Implementation of a smoking cessation protocol in dental practices.

Smoking is an important risk factor for cardiovascular and respiratory diseases, but also for periodontal diseases and orofaryngal types of cancer (mouth, tongue, throat,larynx). Smoking cessation reduces the risk on orofaryngal cancers and has a positive effect on the frequency and severity of gum infections. Dentists can play a role in primary and secondary prevention of tobacco addiction. They can often directly observe if patients smoke and can easily address the issue of smoking cessation because of the direct relationship between oral health and smoking. Patients consider the direct relation between smoking and consequences for (discolouring) teeth as a good opportunity for dentists to discuss smoking. Following several international guidelines the national Dutch guidelines for the Treatment of Tobacco Addiction recommend to involve dental professionals in smoking disencouragement campaigns, to organise trainings, to develop and/or improve patient education materials and reimburse counseling activities. It is unclear how the guidelines can best be implemented in the dental practices. The present study
investigates the effectiveness of a multifaceted implementation strategy targetted at the knowledge, attitudes and behaviour of the dental team members. In a randomised controlled trial (N = 2 x 30 practices, 2 x 650 patients) the effectiveness of a combination of small scale education for the whole team, patient-mediated monitoring and feedback of the provision of cessation advice, patient education materials and a task organisation protocol for the various members of the dental team will be studied compared to the usual guideline implementation strategies.

The intervention increases advice giving of dental professionals, the number of patients having quit smoking and the number of quit attempts.

Provision of a 4 hour central course for whole practice teams, patient-mediated monitoring and feedback of the provision of cessation advice, patient education materials and a task organisation protocol for the various members of the dental team.
The dental teams in the control group deliver usual care.