Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial.

OBJECTIVES: Tobacco use adversely affects oral health. Clinical guidelines recommend that oral health professionals promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented successfully. This study aimed to evaluate two interventions to enhance tobacco use prevention and cessation (TUPAC) counselling among oral health professionals in Finland. METHODS: We used a cluster-randomized community trial to test educational and fee-for-service interventions in enhancing TUPAC counselling among a sample of dentists (n=73) and dental hygienists (n=22) in Finland. Educational intervention consisted of 1 day of training, including lectures, interactive sessions, multimedia demonstrations and a role play session with standard patient cases. Fee-for-service intervention consisted of monetary compensation for providing tobacco use prevention or cessation counselling. TUPAC counselling procedures provided were reported and measured using an electronic dental records system. In data analysis, intent-to-treat principles were followed at both individual and cluster levels. Descriptive analysis included chi-square and t-tests. A general linear model for repeated measures was used to compare the outcome measures by intervention group. RESULTS: Of 95 providers, 73 participated (76.8%). In preventive counselling, there was no statistically significant time effect or group-by-time interaction. In cessation counselling, statistically significant group-by-time interaction was found after a 6-month follow-up (F=2.31; P=0.007), indicating that counselling activity increased significantly in intervention groups. On average, dental hygienists showed greater activity in tobacco prevention (F=12.13; P=0.001) and cessation counselling (F=30.19; P<0.001) than did dentists. In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F=5.95; P<0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists. CONCLUSIONS: Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.

The Life-course Approach in Assessment of Dental Health: A Cross Sectional Study among Finnish and Turkish Pre-adolescents.

OBJECTIVES: Interest is growing on conceptualizing dental disease aetiology under the life-course approach. The aim of this study was to assess the association of dental caries experience with the major components of life-course approach, health- and behavioral capital, among Turkish and Finnish pre-adolescents, with different family-related characteristics, as this association has not been explored yet. METHODS: A cross-sectional study of Finnish (n=338) and Turkish (n=611) pre-adolescents was undertaken with questionnaires and oral health data. RESULTS: Turkish pre-adolescents, more dentally diseased (84%) than the Finnish (33%) (P<.01), had lower means of health (body height-weight) and behavioural (self-esteem, tooth-brushing self-efficacy) capital, (P<.01). Finnish pre-adolescents were less likely to live in two-parent families (P=.001) and spent less time with their mothers (P<.05). Turkish pre-adolescents with high levels of self-esteem were more likely to spend time with their mothers and less likely to live in families with three or more children (28%) than were their counterparts with low levels of self-esteem (41%). Such associations were not evident among Finnish pre-adolescents (P>.05). Health capital, in terms of body height, and family-related characteristics in differing patterns, contributed to DMFT, in common, among Turkish and Finnish pre-adolescents. Self-esteem, behavioural capital was explanatory variable for DMFT only for the Turks. CONCLUSIONS: Dental health of pre-adolescents was associated with health- and behavioural capital in different pathways under the influence of family-related characteristics. The cooperation of paediatricians and dentists is vital in assessment of general and dental health in a holistic context throughout the life-course, to enhance the well-being of pre-adolescents.