Smoking Cessation
A Brief Intervention Initiative for Dental
Practices
Introduction and Background
Smoking is linked specifically to a range of oral diseases, including
periodontal disease and oral cancer1. A recent systematic review2
suggested that smoking and tobacco control interventions in the dental
setting that include oral examination and counselling are likely to be
effective.
1,278, 138 adults accessed NHS GDS dentistry in the 24 months prior
to30 June 20143. If we assume, 21% of those adults were smokers4,
268,409 adult smokers attended NHS dental practices in the 24 month
period. In 2010, 7 out of 10 smokers reported that they would like to stop
smoking5. Hence, there is a significant potential for dental teams to make
an impact on smoking cessation rates in Wales.
The Tobacco Control Action Plan for Wales6 aims to reduce smoking
prevalence in Wales to 16% by 2020. This plan states that pharmacists,
dentists and other primary care workers should take every opportunity
to encourage smokers to stop smoking, advise on ‘quit strategies’ and
give information on cessation support services and nicotine replacement
therapy. The plan aims to increase the proportion of smokers accessing
NHS Smoking Cessation Services in Wales and includes a specific dental
target:
To ensure that by end of 2016 50% of dental practices have at least one
clinical team member who can apply brief intervention, understand how to
identify smokers who are interested in smoking cessation and know where
to direct them for further advice and support. This proportion is to rise to
75% of practices by 2020.
Reduction in smoking prevalence is one of the Tier 1 Health Board targets
in Wales. Further, the National Oral Health Plan7 calls for local action on
smoking cessation, and this is reflected in Health Boards’ Local Oral
Health Plans.
The Potential Contribution of Dental Practices
Evidence shows that most primary care dental teams believe that helping
patients stop smoking is important, but the lack of practice time and
uncertainty about what local smoking cessations services are available
and/or how to refer has been cited as barriers8.
However, we recognise that the current contractual arrangement in the
general dental service (GDS) does not encourage health promotion and
prevention.
Therefore, Public Health Wales is seeking to increase the number of
referrals into Stop Smoking Wales (SSW), through incentivising dental
practices to refer in their patients who are smokers and wish to quit.
An initiative to encourage brief intervention in smoking cessation by NHS
dental practices and referral by NHS dental practices to SSW will go live
on 12 January 2015. The arrangement between Public Health Wales and a
participating practice will be separate to the GDS contract. Practices will
be reimbursed at a rate of £7 for every referral made.
In minority ethnic groups, different tobacco products are used more
commonly than in the general population. Tobacco comes in a variety of
other forms besides cigarettes, including chewing tobacco and the
smoking of water-pipes (also known as Shisha). According to the British
Heart Foundation, a single puff of Shisha is equivalent to inhaling the
smoke from a whole cigarette.
References
1. Delivering Better Oral Health: An Evidence-based Toolkit for
Prevention, Third Edition, Public Health England, June 2014
2. Carr AB, Ebbert J. Interventions for tobacco cessation in the dental
setting. Cochrane Database of Systematic Reviews 2012, Issue 6.
Art. No. CD005084. DOI:10.1002/14651858.CD005084.pub3.
3. Stats Wales (2014). NHS patients treated for adults and children by
local health board.
4. https://statswales.wales.gov.uk/Catalogue/Health-and-SocialCare/General-Dental-Services/CurrentContract/NHSPatientsTreatedForAdultsAndChildren-byLocalHealthBoard-PatientTypeWelsh
Health
Survey.
Welsh
Government
2013.
http://wales.gov.uk/statistics-andresearch/welsh-health-survey/?lang=en
5. Tobacco and health in Wales, June 2012, Public Health Observatory
and Welsh Government.
http://www.wales.nhs.uk/sitesplus/922/page/59800
6. Tobacco Control Action Plan for Wales, Welsh Government, February
2012.
7. National Oral Health Plan. Welsh Government, March 2013.
8. Csikar J, Williams SA, Beal J. Do smoking cessation activities as part
of oral health promotion vary between dental care providers relative
to the NHS/private treatment mix offered? A study in West
Yorkshire. Primary Dental Care, 2009; 16 (2): 45-50.
Bibliography
Brief interventions and referral for smoking cessation, March 2006
NICE public health guidance 1
http://guidance.nice.org.uk/PH1/Guidance/pdf/English
Stopping Smoking. The Benefits and Aids to Quitting, Action on Smoking
and Health, June 2013.
ASH Wales and BHF Cymru (2013). The economic cost of smoking to
Wales: a review of existing evidence.
Smoke free and smiling. Helping dental patients to quit tobacco, Second
edition, Public Health England, March 2014