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Dr.R.Ganesh, Post-graduate student, Dept.

of Public Health Dentistry

To assess the feasibility and acceptability of potential benefits of a dentist's intervention during a medical smoking cessation program, as part of the usual care for smokers attending a smoking cessation clinic.

Study participants were recruited through public advertisements in the hospital area and in local newspapers. Interested participants were invited to call the study center. A description of the trial was provided and a pre-screening interview was made on the phone.

Age between 18 and 70. Currently smoking for 3 years at least 10 cig./day. A score of minimum 6/10 on the psychometric Likert's scale in response to the question "What is today your motivation to quit smoking from one to ten?".

current pharmacological use to quit smoking. presence of an unstable or life-threatening medical condition. current unstable psychiatric illness. at risk of alcohol consumption. illegal drug consumption. people at risk to develop endocarditis. long-term bisphosphonate treatment. recent oral hygiene intervention (< 6 months).

At the first visit, oral and written explanations of the trial were provided about participant's implication, risks and benefits. Participants gave their written informed consent. Detailed medical, oro-dental and smoking histories were taken. Anthropometric measures were taken.

The study was performed in the Department of ambulatory care and community medicine, which includes a primary care clinic and a dental clinic at the same building.

All participants received an 8-week smoking cessation intervention including individual-based intervention combining replacement therapy and/or bupropion and 4 sessions of counseling.
A counseling session lasted thirty minutes in average.

Four visits (at week # 1, 2, 4, and 8) were scheduled and participants were asked to plan a quit date from the inclusion day until the 4th visit at week 8.

The dental intervention was provided by a dentist trained in periodontology and included two visits.
At the first visit, the dentist performed an orodental exam to rule out oro-dental lesions. At the second visit, one week later, the dentist performed an simple oral hygiene treatment.

The acceptability and feasibility of the dentist's intervention was assessed by a hetero administrated evaluation questionnaire .

Four questions on global satisfaction, acceptability of potential physical annoyances due to the dentist's intervention advantages and disadvantages of the dentist's intervention.

A follow-up visit was scheduled at 6-months for participants that were abstinent at the 4th visit.
Continuous smoking abstinence was defined as self-reporting of continuous smoking abstinence from the 8-week visit to the 6-month visit, and biochemical validation by an expired carbon monoxide rate less than 10 ppm . A maximum of 5 cigarettes smoked during the abstinence period was tolerated. The Lausanne University's Medical School Ethics Committee approved the research protocol

The mean age of the subjects was 36 years (range 22-53 years). 59% of the subjects were women. The mean (SD) [kg/m2] body mass index was 22.4 (3.06), The mean (SD) number of daily smoked cigarettes was 18.7 (8.0). 18% of the subjects had a high level of education.

At least one previous quit attempt was made by 97% of the participants. Nicotine replacement therapy was used by 97% of the participants. At the 8-week visit, the proportion (SD) of participants using transdermal patches was 50% (9.9), lozenges or gums 57.7% (9.8), inhalers 19.2% (7.8), and bupropion 3.8% (3.8).

At the end of the intervention (week 8), 17 (44%) participants were abstinent from smoking. At the 6-month follow- up visit, 6 (15%) reported a confirmed continuous smoking abstinence.

(59%) of the participants had an unhealthy oro-dental status.


11 participants (28.2%) presented gingival inflammation, e.g. bleeding, and 12 (30.8%) had periodontitis.

2 (5.1%) participants presented with a severe form of post adolescent/ adult periodontitis.
3 participants presented with a pre-cancerous lesion, such as hyperkeratosis of the tongue (n = 1) or gingival leucoplakia (n = 2).

Subjects were representative of the smokers from the general population in terms of age, number of smoked cigarettes per day, proportion of men and women and scholar education level.
The results were similar to the observed rates of smoking quit attempts managed in smoking cessation clinics.

