Serving Substance Abuse Professionals Since 1993

Last Update: 06.03.12

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Dental Issues

74 citations. January 2010 to present

Prepared: March 2012

Ahmady AE; Golmohammadi S; Ayremlou S; Khoshnevisan MH/ Lando HA. Tobacco cessation practices of senior dental students in Iran. International Dental Journal 61(6): 302-306, 2011. (26 refs.)

Objective: Tobacco use is prevalent in Iran, especially among men. The aim was to assess cessation practices and identify perceived barriers to delivery of tobacco cessation services by Iranian senior dental students. Design: Descriptive, cross-sectional study. Setting: Iran, Schools of Dentistry, 2009-2010. Participants: 370 (response rate 82%) officially registered senior dental students selected through stratified random sampling. Intervention: Students at 11 dental schools throughout the country completed the survey. Main outcome measure: Students' practice of the US Clinical Practice Guideline 5 As (ask, advise, assess, assist, arrange); interest in training; intention and barriers addressing tobacco use in dental settings. Results and Conclusions: Respondents were primarily female (67.8%). The students were far more likely to be actively involved in asking, advising and assessing patients to quit than in assisting and arranging. Most respondents (68.5%) agreed that it is within the scope of dental practice to help smokers quit. The most important barriers to providing cessation services included perceived patient resistance (44%) and lack of a supportive organisation (36%). This was the first assessment of approaches to tobacco users by dental students in Iran. Although there clearly is room for improvement, the interest of the students toward tobacco cessation is encouraging.

Akl EA; Gaddam S; Gunukula SK; Honeine R; Abou Jaoude P; Irani J. The effects of waterpipe tobacco smoking on health outcomes: A systematic review. (review). International Journal of Epidemiology 39(3): 834-857, 2010. (52 refs.)

Methods: We conducted a systematic review using the Cochrane Collaboration methodology for conducting systematic reviews. We rated the quality of evidence for each outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Results: Twenty-four studies were eligible for this review. Based on the available evidence, waterpipe tobacco smoking was significantly associated with lung cancer [odds ratio (OR) = 2.12; 95% confidence interval (CI) 1.32-3.42], respiratory illness (OR = 2.3; 95% CI 1.1-5.1), low birth-weight (OR = 2.12; 95% CI 1.08-4.18) and periodontal disease (OR = 3-5). It was not significantly associated with bladder cancer (OR = 0.8; 95% CI 0.2-4.0), nasopharyngeal cancer (OR = 0.49; 95% CI 0.20-1.23), oesophageal cancer (OR = 1.85; 95% CI 0.95-3.58), oral dysplasia (OR = 8.33; 95% CI 0.78-9.47) or infertility (OR = 2.5; 95% CI 1.0-6.3) but the CIs did not exclude important associations. Smoking waterpipe in groups was not significantly associated with hepatitis C infection (OR = 0.98; 95% CI 0.80-1.21). The quality of evidence for the different outcomes varied from very low to low. Conclusion: Waterpipe tobacco smoking is possibly associated with a number of deleterious health outcomes. There is a need for high-quality studies to identify and quantify with confidence all the health effects of this form of smoking.

Amemori M; Korhonen T; Kinnunen T; Michie S; Murtomaa H. Enhancing implementation of tobacco use prevention and cessation counselling guideline among dental providers: A cluster randomised controlled trial. Implementation Science 6: article 13, 2011. (22 refs.)

Background: Tobacco use adversely affects oral health. Tobacco use prevention and cessation (TUPAC) counselling guidelines recommend that healthcare providers ask about each patient's tobacco use, assess the patient's readiness and willingness to stop, document tobacco use habits, advise the patient to stop, assist and help in quitting, and arrange monitoring of progress at follow-up appointments. Adherence to such guidelines, especially among dental providers, is poor. To improve guideline implementation, it is essential to understand factors influencing it and find effective ways to influence those factors. The aim of the present study protocol is to introduce a theory-based approach to diagnose implementation difficulties of TUPAC counselling guidelines among dental providers. Methods: Theories of behaviour change have been used to identify key theoretical domains relevant to the behaviours of healthcare providers involved in implementing clinical guidelines. These theoretical domains will inform the development of a questionnaire aimed at assessing the implementation of the TUPAC counselling guidelines among Finnish municipal dental providers. Specific items will be drawn from the guidelines and the literature on TUPAC studies. After identifying potential implementation difficulties, we will design two interventions using theories of behaviour change to link them with relevant behaviour change techniques aiming to improve guideline adherence. For assessing the implementation of TUPAC guidelines, the electronic dental record audit and self-reported questionnaires will be used. Discussion: To improve guideline adherence, the theoretical-domains approach could provide a comprehensive basis for assessing implementation difficulties, as well as designing and evaluating interventions. After having identified implementation difficulties, we will design and test two interventions to enhance TUPAC guideline adherence. Using the cluster randomised controlled design, we aim to provide further evidence on intervention effects, as well as on the validity and feasibility of the theoretical-domain approach. The empirical data collected within this trial will be useful in testing whether this theoretical-domain approach can improve our understanding of the implementation of TUPAC guidelines among dental providers.

Amemori M; Michie S; Korhonen T; Murtomaa H; Kinnunen TH. Assessing implementation difficulties in tobacco use prevention and cessation counselling among dental providers. Implementation Science 6(e-article 50), 2011. (32 refs.)

