Breaking the cycle

Tobacco cessation training helps dental students coach patients to quit.

Dental professionals hold a front-line position for motivating patient behaviors that influence health. One faculty member at Texas A&M University Baylor College of Dentistry is using that opportunity to help encourage cessation of tobacco use.

Dr. Kathleen V. Rankin, professor and associate chair of public health sciences, empowers students to broach this sometimes sensitive subject with patients who stand to benefit from tobacco cessation counseling, support and any needed medication. Students can refer patients to Tobacco Treatment Services at TAMBCD.

During the first, second and third years of dental school, students gain knowledge in behavioral intervention, the use of pharmacotherapy and motivational interviewing to promote tobacco cessation.

This curriculum component was first introduced 12 years ago with second-year dental students. Rankin conducted a grant-funded study in those early years to evaluate changes in dental students’ behavior, knowledge and attitudes in addressing tobacco cessation with patients. This study provided the information needed to determine the number of lecture hours and what specific tobacco topics to include in the dental school’s curriculum.

The training has proven beneficial for students, including third-year dental student Ryan Packard, who says he wasn’t that familiar with any tobacco cessation techniques before dental school, except for the daunting task of quitting cold turkey.

“More than anything I have come to understand the prevalence of tobacco-related illnesses and how tobacco affects specific parts of the body, especially the oral cavity,” Packard says.

Being exposed to tobacco cessation education changed Packard’s attitude and comfort level about bringing up this conversation with patients who use tobacco.

“I feel obligated, as the doctor of the oral cavity, to make sure that patients are properly educated to make the best choice as it relates to tobacco and its use,” he said. Tobacco causes oral cancer as well as bone loss within the jaw, gum disease, increased buildup of plaque and tartar on the teeth and delayed healing following an extraction or oral surgery. “In general, the adverse effects of tobacco are known, but perhaps the methods and opportunities for cessation are less well known.”

Packard says tobacco cessation can be a hard battle to fight, even when an individual is ready to quit. He believes one of the most effective counterattacks is education.

“We need to know the facts about tobacco and appropriate cessation methods, so we can help our patients know,” Packard says.

Rankin says she believes awareness of the facts is key to motivating behavioral changes in patients. That’s why she stays abreast of the latest trends in tobacco use.

“I update the curriculum on a yearly basis, as so much literature is currently being published in the field and new forms of tobacco such as kretek, bidis, hookah, e-cigarettes and snus, among other products, become popular alternatives to traditional cigarettes, especially among youth,” Rankin says.

A tobacco history is integrated within the electronic patient record. This guides students on how to ask tobacco-related questions. According to Rankin, third-year dental students are expected to use motivational interviewing in the course of patient evaluation in the clinic. These open-ended questions create dialogue between the dental student and the patient.

“This helps us know if the patient is ready to quit tobacco, how we can help them develop the behaviors and confidence essential to success and recommend or prescribe medications to reduce withdrawal symptoms,” Rankin said. “If the patient is not ready to quit, the objective is to enhance their motivation to quit. Three prongs must be present for success: Patients must be ready, motivated and confident.”

Packard sees his tobacco cessation training as a benefit for himself as well as his patients.

“There may be hundreds of patients who say no to quitting tobacco for every one patient that accepts our offer for tobacco cessation,” Packard says. “I think it is important that we understand tobacco cessation for that one patient. Everyone makes his or her own choices regarding personal habits, but when a patient chooses it’s time to quit, we will be ready.”