Counseling by Student-Dentists Helps Patients Quit Smoking

BUFFALO, N.Y. -- Students in most dental schools are taught to refer tobacco-using patients they encounter in their clinical training to call a "quit line."

The University at Buffalo's School of Dental Medicine is taking a different tack. In one of the few such programs in the nation, third- and fourth-year UB dental students are using non-judgmental tobacco counseling to encourage their patients to quit.

Results presented today (March 24, 2007) at the 2007 International Association of Dental Research meeting in New Orleans showed that 51 percent of the 89 patients who accepted and received tobacco counseling from the student-dentists agreed to quit immediately.

Of that number, 29 patients, or 32 percent, were still smoke-free after six months. Othman Shibly, D.D.S., UB assistant professor of periodontics and endodontics who developed the program, presented the findings.

"When I took over the responsibility for the dental school's preventive dentistry program," said Shibly, "I thought that major changes needed to be made in the dental curriculum to close the gap between clinical research and clinical practice.

"Students and dentists are taught about the effects of smoking on oral health but, in practice, we only do fillings and other procedures, so I led this effort to identify smoking as a dental problem that dentists should attend to.

"These efforts were based also on our goal of making dental treatment a successful long-term benefit for our patients by addressing all risk factors associated with oral disease," he said. "Research has shown that there is no match for smoking in causing harm to oral health."

The student-dentists received eight hours of training on the effects of tobacco and on how to perform nonjudgmental and personalized tobacco-use assessment and counseling. They adhered to a modified version of the established "5 As" protocol:

-- "Ask" the patient about their smoking habits, type of tobacco used and frequency of use.

-- "Advise" patients about the effects of tobacco on their oral health.

-- "Assess" patients to determine their interest in quitting on a scale of 1-10 (10 being "most interested").

-- "Assist" patients who want to quit by offering nicotine patches and suggestions on how to avoid the temptation to smoke, such as throwing away tobacco and putting away ashtrays.

-- "Arrange" to call patients to see how they are doing.

The counseling program has been incorporated into the school's curriculum and students are graded on their ability to present it.

Shibly said the students are receptive to carrying out the new protocol -- "they are putting their best efforts into learning this so they can incorporate it into their practices" -- but they find it challenging due to pressure of an already-tight dental curriculum.

Most patients are very appreciative, he said. "One woman from Pennsylvania called a couple weeks after her appointment to thank us for making her quit."

Joseph J. Zambon, D.D.S., Ph.D., professor of periodontology and oral biology and associate dean for academic affairs in the dental school, and Michael Cummings, Ph.D., professor and head of cancer pathology and prevention at Roswell Park Cancer Institute, also contributed to the study.

The University at Buffalo is a premier research-intensive public university, the largest and most comprehensive campus in the State University of New York. The School of Dental Medicine is one of five schools that constitute UB's Academic Health Center.