Background: Tobacco use adversely affects oral health. Clinical guidelines recommend that dental providers promote tobacco abstinence and provide patients who use tobacco with brief tobacco use cessation counselling. Research shows that these guidelines are seldom implemented, however. To improve guideline adherence and to develop effective interventions, it is essential to understand provider behaviour and challenges to implementation. This study aimed to develop a theoretically informed measure for assessing among dental providers implementation difficulties related to tobacco use prevention and cessation (TUPAC) counselling guidelines, to evaluate those difficulties among a sample of dental providers, and to investigate a possible underlying structure of applied theoretical domains. Methods: A 35-item questionnaire was developed based on key theoretical domains relevant to the implementation behaviours of healthcare providers. Specific items were drawn mostly from the literature on TUPAC counselling studies of healthcare providers. The data were collected from dentists (n = 73) and dental hygienists (n = 22) in 36 dental clinics in Finland using a web-based survey. Of 95 providers, 73 participated (76.8%). We used Cronbach's alpha to ascertain the internal consistency of the questionnaire. Mean domain scores were calculated to assess different aspects of implementation difficulties and exploratory factor analysis to assess the theoretical domain structure. The authors agreed on the labels assigned to the factors on the basis of their component domains and the broader behavioural and theoretical literature. Results: Internal consistency values for theoretical domains varied from 0.50 ('emotion') to 0.71 ('environmental context and resources'). The domain environmental context and resources had the lowest mean score (21.3%; 95% confidence interval [CI], 17.2 to 25.4) and was identified as a potential implementation difficulty. The domain emotion provided the highest mean score (60%; 95% CI, 55.0 to 65.0). Three factors were extracted that explain 70.8% of the variance: motivation (47.6% of variance, alpha = 0.86), capability (13.3% of variance, alpha = 0.83), and opportunity (10.0% of variance, alpha = 0.71). Conclusions: This study demonstrated a theoretically informed approach to identifying possible implementation difficulties in TUPAC counselling among dental providers. This approach provides a method for moving from diagnosing implementation difficulties to designing and evaluating interventions.

Arora M; Schwarz E; Sivaneswaran S; Banks E. Cigarette smoking and tooth loss in a cohort of older Australians: The 45 and Up Study. Journal of the American Dental Association 141(10): 1242-1249, 2010 , 2010. (35 refs.)

Background. Data regarding the long-term effects of smoking, smoking cessation and environmental tobacco smoke (ETS) on tooth loss are limited. Methods. The authors collected information about tooth loss and other health-related characteristics from a questionnaire administered to 103,042 participants in the 45 and Up Study conducted in New South Wales, Australia. The authors used logistic regression analyses to determine associations of cigarette smoking history and ETS with edentulism, and they adjusted for age, sex, income and education. Results. Current and former smokers had significantly higher odds of experiencing edentulism compared with never smokers (prevalence odds ratio [OR] 2.51; 95 percent confidence interval [CI] 2.31-2.73 and OR, 1.50; 95 percent CI, 1.43-1.58, respectively). Among former smokers, the risk declined significantly with increasing time since smoking cessation; however, the risk remained elevated even in those who ceased smoking 30 or more years previously compared with that in never smokers (OR, 1.10; 95 percent CI, 1.02-1.19). Furthermore, among never smokers, the OR for edentulism was 1.37 (95 percent CI, 1.17-1.60) in those who reported having exposure to ETS for six or more hours per week versus those who were not exposed to any ETS. Conclusions and Clinical Implications. Although the risk of experiencing tooth loss declines with time since smoking cessation, the effects of smoking may persist for at least 30 years. The effect of ETS requires further investigation.

Atkinson S. Hard times can happen to anyone - even a dentist. British Dental Journal 211(9): 435-437, 2011. (0 refs.)

The BDA Benevolent Fund has been helping needy dentists and their families for 130 years, while the Dentist Health Support Trust, founded in 1986, offers support specifically on addiction and other mental health issues. The Ben Fund offers a lifeline to those struggling with poverty arising from illness, accidents, bereavement, addiction, mental health issues, and many other difficulties. It may be that someone needs financial help to deal with a short-term problem before they get themselves back on track, and the Fund can do this with a one-off grant or perhaps an interest-free loan, to be repaid when their life is on an even keel again. Other people may face long-term uncertainty and need regular support.

Bayat E; Bauss O. Effect of smoking on the failure fates of Oothodontic miniscrews. Journal of Orofacial Orthopedics 71(2): 117-124, 2010. (28 refs.)

Objective: The aim of this study was to investigate the effect of cigarette smoking on the failure rates of orthodontic miniscrews. Patients and Methods: Our cohort consisted of 88 patients with a total of 110 orthodontic miniscrews. Based on their smoking habits, the patients were divided into three groups: the Light smokers (<= 10 cigarettes/day), heavy smokers (> 10 cigarettes/day), and non-smokers. The light-smoker group consisted of 14 patients with 18 orthodontic miniscrews, and there were 15 patients with 19 miniscrews among the heavy smokers. The nonsmoker group contained 59 patients with a total of 73 miniscrews. Results: The overall failure rate was 18.2% (n = 20). Heavy smokers revealed a significantly higher failure rate than light smokers (p = 0.005) or non-smokers (p < 0.001). No significant differences were observed between non-smokers and light smokers. Miniscrews in the heavy smoker group exhibited a significantly higher failure rate during the first 4 months after insertion than did the miniscrews in the light smokers (p = 0.008) or non-smokers (p < 0.001). Conclusion: Our results suggest that heavy smoking has a detrimental effect on the success rates of orthodontic miniscrews.

Chandrashekar J; Manjunath BC; Unnikrishnan M. Addressing tobacco control in dental practice: A survey of dentists' knowledge, attitudes and behaviours in India. Oral Health & Preventive Dentistry 9(3): 243-249, 2011. (47 refs.)

Purpose: Dental professionals are strategically placed to be the leaders in tobacco prevention and cessation as they provide preventive and therapeutic services to a basically healthy population on a regular basis. The objective of this study was to assess the tobacco cessation knowledge, attitudes and behaviours of dental practitioners in Kochi (Cochin), Kerala, India. Materials and Methods: A sampling frame of dentists enrolled in the Indian Dental Association (IDA), Kochi (Cochin) branch, practising in Ernakulam city, was obtained from the IDA. The letter describing the rationale for the study contained a 35-item pre-tested questionnaire and was personally delivered along with a stamped envelope. One hundred fourteen dentists returned a usable questionnaire. Data were entered and analysed using SPSS 12. Frequencies were calculated 'for all variables. Results: Based on the responding dentists' self-reports, 54.6% were not confident in tobacco cessation counselling, 10.6% never asked, 60.9% asked in 50% of their patients about tobacco use and 17.6% of the dentists surveyed were smokers themselves. Participating dentists perceived that they were interested in using tobacco cessation counselling, but were not sure of quitting rates in their patients. The average time spent counselling patients about tobacco cessation was less than 2 minutes. Conclusion: The dentists perceived that lack of formal training leads to less motivation about tobacco counselling and hence infrequently incorporated tobacco cessation into their dental practices. The cessation of tobacco habits among dentists is essential.