The dentist intervention helped the smokers to identify their own oral lesions due to smoking, and the oral exam revealed the majority of participants presented with oro dental effects from tobacco.

The recruited participants had an initial motivation to quit smoking of min. 6/10 on the Likert Scale, abstaining from smoking is hard to achieve, even when smokers say that they are ready to stop, and relapse rate is high during the early post-cessation period The dentist intervention helped the smokers to identify their own oral lesions due to smoking, and the oral exam revealed the majority of participants presented with orodental effects from tobacco.

Dental hygienists were not involved in intervention. Response bias might have occurred due to administration of questionnaire by smoking cessation team. The design of the intervention did not allow any further contact between the participants and the dentist until the end of the study. This motivational aid was possibly missing during the consolidation stage.

Source of the article: BMC Public health


About the journal :
Type of journal- Indexed
Publisher of journal- Biomed central

Section of the journal under which the article

is published Original research

It is peer reviewed . Year of the publication : 2010 Volume no.10 Page number: 348
About the authors: Semira Gonseth, Marcelo Abarca, Carlos Madrid and Jacques Cornuz. There is a mention of institutional attachment.

It indicated the topic and focus of the study.


It indicated the research question.

meaningful and complete.


It reflects the aim and objectives of the

study.

It gives an idea of study population and not about

study setting.
It does not give an idea of the design of the study. Title does not look catchy. Title is long. It is specific. Key words have not been mentioned.

Structured, informative.
Comprehensive in its contents and long. It gives the gist of the whole text Information given in the abstract match with what present in the text . It can facilitate reader in his selection of pertinent study. The article follows IMRAD format.

The introduction meaningful and concise.


It is built on existing literature. It has adapted a seminar approach.

It logically presented
The citations relevant and pertinent to the study being reported.

Citations followed correct references in list of references.


It has presented the need of the study.

Mentioned the aim and objectives of the


study.

It stated the research hypothesis


It succeeded in introducing the back ground

of the study subject to the reader .

Methodology presented in a logical , clear and


meaningful manner It is replicable Study design is a non-controlled . It is a pilot study. The study was done on smokers smoking > 10 cigarettes/day for 3 years between age group 18 and 70years.

The study subjects were selected randomly from November 2007


to May 2008. The target population, sampling frame and study population clearly

defined .

Subjects studied in real life circumstances. Inclusion and exclusion criteria mentioned.

Informed consent was taken


Ethical committee approval was taken.

Results not presented in a logical manner.


Important results were not presented in tables. The figures were numbered and titled properly . Results are based on aim and objectives of the study.

The discussion is meaningful.


It highlights the important findings of the study

The authors compared the current findings with


that of the ones already reported in literature The comparison logical and reasoned properly . Implications of the study was discussed. It opens new vistas for further research

Summary was not given. Conclusion is meaningful. It is based on aim and objectives of the study. The research question is answered. No new hypothesis generated. Appropriate suggestions and recommendations were made.

Enough number of reference have been quoted in

the text part of the article. Of recent publications16. (1992-2009). References have been presented according to the scientific convention. Vancouver method was used

There is broad agreement, based on strong evidence, about what constitutes effective treatment of tobacco use and dependence. Physicians should routinely identify patients smoking status and readiness to quit, advise and assist smokers to quit, and offer pharmacotherapy to help them quit . There is insufficient evidence to determine whether nicotine-replacement products or bupropion is superior. Current guidelines and most experts regard them as roughly equivalent. The choice of pharmacotherapy should take the patients preferences and past experiences into consideration, unless one agent is contraindicated.

This article describes the results of studies among dental care providers regarding tobacco cessation in the past two decades. There is good evidence that brief interventions from health professionals can increase rates of smoking cessation. Dentists who implement an effective smoking cessation program can expect to achieve quit rates up to 10-15 percent each year among their patients who smoke or use smokeless tobacco. The challenge is implementing effective treatment in ones practice or institution while using available primary care resources to provide additional benefit.