By Lauren Gaffney
Despite research and public information campaigns citing the dangers, tobacco use remains a significant problem in the United States. Though tobacco use has seen a decline in recent years, as many as 6,000 people begin using these products daily, many of them adolescents. Of current tobacco users, many continue to do so despite failing health or a desire to quit.
Allied dental education curricula recognize this problem and include extensive information on the detrimental effects of tobacco use and how to evaluate and implement a tobacco cessation program for patients who are ready to quit. Tobacco education information is included in nearly all allied dental programs in some form or another. While that is useful, it is unclear how many programs provide clinical opportunities for allied dental students to practice working with patients on tobacco cessation and how many allied dental professionals are able to conduct such programs as professionals.
Yet, studies show that the success of implementing tobacco cessation programs in dental offices and clinics is directly correlated with the involvement of dental hygienists and dental assistants. This fact suggests that developing more clinical opportunities for allied dental students to practice tobacco cessation initiatives should be a top priority. Some allied dental programs are already on their way.
Dental hygiene students at the University of Louisville School of Dentistry are currently involved in a research study of tobacco cessation training on simulated patients. The curriculum includes lectures on tobacco cessation and risk assessment done through collecting information from clinical patients. This research study, run by Professor Jackie Singleton, consists of a one-hour lecture followed by three practice sessions with a standardized patient. After each interview, the “patient” gives the student feedback. To determine if the program has an impact on knowledge and attitudes, participants complete anonymous pre-program and post-program questionnaires.
Other programs already combine didactic and clinical experience and stress the need for students to take their roles as tobacco interventionists quite seriously. In courses taken in their junior and senior years, students in the dental hygiene program at the University of Maryland Dental School, for instance, receive information on interventions, women and tobacco, addiction, office implementation of a cessation program, and pharmacologic adjuncts. In their junior year, students take a class specifically on prevention and control, and seniors take a class called “Perspectives on Dental Hygiene Practice,” which deals in part with periodontal disease and tobacco use.
In a clinical setting, each student is required to complete a competency on an intervention with a tobacco-using patient through the use of the AHRQ guideline, the five As—ask, advise, assess, assist, and arrange—a widely accepted model of tobacco cessation. According to Professor Jackie Fried, the director of the division of dental hygiene, over the past five years students have presented case conferences on patients who exhibit oral manifestations or oral pathology related to tobacco use. This year, students presented a poster exploring the relationship between tobacco and oral cancer and the role of the media.
Often tobacco cessation education programs focus specifically on cessation programs for cigarette, pipe, and cigar smokers, but few are tailored to help users of chewing tobacco quit. Cindy Schroeder, an allied dental education instructor at the School of Health Related Professions at the University of Medicine and Dentistry of New Jersey, has incorporated extensive information about smokeless tobacco use among adolescents into her lectures on tobacco cessation. Many adolescent boys involved in sports begin using smokeless tobacco because it has historically been a part of the sport they play, but they do not realize that it is not a safe alternative to cigarettes or cigars. Professor Schroeder emphasizes the use of intraoral cameras to show patients whitish lesions on the mucosa that they may not have noticed themselves. This type of treatment is very effective in adolescents because of the high value they place on their appearance.
These approaches to tobacco cessation in allied dental education help students prepare to assume the role of interventionist in a clinical setting. According to Dr. Linda Hanlon, former Director of Dental Hygiene at the Forsyth Institute, “Dental hygienists and dental hygiene educators see the introduction of tobacco cessation programs as another preventive service that they should be providing to their patients.” While a great number of these programs strive to prepare students to help their patients quit using tobacco through increased clinical practice, others do not provide enough hands-on experience to leave students feeling comfortable to assume this role. Even those students who do feel adequately prepared generally must comply with the policies of their supervising dentist. Despite findings that these programs are quite successful when they are supervised or implemented by allied dental professionals, some dentists do not make tobacco cessation a part of their oral health care efforts.
Emphasizing the key role allied dental professionals play in successful tobacco cessation programs and applying a multidisciplinary curriculum approach may help boost the number of tobacco interventions conducted in dental offices and clinics.