Clareboets S; Sivarajasingam V; Chestnutt IG. Smoking cessation advice: Knowledge, attitude and practice among clinical dental students. British Dental Journal 208(4): 173-177, 2010. (39 refs.)

Objective To examine knowledge, attitude and current practice among clinical dental students in giving smoking cessation advice (SCA) and to explore the barriers to this activity. Design and setting A self-administered questionnaire survey of clinical dental students at Cardiff University School of Dentistry. Materials and methods In 2008, clinical dental students were surveyed (n = 181). Information on smoking cessation practices, students' attitude, potential barriers and level of preparedness to deliver SCA, knowledge of association between tobacco use and various pathological conditions and demographics and tobacco use by clinical dental students were gathered. Results One hundred and sixty-one (89%) students responded. All students enquired about patient smoking habits in the previous three months but were inconsistent in providing SCA - only one third of students gave SCA all or nearly all the time. Students had good knowledge of the associated health risks with tobacco use. A majority of students perceived barriers in providing patients with SCA. Those who provided advice were more likely to have positive attitudes and reported feeling adequately prepared. Conclusions Dental educators should address students' perceived barriers towards providing SCA when designing smoking cessation curricula in order to produce dentists who are confident and competent to provide this important health care intervention.

Crail J; Lahtinen A; Beck-Mannagetta J; Benzian H; Enmark B; Jenner T et al. Role and models for compensation of tobacco use prevention and cessation by oral health professionals. International Dental Journal 60(1): 73-79, 2010. (10 refs.)

Appropriate compensation of tobacco use prevention and cessation (TUPAC) would give oral health professionals better incentives to provide TUPAC, which is considered part of their professional and ethical responsibility and improves quality of care. Barriers for compensation are that tobacco addiction is not recognised as a chronic disease but rather as a behavioural disorder or merely as a risk factor for other diseases. TUPAC-related compensation should be available to oral health professionals, be in appropriate relation to other dental therapeutic interventions and should not be funded from existing oral health care budgets alone. We recommend modifying existing treatment and billing codes or creating new codes for TUPAC. Furthermore, we suggest a four-staged model for TUPAC compensation. Stages 1 and 2 are basic care, stage 3 is intermediate care and stage 4 is advanced care. Proceeding from stage 1 to other stages may happen immediately or over many years. Stage 1: Identification and documentation of tobacco use is part of each patient's medical history and included into oral examination with no extra compensation. Stage 2: Brief intervention consists of a motivational interview and providing information about existing support. This stage should be coded/reimbursed as a short preventive intervention similar to other advice for oral care. Stage 3: Intermediate care consists of a motivational interview, assessment of tobacco dependency, informing about possible support and pharmacotherapy, if appropriate. This stage should be coded as preventive intervention similar to an oral hygiene instruction. Stage 4: Advanced care. Treatment codes should be created for advanced interventions by oral health professionals with adequate qualification. Interventions should follow established guidelines and use the most cost-effective approaches.

D'Amore MM; Cheng DM; Kressin NR; Jones J; Samet JH; Winter M et al. Oral health of substance-dependent individuals: Impact of specific substances. Journal of Substance Abuse Treatment 41(2): 179-185, 2011. (54 refs.)

Little is known about how different types of substances affect oral health. Our objective was to examine the respective effects of alcohol, stimulants, opioids, and marijuana on oral health in substance-dependent persons. Using self-reported data from 563 substance-dependent individuals, we found that most reported unsatisfactory oral health, with their most recent dental visit more than I year ago. In multivariable logistic regressions, none of the substance types were significantly associated with oral health status. However, opioid use was significantly related to a worse overall oral health rating compared to I year ago. These findings highlight the poor oral health of individuals with substance dependence and the need to address declining oral health among opioid users. General health and specialty addiction care providers should be aware of oral health problems among these patients. In addition, engagement into addiction and medical care may be facilitated by addressing oral health concerns.

Davis JM; Koerber A. Assessment of tobacco dependence curricula in U.S. dental hygiene programs. Journal of Dental Education 74(10): 1066-1073, 2010 , 2010. (38 refs.)

Tobacco dependence education (TDE) continues to be a vital component of dental hygiene curricula made even more important by the fact that tobacco cessation in adults in the United States has stagnated over the past ten years. This study was undertaken to assess the salient characteristics of TDE in U.S. dental hygiene programs. A fifty-one question survey was mailed to the program directors of all 283 accredited dental hygiene programs during the 2007-08 school year (this number does not include the programs in Illinois, which were excluded since they had participated in a previous study). A total of 187 schools returned the survey for a return rate of 66 percent. Curricular content, minutes spent on each topic, existing level of clinical competence measured, expected level of clinical competence, and resources used were assessed. Researchpondents reported an average of 6.7 hours spent on all identified components of tobacco education. While 77 percent of respondents reported formally assessing whether a student asked if a patient used tobacco, only 26 percent indicated having a formal competency utilizing all of the U.S. Public Health Service's Clinical Practice Guideline 5 As and 5 Rs. In contrast, 72 percent of program directors reported expecting their graduates to be competent in a moderate intervention that included all 5 As. Though there is a clear commitment to TDE among dental hygiene programs in the United States, we recommend training to a more intensive level of TDE in order to facilitate broader adoption of comprehensive, evidence-based guidelines.

Davis JM; Ramseier CA; Mattheos N; Schoonheim-Klein M; Compton S; Al-Hazmi N et al. Education of tobacco use prevention and cessation for dental professionals - a paradigm shift. International Dental Journal 60(1): 60-72, 2010. (88 refs.)

The use of tobacco continues to be a substantial risk factor in the development and progression of oral cancer, periodontitis, implant failure and poor wound healing. Dental and dental hygiene education providers have made great advances towards the incorporation of tobacco education into their curricula in recent years. Unfortunately, however, both medical and dental education research has consistently reported schools providing only basic knowledge-based curricula that rarely incorporate more effective, behaviourally-based components affecting long-term change. The limited training of oral healthcare students, at least in part, is reflected in practising dental professionals continuing to report offering incomplete tobacco interventions. In order to prepare the next generation of oral healthcare providers, this paper proposes a paradigm shift in how tobacco use prevention and cessation (TUPAC) may be incorporated into existing curricula. It is suggested that schools should carefully consider: to what level of competency should TUPAC be trained in dental and dental hygiene schools; the importance of establishing rapport through good communication skills; the core knowledge level for TUPAC; suggested instructional and assessment strategies; the importance of continuing professional education for the enhancement of TUPAC.

