Oral Health and Preventive Dentistry, 01/2006

Tobacco use is a significant public health problem across Europe. Each year over half a million Europeans die prematurely due to a smoking-related disease. Tobacco use is a primary cause of many oral diseases and adverse oral conditions. The prevalence of tobacco use varies considerably across Europe, although in many countries overall rates of use have declined in recent years. However, tobacco use among women and young people is rising in several European countries. Tobacco behaviour is influenced by an array of factors, and quitting is a major challenge for many tobacco users. Tobacco use is now considered a chronic progressive relapsing condition requiring very specific support and assistance. To reduce tobacco use across Europe, a range of complementary actions and policies are required at an international, national and local level. The WHO Framework Convention on Tobacco Control (FCTC) outlines an array of evidence-based policies that can be implemented to prevent tobacco use and promote cessation. National dental associations and professional groups across Europe have an important role to play in supporting the ratification and implementation of the FCTC. The aim of this paper is to outline the public health aspects of tobacco control and highlight how the oral health professions across Europe can become actively engaged in this important and relevant area of prevention. Keywords: public health, tobacco control, oral health professions

Tobacco use cessation (TUC) in dentistry is critical to reducing the effect of a major risk factor for both oral and systematic diseases. The effect of TUC interventions has been widely reported. The data show that the success of TUC without professional support is negligible but that behavioural and pharmacological interventions are effective. Furthermore, the greater the intensity of support, the greater the quit rate and success rates are similar comparing different health care professionals including dental professionals. Although few studies have been performed in dental practice, it is clear that TUC should be embedded in routine oral health care. In addition to evaluating the effect of TUC, several studies have investigated barriers to implementing TUC in dental settings. A large number of barriers have been reported. These studies highlight the importance of further training for dental professionals but also identify the need for major cultural and policy changes to facilitate the provision of TUC. Research on barriers to TUC in dental care could be facilitated by employing qualitative or mixed methods designs and studies that evaluate the impact of changing such barriers on TUC provision. Such an approach will help to close the gap between research findings and implementation. Regarding the measurement of outcomes from TUC, no gold standards exist currently. Therefore both self-reported and biochemical measures of tobacco use should be reported in evaluation studies. It is also clear that feedback from biochemical testing of tobacco use can increase success rates in tobacco use cessation. Keywords: tobacco use cessation, smoking cessation, smoking, risk factors, oral health, barriers, primary prevention

Oral health care professionals are aware of their responsibility to advise patients to stop using tobacco. However, they do not feel sufficiently prepared to help their patients to quit, and consequently are not confident in providing these preventive measures. This fact reflects the lack of emphasis on tobacco cessation in both dental and dental hygiene undergraduate education. It may therefore be assumed that improvement of dental and dental hygiene education in tobacco use cessation counselling may result in increased self-confidence and frequency of its provision. The importance of making space in the curriculum for tobacco use prevention and cessation has to be emphasised. Dental schools and dental hygiene programmes have to be reminded of the key role the dental profession has in tobacco control. Next to the public health aspect of tobacco control, such involvement may be both an ethical and a legal responsibility. The implementation of effective tobacco use prevention and cessation in a dental educational setting requires a multidisciplinary approach involving the school's entire teaching personnel and external experts. In general, a knowledge base attained through lecture, Problem-Based Learning (PBL), or E-Learning, and clinical skills attained through clinical instructions and practices is required. It is suggested that curriculum content should include (1) the biological effects of tobacco use, (2) the history of tobacco culture and psychosocial aspects of tobacco use, (3) prevention and treatment of tobacco use and dependence, and (4) development of clinical skills for tobacco use prevention and cessation. Keywords: tobacco use prevention, tobacco use cessation, dental education, dental hygiene education, smoking cessation, undergraduate education

Tobacco use prevention (TUC) guidelines are mostly designed for undergraduate education. Most practising dental professionals have not been trained in TUC and so current and future guidelines need to be adapted for continuing education. It is important to motivate dental professionals to be involved in TUC. 'The 3 Ts' is one suggested method of stimulating this motivation. Two levels of TUC are recommended, and both brief advice and enhanced interventions can be incorporated into routine practice. It is recommended that TUC continuing education on these interventions should be provided by a team of dental and trans- disciplinary experts. The maintenance of TUC involvement can be divided in individual and collective strategies. The international dental professional organisations can provide important 'benchmarks' for minimum clinical standards and for the involvement of both national dental organisations and individual dental health professionals in TUC continuing education. Keywords: tobacco cessation, continuing education, short intervention, enhanced intervention, dentistry

Competent behavioural change intervention can be learned, practised and developed. Therefore, the teaching and assessment of this ability should be within the scope of both the undergraduate and post-graduate curriculum. Assessment should target knowledge base and skills in the areas of counselling, communication and behaviour. Assessment of the knowledge base should ideally be conducted in a comprehensive, multidisciplinary, centrally based manner in the preclinical curriculum. Assessment of skills in the areas of communication, counselling and behaviour change is a wider aim that should be integral throughout the curriculum. In continuing education (CE) environments, an initial 'screening' assessment would help educators to adjust the course to the participants' background and needs. Furthermore, three major assessment schemes are proposed: (1) assessment of knowledge and skills, (2) evaluation of the whole course by the participants, and (3) assessment of the implementation process, four to six months after completion. Keywords: assessment, oral healthcare education, behavioural change intervention, tobacco use cessation, undergraduate education, post-graduate education, continuing education