeatedly over time. This study investigates whether oral health complaints can be seized as an opportunity to start smoking cessation counselling.
A structured patient questionnaire in a sample of 1101 smokers (52.1% women, mean age 40.4 years) in a convenience sample of 87 primary care dental practices. The I-change model was used to describe factors influencing behavioural change. Dependent factors such as intention to quit smoking and related factors (attitude, social support and self-efficacy) were analysed in relation to independent factors such as oral health complaints (gingiva problems, gingiva inflammation, oral cancer and discoloured teeth) using a general linear model (univariate analysis), multinomial logistic regression analysis and multiple linear regression analysis.
A total of 56.3% had discoloured teeth, 27% of the smokers had a problem with their gums and 15.7% had gingiva inflammation. We found no direct relation between oral health complaints and the intention to quit smoking. However, teeth discolouration was positively related to attitudes towards smoking cessation [β, Confidential interval (95%); 1.92 (1.45-2.40 for advantages and -0.86(-1.18 to -0.53) for disadvantages] and negatively to self-efficacy regarding quitting [-2.69 (-3.49 to 1.88)].
We found no direct relation between oral health complaints and the intention to quit smoking, but oral health complaints and especially teeth discolouration were related to factors influencing the quit intention. Patients with discoloured teeth are more likely to have a positive attitude towards smoking cessation but are uncertain to persist smoking cessation. It is suggested that teeth discolouration can be a good entrance for addressing smoking cessation in daily dental practice.
Community Dentistry And Oral Epidemiology 10/2010; 38(5):470-8. · 1.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate determinants of the provision of smoking cessation advice and counselling by various dental professionals in the dental team (dentists, dental hygienists and prevention auxiliaries).
Sixty-two general dental practices in the Netherlands.
Multivariate logistic analyses of self-reported counselling behaviour collected from questionnaires for dentists (n = 72), dental hygienists (n = 31) and prevention auxiliaries (n = 50) in general dental practices.
Stimuli and barriers for smoking cessation counselling and advice behaviour to patients with or without oral health problems.
Dental hygienists provided more general cessation advice and counselling than dentists. However, when patients had oral complaints, dentists counselled more often compared to prevention auxiliaries. The support from experienced colleagues positively influenced the provision of advice and counselling as well as the perceived self-efficacy for all kinds of dental professionals.
The provision of general smoking cessation advice to patients with no acute oral complaints can be improved by more involvement of the dentist and/or task delegation to prevention auxiliaries and dental hygienists. Social support is important in encouraging more smoking cessation advice and counselling. Implementation strategies for support of smoking cessation in dental care should focus on creating a positive advice culture among colleagues.
British dental journal official journal of the British Dental Association: BDJ online 05/2009; 206(7):E13; discussion 376-7. · 1.09 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Smoking may cause periodontal diseases and raises the chance of getting oral cancer. The Dutch Guideline for the Treatment of Tobacco Addiction recommends that dental professionals explicitly advise all patients who smoke to stop smoking. In 12 dental practices a study was made of how the guidelines could be implemented. The strategy consisted of a patient protocol for minimal, one-time cessation advice or for more intensive supervision, a patient leaflet, centralized training for the dental team, and repeated monitoring with feedback on the patients' experience of the behaviour that they have been advised to follow. Before the training and again 3 months after, professionals (n = 38) and an a-select sample of smoking patients (n = 197) completed questionnaires. A majority of patients was receptive to cessation advice of a dentist (95%) or counseling (68%). After 3 months it appeared that patient behaviour as reported by patients with respect to all points of the patient protocol had significantly improved.
Nederlands tijdschrift voor tandheelkunde 10/2008; 115(9):460-5.
[Show abstract][Hide abstract] ABSTRACT: Roken kan leiden tot parodontale aandoeningen en verhoogt de kans op mondkanker. De nationale ‘Richtlijn Behandeling Tabaksverslaving’ beveelt aan dat tandheelkundige zorgverleners alle rokende patiënten actief een stopadvies geven. In 12 tandartspraktijken werd onderzocht hoe deze richtlijn kan worden geïmplementeerd. De implementatiestrategie bevatte een centrale training voor het praktijkteam, een protocol voor een minimaal, kort stopadvies of voor een intensievere stopbegeleiding, een patiëntenfolder en herhaalde monitoring met terugkoppeling van het door patiënten ervaren adviesgedrag. Voorafgaand aan de training en 3 maanden later werden via vragenlijsten gegevens verzameld bij zorgverleners (n = 38) en bij een aselecte steekproef van rokende patiënten (n = 197). Een meerderheid van patiënten accepteerde een adviserende rol (95%) of een begeleidende rol (68%) van de tandarts. Na 3 maanden bleek het adviesgedrag van de tandheelkundige zorgverlener, zoals gerapporteerd door de patiënt, op alle onderdelen van de protocollen significant verbeterd.
Nederlands tijdschrift voor tandheelkunde 01/2008; 115(9):460-465.