The impact of brief tobacco treatment training on practice behaviours, self-efficacy and attitudes among healthcare providers.

INTRODUCTION AND PURPOSE: The need for aggressive efforts to help tobacco users quit remains a healthcare priority. Brief interventions delivered in the healthcare environment continue to be a valuable component of a comprehensive tobacco control policy. Unfortunately, such treatments are offered less often than desired, and quality is variable. Previous research has demonstrated the value of training experiences in increasing treatment availability, quality, as well as improving clinical outcomes. Less is known about how specific clinical activities and other features are impacted as a function of training. These issues were explored within the context of a standardised 5A's (ASK, ADVISE, ASSESS, ASSIST, ARRANGE) brief intervention training program. METHODS: A variety of healthcare providers participated in this study. Survey methodology was employed to collect Practice Behaviour, Self-Efficacy and Attitude ratings at pretraining, post training and 6-month follow-up. Linear mixed effects models were used to evaluate primary outcomes, and linear regression to explore the relationships among clinical variables. RESULTS: Pretraining data suggested overall modest levels of tobacco treatment activity, with limited direct intervention (ASSIST) or follow-up (ARRANGE) efforts. The training experience was shown to have a substantial and sustained impact on 5A's Practice Behaviour ratings, and other clinical indicators (all Pre vs. Post and Pre vs. Follow-up comparisons p < 0.001). Self-Efficacy at post training predicted practice behaviours at follow-up (for ADVISE, ASSESS, ASSIST and ARRANGE: all p's < 0.05). CONCLUSIONS: The value of a structured training experience was confirmed, and findings served to clarify the specific nature of training program impact.

Tobacco cessation: a practical dental service.

Tobacco use is a complex addiction that must be addressed in all aspects of health care. Despite the deleterious and costly outcomes of tobacco use, Americans still are smoking and using smokeless tobacco. Dentists are trained to detect oral lesions and periodontal problems that are related to tobacco use. Dentists also are in a position to help prevent the initiation of tobacco use by children and adolescents through the use of positive anti-tobacco messages. Over the past decade, tobacco cessation strategies have been modified for practical use in the dental setting.

Tobacco and dental implants.

Dental implants are the ideal standard of care for many oral health care providers. Tobacco use is an impediment to the success of this sophisticated procedure. Dentists who are trained to help their patients stop using tobacco are in position to improve their success rates with dental implants. A suggested protocol for tobacco cessation in the implant practice, if utilized, could raise the standard of health care in the dental office.

Patient management in a tobacco-cessation program in the dental practice.

Smoking and smokeless tobacco can cause significant damage to the oral cavity, including life-threatening cancers. Consequently, dentists and their office staffs should and can play an influential role in advising their patients to quit using tobacco. The National Cancer Institute has developed the "Four A's" approach to tobacco-cessation counseling: (1) ask about tobacco use; (2) advise to quit; (3) assist with quitting; and (4) arrange for follow-up. With minimal expenditures of treatment time, the dentist and office staff can encourage patients to quit using tobacco through nonconfrontational messages that point out the clinical damage caused by smoking and smokeless tobacco. Besides behavior modification, dentists can prescribe several Food and Drug Administration-approved pharmaceutical agents as adjuncts to a tobacco-cessation program. Nicotine polacrilex (gum) and nicotine transdermal systems have proven very useful in helping tobacco users quit their habit.

Focal osteoporotic bone marrow defect in the anterior maxilla.

An unusual presentation of a focal osteoporotic bone marrow defect is documented. A definitive diagnosis could not be established on the basis of the location, history, clinical, and radiographic appearance. A biopsy provided the identity of the lesion.