Clearing the smoke: are tobacco cessation interventions by the dental team successful?

AIMS: This study aimed to assess the outcomes of tailored tobacco cessation interventions in a dental clinic setting over one year. DESIGN: This interventional study recruited 1206 tobacco users who attended a smoking cessation clinic within an Oral Medicine Department in Bangalore, India. Baseline characteristics were recorded followed by a tailored smoking cessation intervention, delivered by trained faculty members and students. This followed the 3Es and 6As model - including a combination of personalised counselling, pharmacotherapy and one year follow up. CASE SELECTION: 1206 participants were recruited. 95% were already receiving treatment within the dental hospital and 5% were walk-in patients, attempting to quit tobacco use. Participants who had been smoking or using smokeless tobacco more than twice daily for greater than 6 months were included in the study. Participants were excluded from the study if they were currently using nicotine replacement therapy (NRT) or non-NRT therapy for tobacco cessation, pregnant and lactating women, a recent history of myocardial infarction or a history of gastric ulcers. RESULTS: Outcomes were categorised into the following four groups; Complete abstinence, Harm reduction (>50% reduction), No change and lost to follow up. Of the patients who completed the 12 month follow up, 18% quit tobacco use (n = 180), 34.2% reduced their tobacco usage by greater than 50% (n = 342), 41.5% exhibited no change (n = 415) and 6.2% relapsed (n = 62). Salivary nicotine levels were used to confirm self-reported abstinence. CONCLUSION: This study shows that dental professional led tobacco cessation programmes can be successful in supporting patients to quit or reduce tobacco usage.

Mirror, mirror on the wall-is toothbrushing instruction via a three-dimensional motion-tracked system the fairest of them all?

AIMS: To assess the efficacy of a smart toothbrush and mirror (STM) system which provided computer-assisted toothbrushing instruction versus conventional verbal toothbrushing instruction (TBI) amongst a group of 6-12-year-old children. DESIGN: This randomised controlled trial comprised South Korean school children who were randomly allocated to one of two arms - the STM (n = 21) or the conventional TBI arm (n = 21). The STM system used identical brushes as the TBI group, but with the brush employing three-dimensional motion tracking systems alongside a mirror with an inbuilt computer to guide the user. Modified Quigley-Hein plaque indexes were taken at baseline, immediately after STM/TBI, and then at 1 week and 1 month. RESULTS: Overall, there was a statistically significant reduction in the average whole-mouth plaque scores for both groups, 40.50% and 40.57% for the STM group and TBI group respectively. There was no statistical significance that either arm was more effective in reducing plaque scores than the other. Both groups demonstrated time to be a statistically significant factor in reducing plaque indices. CONCLUSION: There is no conclusive evidence that the STM system offers any benefits in terms of plaque control over conventional TBI in this study.

'Implanting' knowledge - how best to aid patient understanding and retention of information regarding peri-implantitis.

Aims The study primarily assessed the efficacy of different communication methods on patients' comprehension and recall of knowledge relating to peri-implantitis. Secondarily, the study assessed the effect of different communication methods on patients' beliefs in line with the health belief model.Design A prospective randomised controlled trialMethods Ninety-nine patients with a diagnosis of peri-implantitis were recruited over 25 months. They were randomly allocated to one of three arms of the trial. Group one was given a leaflet with visual aids, group two a leaflet with no visual aids and group three verbal information only. A questionnaire was used to assess their understanding and retention of knowledge relating to peri-implantitis at baseline, three months and six months. Secondly, the questionnaire assessed the influence of the communication strategy on the components of the 'health belief model' relating to peri-implantitis - perceived severity, susceptibility, benefits, barriers, self-efficacy and behavioural intentions.Results Of the 99 patients who were initially recruited, 85 remained at three months and 78 at six months. At baseline, group one (who were provided with a leaflet and visual aids) showed better comprehension when compared to the other groups. This was statistically significant. However, there was no statistically significant difference in recall of information at three and six months, between any group. Questions relating to the health belief model showed there was statistical significance in the control group who perceived the barriers to good implant hygiene to be more difficult than both test groups. There was some statistical significance in the perceived susceptibility to peri-implantitis between groups.Conclusion The use of leaflets with visual aids as a communication strategy appears to improve patient comprehension of information regarding factors associated with peri-implantitis in the short term in this patient group. However, it does not appear to translate to improved recall of the same information at follow-up.

Dental material allergies and oral soft tissue reactions.

Dental materials can cause reactions to the oral mucosa and present to the general dental practitioner. These are often referred to as 'allergies' but are frequently lichenoid reactions. Most of these are related to dental amalgam restorations and can be remedied by replacing the restoration with another suitable material. Other metals, including gold, palladium, nickel and chrome, have also been reported to trigger mucosal changes. Less commonly, issues arise from other restorative materials, including denture acrylics, composites and glass polyalkenoates. Reactions are also reported due to endodontic and sealing materials. It is unclear what role skin 'patch' testing has in managing dental material allergies. This article aims to give the practitioner a clearer picture of dental material allergy issues and how they should be approached in primary dental practice.