Davis JM; Stockdale MS; Cropper M. Evaluation of a comprehensive tobacco cessation curriculum for dental hygiene programs. Journal of Dental Education 74(5): 472-479, 2010 , 2010. (29 refs.)

Dental health care providers continue to offer inconsistent and limited tobacco use cessation (TUC) interventions even though smoking-related morbidity and mortality continue to be a substantial health concern. Our purpose was to conduct a comprehensive, three-year (2003-06) TUC curriculum evaluation that included assessment of existing TUC education offered; dental hygiene educators' readiness to incorporate TUC education into the curriculum; and development of a pre-test/post-test assessment instrument and faculty development program. This curriculum study was carried out alongside a research study to evaluate the effectiveness of a peer-reviewed tobacco curriculum (Tobacco Free! Curriculum). Faculty members (baseline n=97; third-year n=42) from the twelve dental hygiene associate degree programs in Illinois participated in the study, which included a pre-treatment survey, six hours of on-site TUC curriculum training, and a post-treatment survey to determine the attitudes, perceived barriers, and current practices in tobacco education. Results showed an average increase of eighty-five minutes spent on tobacco education in the dental hygiene curriculum, a large positive increase in the percentage of faculty members who formally assessed the use of 5As and 5Rs (21 percent to 88 percent), and a dramatic increase (+100) in the percentage of faculty members who taught or included most of the thirteen TUC content areas following the introduction of the curriculum and training program.

Dukic W; Dobrijevic TT; Katunaric M; Milardovic S; Segovic S. Erosive lesions in patients with alcoholism. Journal of the American Dental Association 141(12): 1452-1458, 2010. (70 refs.)

Background: The authors conducted a study to determine the occurrence of erosive tooth lesions in patients with alcoholism and to establish the influence of salivary flow rates and pH levels on their appearance Methods: The authors conducted a cross sectional study in 140 participants (70 with clinically diagnosed alcoholism who were undergoing therapy for their addiction were in the test group and 70 who did not consume alcohol were in the control group) The authors determined the participants salivary statuses by measuring the flow rates and pH levels of both unstimulated and stimulated saliva Results: The authors found more erosive lesions in the test group (P < 01) They detected a higher number of erosive lesions in participants in the test group who had a pH range of 5 to 6 compared with a pH range of 6 to 7 (P = 01) They found a significant correlation between alcoholism and unstimulated salivary flow rate (P < 05) Conclusions: The salivary flow rate was similar in control and test groups The prevalence of erosion in the test group was higher than that in the control group which may be related to the decrease in salivary pH of both stimulated and unstimulated saliva in this group The results of the study showed no connection between erosion prevalence and pH levels and stimulated salivary flow rates Clinical Implications Patients with alcoholism may be at risk of developing erosive lesions on their teeth owing to the low pH level of their oral environment and decreased saliva levels

Gallagher JE; Alajbeg I; Buchler S; Carrassi A; Hovius M; Jacobs A et al. Public health aspects of tobacco control revisited. International Dental Journal 60(1): 31-49, 2010. (74 refs.)

The tobacco epidemic presents a major public health challenge, globally, and within Europe. The aim of the Public Health Work Stream at the 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals was to review the public health aspects of tobacco control and make recommendations for action. The paper reports on the size of the tobacco challenge; from the associated mortality and morbidity to the prevalence of exposure to, and use of, tobacco. It provides a review of progress on tobacco control measures, as monitored by the World Health Organisation, and the impact of multiple influences on tobacco use. Every member of the dental team was considered to have a role as a public health advocate in promoting health and preventing disease in order to address health inequalities. A range of evidence-based approaches to tobacco control from clinical practice through to public policy are advocated, using the principles of the Ottawa Charter, recognising the multiple determinants of health. Tackling the tobacco epidemic may require a paradigm shift in oral healthcare. Therefore, key resources for health professionals on tobacco control are discussed and the implications of the findings for research, policy and practice in Europe are explored.

Gonseth S; Abarca M; Madrid C; Cornuz J. A pilot study combining individual-based smoking cessation counseling, pharmacotherapy, and dental hygiene intervention. BMC Public Health 10: article 348, 2010. (29 refs.)

Background: Dentists are in a unique position to advise smokers to quit by providing effective counseling on the various aspects of tobacco-induced diseases. The present study assessed the feasibility and acceptability of integrating dentists in a medical smoking cessation intervention. Methods: Smokers willing to quit underwent an 8-week smoking cessation intervention combining individual-based counseling and nicotine replacement therapy and/or bupropion, provided by a general internist. In addition, a dentist performed a dental exam, followed by an oral hygiene treatment and gave information about chronic effects of smoking on oral health. Outcomes were acceptability, global satisfaction of the dentist's intervention, and smoking abstinence at 6-month. Results: 39 adult smokers were included, and 27 (69%) completed the study. Global acceptability of the dental intervention was very high (94% yes, 6% mostly yes). Annoyances at the dental exam were described as acceptable by participants (61% yes, 23% mostly yes, 6%, mostly no, 10% no). Participants provided very positive qualitative comments about the dentist counseling, the oral exam, and the resulting motivational effect, emphasizing the feeling of oral cleanliness and health that encouraged smoking abstinence. At the end of the intervention (week 8), 17 (44%) participants reported smoking abstinence. After 6 months, 6 (15%, 95% CI 3.5 to 27.2) reported a confirmed continuous smoking abstinence. Discussion: We explored a new multi-disciplinary approach to smoking cessation, which included medical and dental interventions. Despite the small sample size and non-controlled study design, the observed rate was similar to that found in standard medical care. In terms of acceptability and feasibility, our results support further investigations in this field.

Gordon JS; Andrews JA; Albert DA; Crews KM; Payne TJ; Severson HH. Tobacco cessation via public dental clinics: Results of a randomized trial. American Journal of Public Health 100(7): 1307-1312, 2010. (15 refs.)

Objectives. We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit. Methods. We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group. Results. We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence (F-1,F-12=6.84;P<.05) and prolonged abstinence (F-1,F-12=14.62; P<.01) than did those in the usual care group. Conclusions. The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans.

