Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

[Model program for screening oral cancers in the Roma population]. / Modellprogram ajak-szájüregi daganatok szûrôvizsgálatára roma populációban.

Oral cancer has been identified as a significant public health threat. It is reported that about 3,800 new cases of oral cancer are diagnosed in Hungary each year with approximately 1,700 associated deaths. Oral cancer is the 6th most common cancer in men. Most oral cancers are preventable; 75% of oral cancers are related to tobacco use, alcohol use, or use of both substances together. While there is insufficient evidence to support or refute the use of visual examination as a method of screening for oral cancer in the general population, screening in high-risk populations is highly recommended. It was presumed that high-risk behavior including tobacco and alcohol use is one of the characteristics of Roma people. The main aim of the study was to elaborate a screening model program for the Roma population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. In the program we planned to survey the risk factors in the target population, establish the diagnosis of oral cancer and/or pre-cancer and direct the patients to health care facilities. First we determined the target population in four Hungarian towns with the help of Roma social workers and local public health officers. We assembled a questionnaire on risk factors. Training for Roma social workers and screening personnel was also accomplished. Screening for oral precancerous lesions and cancer and survey the risk factors in the target population were performed at the same time. Patients screened to be positive were referred to specialists. Altogether 1,146 persons, 656 male and 490 female (age 20-77 years, mean 40 years), participated in the screening; 84% of them reported on some kind of complaints. We have got valid data on risk factors in connection with oral cancer. More than fifty percent of participants did not clean their teeth regularly, 75% were smokers, while 45% drunk alcohol regularly. 1,6% of screened participants had oral lesions that did not require referral to a specialist, while 2.3% of the screened subjects had referable oral mucosal lesions including leukoplakia. The overwhelming majority (93%) of participants screened to be positive did not see dentist regularly. As a conclusion, we elaborated a screening model program, which is applicable for disadvantaged (e.g. Roma) population to determine risk factors of oral cancer and establish early diagnosis hence to reduce morbidity and mortality. We surveyed the risk factors in the target population, established the diagnosis of oral cancer and/or pre-cancer lesions and directed the patients to care facilities. We also assisted them to get appropriate long-term care and follow-up. The importance of screening activities targeted on high-risk population was underlined.

5.1 The demography of oral diseases, future challenges and the implications for dental education.

This Section considered the immense challenges presented by the changing demography of populations (in particular, cross-boundary flow), changing oral and dental disease trends. It also considered the difficulties of gathering data on such information. It then considered how these challenges may affect the education of the dental team in the future. The Section considered the concept of the 'global village' as a representation of the changing world demography. We were at pains to recognize that our role was in considering both emerging and established market economies. In fact, a major part of the Section's activities concentrated on the development of the professional ethic of social responsibility - represented at the local, regional, national and international levels. We considered a finite group of oral and dental diseases, namely dental caries, periodontal diseases, oral cancer and cranio-facial disorders. In addition, we chose to comment on systemic diseases influenced by oral diseases, oral diseases influenced by systemic diseases and iatrogenic diseases (including prion disorders and cross-infection control issues). The Section recognized the profound difference between needs and demands in the provision of oral and dental health care. We considered the concept of best practices within our working remit and named these as: * the gathering of valid data on health trends; * uniformity in the measurement of disease and diagnostic parameters; * the identification of a core curriculum which best addresses an increased awareness of changing demography; and * a multidisciplinary approach to education and research in the context of global collaboration. The Section recognized the enormous potential for global networking with the explosion of information and communication technology. We investigated the requirements in converging towards higher global standards, while accepting and appreciating important regional and continental differences. To this end, the Section has put forward a number of important recommendations and realistic goals.