Dentist-driven Anti-Smoking/Tobacco Counseling

[ingemar]

Hi guys,

I'm wondering what your opinions are on dentists and other oral health practitioners providing tobacco cessation counseling to patients.

Do you ask if patients use tobacco? Do you prescribe medications and quit-aids to kick the addiction? Are you taught at school to counsel patients to stop? Have you experienced any barriers to doing this such as time constraints, lack of resources, lack of financial reimbursement, lack of knowledge, angry patients, etc? Should dentists be responsible for tobacco use counseling?

Any comments or insight into the matter would be cool

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[SuperC]

1. Opinions are on dentists and other oral health practitioners providing tobacco cessation counseling to patients.
- YES!!! Dentists, Hygienists, Nurses, MDs ALL should promote smoking cessation. Most people see their dentists more often than an MD, so there is nothing wrong with taking 2 minutes to talk about quitting!

2. Do you ask if patients use tobacco? Dentists have pts fill out a standard medical history which includes tobacco habits

3. Do you prescribe medications and quit-aids to kick the addiction?
Yes, dentists can prescribe meds for smoking cessation. I personally would stay away from off label scripts, nevertheless, it can be done

4. Are you taught at school to counsel patients to stop?
Yes, we have had several lectures 5-10

5. Have you experienced any barriers to doing this such as time constraints, lack of resources, lack of financial reimbursement, lack of knowledge, angry patients, etc?
These have been limited to lecture and my own personal struggle to quit up to this point. My patient interaction has been limited.

6. Should dentists be responsible for tobacco use counseling? YES. (not to regurgitate from lecture) Dentist are health care providers, any dentist that did not spend a little time talking about cessation is not doing their job.

-C

 

[burton117]

Hi guys,

I'm wondering what your opinions are on dentists and other oral health practitioners providing tobacco cessation counseling to patients.

Do you ask if patients use tobacco? Do you prescribe medications and quit-aids to kick the addiction? Are you taught at school to counsel patients to stop? Have you experienced any barriers to doing this such as time constraints, lack of resources, lack of financial reimbursement, lack of knowledge, angry patients, etc? Should dentists be responsible for tobacco use counseling?

Any comments or insight into the matter would be cool

I would also be interested in hearing about dentists writing prescriptions for tobacco cessation products (Nicorette, etc...)

 

[SuperC]

I would also be interested in hearing about dentists writing prescriptions for tobacco cessation products (Nicorette, etc...)

Nicotine Replacement is an OTC. This would include things like gum, patches, inhalers

Prescription drugs like Chantix or Zyban is a drug specifically for smoking cessation, Chantix blocks nicotine binding to its receptor, I cannot recall how Zyban works, it may be the same

Off label scrips usually involve anti-depressants, the only one I can think of off hand is wellbutrin which has has some success in treating withdrawals.

Often, success rates are usually higher when NRT is used in conjunction of some sort of prescription.

This is all my weak brain can muster off the top of my head.

-C

 

[crazy_sherm]

Wellbutrin and Zyban are actually the same thing (bupropion), the latter is just the marketting name when used for smoking cessation. Prescribing this is a bit of a double-edged sword since there is a high incidence of xerostomia associated with its use.

 

[pmantz]

Wellbutrin and Zyban are actually the same thing (bupropion), the latter is just the marketting name when used for smoking cessation. Prescribing this is a bit of a double-edged sword since there is a high incidence of xerostomia associated with its use.

You beat me to the punch.

 

[ingemar]

Any fear of patients getting hostile and angered if you bring up quitting smoking? Dentistry is a competitive industry where patients can go elsewhere if they don't like the care that you provide. What are some strategies to convey the importance of quitting to the patient without nagging? They say that 70% of smokers want to quit, and they could definitely use the dentist's help...but I'm not sure if they want to hear it from the dentist.

 

[aphistis]

Any fear of patients getting hostile and angered if you bring up quitting smoking? Dentistry is a competitive industry where patients can go elsewhere if they don't like the care that you provide. What are some strategies to convey the importance of quitting to the patient without nagging? They say that 70% of smokers want to quit, and they could definitely use the dentist's help...but I'm not sure if they want to hear it from the dentist.

The best is to simply not nag. You make sure they have the information, and you encourage them to quit if they show interest, but at the end of the day our patients are (mostly) grown adults who make their own decisions. We have an ethical responsibility to educate and inform, but it's neither helpful nor prudent to browbeat patients who refuse our recommendations.

 

[SuperC]

Wellbutrin and Zyban are actually the same thing (bupropion), the latter is just the marketting name when used for smoking cessation. Prescribing this is a bit of a double-edged sword since there is a high incidence of xerostomia associated with its use.

Thank you for the correction!
-C

 

[BuckeyMcGee]

The best is to simply not nag. You make sure they have the information, and you encourage them to quit if they show interest, but at the end of the day our patients are (mostly) grown adults who make their own decisions. We have an ethical responsibility to educate and inform, but it's neither helpful nor prudent to browbeat patients who refuse our recommendations.

I agree. I know we're supposed to atleast inform the patient of the potential risks of smoking but I'm not going to treat my patients like a child and lecture them on all the ills of the habit. People these days know that smoking kills and what smoker would want to go to a dentist who nags them to quit every time they see them? Last year we were given a really bad seminar done by the psychology department at our school on getting patients to quit, complete with motivational interviewing and all that jazz (videos of lame acting with students and the whole "on a scale from 1-10, where do you think you fall in wanting to quit" thing). I think it is a personal decision and one that you should advise against as a dentist but realize it isn't the end of the world. By the way, lots of dentists smoke - good ones too. I think the whole concept is kind of silly but I guess if that makes them happy, then so be it. Okay, its almost 2 am and ortho begins at 7:50...I am so bored..