Gordon JS; Andrews JA; Crews KM; Payne TJ; Severson HH; Lichtenstein E. Do faxed quitline referrals add value to dental office-based tobacco-use cessation interventions? Journal of The American Dental Association 141(8): 1000-1007, 2010 , 2010. (24 refs.)

Background. The Ask, Advise, Refer (AAR) model of intervening with patients who use tobacco promotes a brief office-based intervention plus referral to a tobacco quitline. However, there is little evidence that this model is effective. The primary aim of this study was to evaluate the effects on patients' tobacco use of two levels of a dental office-based intervention compared with usual care. Methods. The, authors randomly assigned 68 private dental clinics to one of three conditions: 5 As (Ask, Advise, Assess, Assist, Arrange); 3 As (AAR model); or usual care, and they enrolled 2,160 participants. Results. At the 12-month assessment, compared with those in usual care, participants in the two intervention conditions combined were more likely to report cessation of tobacco use, as measured by nine-month prolonged abstinence (3 percent versus 2 percent; F-1,F-66 = 3.97, P < .10) and 12-month point prevalence (12 percent versus 8 percent; F-1,F-66 = 7.32, P < .01). There were no significant differences between participants in the clinics using the 5 As and 3 As strategies. Conclusions. The results of this study are inconclusive as to whether referrals to a quitline add value to brief dental office based interventions. Patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling. Clinical Implications. The results confirm those of previous research: that training dental practitioners to provide brief tobacco-use cessation advice and assistance results in a change in their behavior, and that these practitioners are effective in helping their patients to quit using tobacco.

Han DH; Lim SY; Sun BC; Paek D; Kim HD. The association of metabolic syndrome with periodontal disease is confounded by age and smoking in a Korean population: the Shiwha-Banwol Environmental Health Study. Journal of Clinical Peridontology 37(7): 609-616, 2010. (42 refs.)

Aim: Because metabolic syndrome (MS) is pro-inflammatory and periodontitis is inflammatory, we issued the hypothesis that MS (the explanatory variable) is associated with periodontitis (the outcome variable). This study aimed to examine the link between MS and periodontitis among Koreans. Materials and Methods: From the Shiwha-Banwol Environmental Health Study, 1046 subjects aged 18 years or older were cross-sectionally surveyed. All participants underwent comprehensive dental and medical health examinations. The community periodontal index was used to assess periodontitis. Age, gender, monthly family income, smoking, drinking, frequency of daily teeth brushing, and physical activity were evaluated as confounders. Results: MS was strongly associated with periodontitis [odds ratio (OR): 1.7, 95% confidence interval (CI): 1.22-2.37], and MS with more components had a higher association. The association was higher for elders aged 65 years or more, males, and smokers. MS including both high glucose and hypertension had a higher association with the OR of 2.19 (95% CI: 1.23-3.90) comparing with other types of MS. Conclusions: Our results suggested that MS might be associated with periodontitis and the association was confounded by age, gender, and smoking. MS with high glucose and hypertension showed the higher impact on this link.

Hanioka T; Ojima M; Tanaka K; Yamamoto M. Does secondhand smoke affect the development of dental caries in children? A systematic review. (review). International Journal of Environmental Research and Public Health 8(5): 1503- 1519, 2011. (49 refs.)

This review evaluated evidence of the relationship between secondhand smoke (SHS) and dental caries in children in epidemiological studies. Relevant literature was searched and screened, and the methodological quality was assessed. The search yielded 42 citations. High-quality studies including one cohort format and 14 case-control format studies were selected. Early childhood caries was examined in 11 studies. The independent association of SHS was significant in 10 studies, and the strength was mostly weak to moderate. One study did not select SHS as a significant variable. Three studies reported decreases in the risk of previous exposure, and the association was not significant. Dose-response relationships were evident in five studies. Permanent teeth were examined in seven studies. Five studies reported significant associations, which were mostly weak. The risk of previous exposure remained similar to that of current exposure, and a dose-response relationship was not evident in one study. The overall evidence for the causal association in early childhood caries is possible regarding epidemiological studies, and the evidence of permanent teeth and the effect of maternal smoking during pregnancy were insufficient. The results warrant further studies of deciduous teeth using a cohort format and basic studies regarding the underlying mechanism.

Hedman E; Riis U; Gabre P. The impact of behavioural interventions on young people's attitudes toward tobacco use26. Oral Health & Preventive Dentistry 8(1): 23-32, 2010 , 2010. (26 refs.)

Purpose: The objective of the present study was to study the ability to influence young at-risk patients attitudes toward tobacco use through two intervention methods that were performed by dental health professionals. Materials and Methods: Two inteiventions, a brief individual motivational interview and an adapted school lecture, were studied, and both were compared with a control group. Before and after interventions, a questionnaire was used. Patients born in 1989 and 1992 who were judged by the dental personnel as potentially at risk for dental diseases, a total of 301 individuals, were included. Results: Both before and after interventions, the results showed a generally negative attitude towards tobacco use. A majority of the participants were positive towards measures that were taken to control the spread of tobacco use, younger participants (born 1992) to a greater extent (73%) than the older participants (born 1989) (54%) Important factors that kept the participants away from tobacco use were the harmful effects and the approaches of parents and friends. The older participants believed to a greater extent that they would try smoking as adults. No change in tobacco use was registered after intervention, although the participants reported an increased use among friends. Conclusions: The two pedagogical methods that were used in the present study influenced the young people's attitudes towards tobacco use only to a small extent. However, the period between 12 and 15 years old seems to provide a good opportunity to influence attitudes towards tobacco. The adolescents' demand for interactive learning and their development of attitudes and tobacco use habits in relation to family and friends provide opportunities to use new pedagogical models.

Huang BY; Inagaki K; Yoshii C; Kano M; Abbott PV; Noguchi T et al. Social nicotine dependence in Australian dental undergraduate students. International Dental Journal 61(3): 152-156, 2011. (18 refs.)

Objectives: This study aimed to investigate dental undergraduate students' tobacco usage and social nicotine dependence in Australia. A special interest was to identify the role of factors such as age, gender, year of dental education and cohabitants' smoking status for social nicotine dependence. Materials and methods: A sample of 252, first-to-fifth year undergraduate students in an Australian dental school was used. Each completed a self-administered questionnaire. Results: The smoking rate was 4.8%. Current smokers displayed higher social nicotine dependence than those that had never smoked (t = 3.1, df = 244, P = 0.002). Dental undergraduate students that showed higher social nicotine dependence (P = 0.001, OR = 1.3, 95% CI: 1.1-1.6), or that had smoking cohabitants (P = 0.016, OR = 4.8, 95% CI: 1.3-17.0), were more likely to smoke. Students' social nicotine dependence increased with year of dental study (P = 0.043, beta = 0.4, t = 2.0). Social nicotine dependence enhanced tobacco usage among Year-1-to-4 students (P = 0.005, OR = 1.4, 95% CI: 1.1-1.7) but not Year-5 undergraduates (P = 0.432). Conclusions: Social nicotine dependence has become a developing issue in dental education. Tobacco control should be highlighted in the dental curriculum. Future investigations into the effects of dental education on social nocotine dependence and tobacco usage are indicated.

Huggett KN; Westerman GH; Barone EJ; Lofgreen AS. Substance use and dependence education in predoctoral dental curricula: Results of a survey of U.S. and Canadian dental schools. Journal of Dental Education 75(8): 1003-1009, 2011. (11 refs.)

The purpose of this study was to obtain information about education in substance use and dependence that appears in the predoctoral curricula of U.S. and Canadian dental schools. Sixty-eight deans were sent a twenty-item survey requesting information about when in the curriculum these subjects were taught, what instructional methods were used, and whether behavior change instruction was included to address these issues in clinical interactions. The survey had an 81 percent response rate. The topics of alcohol use and dependence, tobacco use and dependence, and prescription drug misuse and abuse were reported in over 90 percent (N=55) of responding schools' predoctoral curricula. The topic of other substance use and dependence was reported in only 72.7 percent (N=40) of these schools. The primary instructional method reported was the use of lecture. Less frequently used methods included small-group instruction, instruction in school-based clinic, community-based extramural settings, and independent study. As future health professionals, dental students are an important source for patients concerning substance use, abuse, and treatment. Our investigation confirmed that alcohol, tobacco, and prescription drug abuse is addressed widely in predoctoral dental curricula, but other substance use and dependence are less frequently addressed.

Hugoson A; Rolandsson M. Periodontal disease in relation to smoking and the use of Swedish snus: Epidemiological studies covering 20 years (1983-2003). Journal of Clinical Periodontology 38(9): 809-816, 2011. (48 refs.)

Aim: The aim of the present study was to examine how deleterious current smoking and the use of Swedish moist snuff (snus) is for periodontal health compared with non-tobacco users. Materials and Methods: The studies comprised three epidemiological cross-sectional studies, in 1983, 1993 and 2003, of stratified random samples aged 20, 30, 40, 50, 60 and 70 years. The numbers of dentate participants were 550, 552 and 523, respectively. The participants were examined clinically and radiographically. Diagnostic criteria were the number of teeth, plaque, gingival status, probing pocket depth (PPD) >= 4 mm, height of the alveolar bone level and classification by periodontal disease experience. In addition, participants were asked about their tobacco habits. Results: Multiple logistic regression shows, after adjusting for age, gender and sociodemographic variables, that relative to non-tobacco users, cigarette smokers had statistically significant less gingivitis, a higher frequency of PPD >= 4 mm and a higher incidence of severe periodontitis. There was no significant association between gingivitis, frequency of PPD >= 4 mm and periodontal disease experience and snus use. Conclusions: Cigarette smokers were found to have a statistically significant higher risk of severe periodontitis than non-tobacco users and users of snus. Using snus did not seem to be a risk factor for periodontitis.

Jamieson LM; Gunthorpe W; Cairney SJ; Sayers SM; Roberts-Thomson KF; Slade GD. Substance use and periodontal disease among Australian Aboriginal young adults. Addiction 105(4): 719-726, 2010. (27 refs.)

Aim: To investigate the effects of tobacco, marijuana, alcohol and petrol sniffing on periodontal disease among Australian Aboriginal young adults. Design: Cross-sectional nested within a long-standing prospective longitudinal study. Setting: Aboriginal communities in Australia's Northern Territory. Participants: Members of the Aboriginal Birth Cohort study who were recruited from birth between January 1987 and March 1990 at the Royal Darwin Hospital, Northern Territory, Australia. Data were from wave III, when the mean age of participants was 18 years. Measurements: Clinical dental examination and self-report questionnaire. Findings: Of 425 participants with complete data, 26.6% had moderate/severe periodontal disease. There was elevated risk of periodontal disease associated with tobacco [prevalence ratio (PR) = 1.59, 95% CI = 1.06-2.40], marijuana (PR = 1.44, 95% CI = 1.05-1.97) and petrol sniffing (PR = 1.83, 95% CI = 1.08-3.11), but not alcohol (PR = 0.92, 95% CI = 0.67-1.27). Stratified analysis showed that the effect of marijuana persisted among tobacco users (PR = 1.47, 95% CI 1.03-2.11). It was not possible to isolate an independent effect of petrol sniffing because all petrol sniffers used both marijuana and tobacco, although among smokers of both substances, petrol sniffing was associated with an 11.8% increased prevalence of periodontal disease. Conclusions: This is the first time that substance use has been linked with periodontal disease in a young Australian Aboriginal adult population, and the first time that petrol sniffing has been linked with periodontal disease in any population. The role of substance use in periodontal disease among this, and other, marginalized groups warrants further investigation.

Kapferer I; Berger K; Stuerz K; Beier US. Self-reported complications with lip and tongue piercing. Quintessence International 41(9): 731-737, 2010 , 2010. (20 refs.)

Objectives: Owing to the overwhelming popularity of oral piercing, general practitioners should be prepared to address complications arising as a result of oral piercing and to provide patients with accurate information. The purpose of this cross-sectional study was to assess the prevalence of early and late complications associated with lip and tongue piercing in a population obtained from a nondental setting. Possible cofactors were evaluated. Method and Materials: The study cohort included 130 lip and 80 tongue piercings. Participants were asked to complete a questionnaire to determine demographic data, smoking habits, characteristics of the piercing worn (time since piercing, material-plastic or metal), postpiercing complications, and possible cofactors. Results: Prevalence of early piercing complications was 87.83%. Although there was no statistically significant difference in the overall prevalence of early postpiercing complications after lip or tongue piercing, the type of complication differed significantly according to the piercing location. Significant cofactors for early complications were oral hygiene behavior, gender, and the person who performed the piercing. The highest prevalence of late complications was found to be recurrent infections and gingival recessions. As cofactors, time since piercing and oral hygiene behavior had a significant impact on late complications. Conclusion: Early complications after oral piercing are frequent. Oral health care might be an important tool to minimize early and late postpiercing complications. Owing to the high prevalence of late complications-especially after median lip piercing-persons with oral piercing should attend regular dental checks and receive professional advice on tooth cleaning and oral hygiene.

Khami MR; Murtomaa H; Razeghi S; Virtanen JI. Smoking and its determinants among Iranian dental students. Medical Principles and Practice 19(5): 390-394, 2010 , 2010. (25 refs.)

Objective: The objective of the present study was to investigate smoking habits of Iranian dental students in relation to their background characteristics and oral self-care (OSC). Subjects and Methods: A survey in the form of a questionnaire was conducted of 327 senior dental students in seven randomly selected state dental schools in Iran. In addition to smoking habits and background characteristics, the students were asked about OSC. A recommended level of OSC was defined as a combination of brushing at least twice a day, frequent use of fluoridated toothpaste, and eating sugary snacks less than daily. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 263 students (113 males and 150 females) completely answered the questions and were included in the analyses. Results: Of the 263 students, 59 (23%, 37 males and 22 females) reported current smoking (cigarette, pipe, or water pipe). Current smoking was associated with male gender (OR = 2.9, 95% CI = 1.4-5.6), level of father's education (OR = 1.4, 95% CI = 1.1-1.8), and OSC (OR = 4.4, 95% CI = 1.3-14.9). Conclusion: Smoking among Iranian dental students is similar to their socioeconomic group, and is associated with the characteristics of their background, such as gender and father's level of education, as well as the quality of OSC. The results indicate a need to include smoking cessation education and public health activities in the dental curriculum to provide future health care professionals and role models for patients with adequate training in up-to-date patient management to control smoking.

Khan S. Effect of smoking on periodontal health. Disease-A-Month 57(4): 214- 217, 2011. (23 refs.)

The relationship between smoking and periodontal diseases has been studied extensively over the past 15 years and both cross-sectional and longitudinal studies provide strong epidemiologic evidence of a positive association between smoking and clinical and radiographic signs of and risk of periodontitis in smokers. Smoking is associated with a two- to 8-fold increased risk for periodontal attachment and/or bone loss. The article addresses effects of smoking on periodontal tissue, on plaque bacteria, on host response, on healing and treatment response.

Klosa K; Wiltfang J; Wenz HJ; Koller M; Hertrampf K. Dentists' opinions and practices in oral cancer prevention and early detection in Northern Germany. European Journal of Cancer Prevention 20(4): 313- 319, 2011. (27 refs.)

The objective of this study was to evaluate opinions and practices, related to oral cancer prevention and early detection, of dentists in Northern Germany, with focus on risk assessment and routine oral examination by means of a standardized questionnaire. In November 2007, a self-administered validated questionnaire was mailed to all dentists in Schleswig-Holstein (n = 2233), followed by two reminders, after 3 and 6 weeks. The survey was composed of 41 items and was divided into sections on several aspects of oral cancer. For this study, self-reported information about the assessment of the patients' health history and the dentists' activities with regard to the initial and recall appointments of younger compared with older patients were evaluated. The dentists' evaluation of the health history showed a clear focus on tobacco in contrast to alcohol. Dentists' opinions and practices in routine oral examination showed interesting discrepancies. Sixty-five percent, 94%, of the dentists agreed that this examination for younger (18-39 years) and older patients (>= 40 years) should be provided annually. But, only 25%, 30%, of the dentists always examined their younger and older patients at the initial appointment. Approximately 20%, less than 30% always investigated younger and older patients at the recall appointment. The results emphasized a discrepancy in the dentists' assessments of the health history. Dentists' opinions about the routine examination differed considerably from the actual integration in the daily work. These findings underline the need for the implementation of targeted educational programmes with focus on primary and secondary prevention.

Liu SW; Lien MH; Fenske NA. The effects of alcohol and drug abuse on the skin. Clinics in Dermatology 28(4): 391-399, 2010. (89 refs.)

Skin changes associated with alcohol and drug abuse can be the earliest clinical manifestation of these disorders. The signs associated with these conditions may be distinctive and easily recognizable. Alcohol abuse can present with jaundice, pruritus, hyperpigmentation, and urticaria. Commonly associated vascular changes include spider telangiectasias, angiomas, caput medusas, flushing, and palmar erythema. Disease states related to alcohol abuse include psoriasis, porphyria cutanea tarda, and nutritional deficiencies. Alcohol abuse may predispose to the development of carcinomas of the skin, oropharynx, liver, pancreas, and breast. Cutaneous signs of drug abuse include skin granulomas, ulcerations, and recurrent infections. Specifically, oral disease and tooth decay are examples of stigmata often associated with methamphetamine abuse, a popular and inexpensive drug now on the scene. By being cognizant of these cutaneous markers of alcohol and drug abuse, dermatologists are often in the unique position of being able to recognize these changes, prompting early diagnosis and intervention, hopefully resulting in a better clinical outcome for these troubled patients and their families.

Lopez-Valverde A; De Vicente J; Cutando A. The surgeons Halsted and Hall, cocaine and the discovery of dental anaesthesia by nerve blocking. British Dental Journal 211(10): 485-487, 2011. (23 refs.)

William Stewart Halsted is considered to be one of the most influential and innovative surgeons the USA has ever produced. His contributions to surgery are abundant, ranging from sophisticated surgical techniques in the field of breast surgery, surgery of the digestive apparatus and traumatological interventions, to the introduction of gloves in the operating theatre. Here we present Dr Halsted, together with his aide Dr Hall, as the discoverers of the technique for blocking the inferior alveolar nerve and the antero-superior dental nerve using cocaine as an anaesthetic. The anaesthetic technique, described perfectly by both surgeons in 1885, has been revolutionary in the practice of odontology since its introduction, offering dentists the possibility of performing invasive interventions to the maxillary without pain.

McAuley A; Goodall CA; Ogden GR; Shepherd S; Cruikshank K. Delivering alcohol screening and alcohol brief interventions within general dental practice: Rationale and overview of the evidence. (review). British Dental Journal 210(9): e15, 2011. (53 refs.)

Alcohol consumption and affordability in the UK has increased over the last 50 years and is associated with a range of adverse oral health outcomes, the most serious of which, oral cancer, is also increasing in incidence. Despite this, routine screening and intervention relating to alcohol consumption within general dental practice remains uncommon. This review of the literature describes the background and outlines the evidence base for undertaking alcohol screening and delivering brief interventions in general dental practice. Consideration will be given to the rationale for, and range of issues related to, introducing this into general dental practice.

McClain MA; McClain CR; Ditmyer MM; Dounis G; Mobley CC. Ninth-grade students' perceived attitudes and behaviors in a tobacco cessation program delivered by dental educators. Journal Of Dental Education 75(10): 1345-1353, 2011. (26 refs.)

This study measured whether a tobacco cessation program in Nevada's Clark County School District (CCSD) delivered by dental educators affected ninth-grade students' short-term perceived knowledge, attitudes, behaviors, and intentions (KABI) toward tobacco use and whether the CCSD's immersion approach led to positive changes in students' KABI. A quantitative research methodology with a descriptive research design was used. Data were collected from 617 students using pre- and post-program surveys self-administered by the participants. The surveys were based on those used previously in national and other large-scale epidemiologic studies assessing tobacco intervention program effectiveness. The survey data revealed that, after the program, more students had an increased awareness of tobacco use dangers to their health and significantly increased awareness of the negative consequences of tobacco use. The number of students who did or did not use tobacco changed very little as a result of the program, but the tobacco users on the post-program survey did report statistically significant decreases in overall use. Significant reduction in tobacco usage by the tobacco users indicates some desire on the part of smoking students to quit or reduce their tobacco usage. Little evidence of major changes in student attitudes was found.

McClellan SF; Olde BA; Freeman DH; Mann WF; Rotruck JR. Smokeless tobacco use among military flight personnel: A survey of 543 aviators. Aviation, Space, and Environmental Medicine 81(6): 575-580, 2010. (20 refs.)

Introduction: Although there has been a steady decline in smoking rates among adults in the United States in recent years, the consumption of smokeless tobacco (ST) continues to increase. Moreover, ST use in the U.S. military is far higher than in the general population. This study was designed to determine the extent of ST use in a military aviation population and measure users' attitudes toward elements of a proposed cessation program. Methods: A study was conducted at two naval aviation training wings in western Florida. The target population (N = 2233) included flight instructors, students, and staff/support personnel who were rated aviators or flight officers. A total of 543 usable questionnaires were returned, yielding a response rate of 24.3%. Results: There were 71 respondents who reported using ST in the last 30 d (13.1%). This group responded favorably to questions regarding the involvement of both medical and dental health professionals as critical components of an effective ST cessation program. Discussion: This survey provides evidence for a rate of ST use among military aviators that is much higher than the U.S. national civilian average of 3.5%. Drawing upon the background of previous dental health-based studies, we propose augmenting existing tobacco cessation resources by creating separate ST cessation programs to reduce ST use among U.S. military aviators.

McNiel AD; Muzzin KB; DeWald JP; McCann AL; Schneiderman ED; Scofield J et al. The nonmedical use of prescription stimulants among dental and dental hygiene students. Journal of Dental Education 75(3): 365-376, 2011. (48 refs.)

The purpose of this study was to determine the nonmedical use of prescription attention deficit disorder (ADD) stimulant medication among dental and dental hygiene students. A questionnaire was used to examine demographic information, student experiences, and perceptions of prescription stimulant medication and to determine if students used a prescription stimulant nonmedically. In 2008, 401 surveys were mailed to dental education institutions in the south-central region of the United States, and 243 surveys (61 percent) were returned. The survey found that 12.4 percent of these students used a prescription stimulant nonmedically and, of those, 70 percent took it to improve attention and/or concentration. The most commonly reported stimulant medication used nonmedically was Adderall (77 percent). The majority (87 percent) of the students obtained the medication through friends, and 90 percent began using the drug in college. Even though 74 percent of the students reported being stressed, chi-square analysis found no significant association between nonmedical use of ADD stimulant medication and stress level (p=0.585). Sixteen percent of the students surveyed felt it was easy to obtain stimulant medication for nonmedical use at their school, and 17 percent thought it was a problem within their institution. These results may help administrators and faculty members become aware of potential problems with the misuse of ADD stimulant medication.

Moimaz SAS; Zina LG; Saliba O; Garbin CAS. Smoking and periodontal sisease: Clinical evidence for an ssociation. Oral Health & Preventive Dentistry 7(4): 369-376, 2009 , 2009. (44 refs.)

Purpose: The aim of the present study was to assess the periodontal condition and smoking status, according to dose and duration information, and to estimate the percentage of subjects with periodontitis attributable to cigarette smoking in a representative adult rural population in southern Brazil. Materials and Methods: Bivariate statistical analysis was used to evaluate the association of smoking status with periodontitis in a cross-sectional study comprising 165 dentate individuals, aged 35 to 66 years, subjected to oral clinical examination of six sites per tooth in all sextants. Results: The prevalence of periodontitis (having >= 1 pocket of >= 4 mm around the index teeth) in the population was 35.2%. Overall, 13.9% had a cumulative loss of attachment > 4 mm; 35.7% of subjects were current smokers, classified as heavy (average 25.3 pack years), moderate (average 14.6 pack years) and light smokers (average 3.1 pack years). Statistical analysis showed that current smokers had an 11 times (95% confidence interval [Cl] = 4.69 to 26.62) and former smokers had a nine times (95% CI = 3.29 to 25.96) greater probability of having established periodontitis compared with non-smokers. The number of pack years (P = 0.0004) and years of smoking exposure (P = 0.0013) were associated with an increased prevalence of periodontitis. The number of current smokers with periodontitis might be reduced by 80%, had they not smoked cigarettes. Of the subjects with periodontitis, 64% could be prevented among current smokers by eliminating tobacco consumption. Conclusions: Cigarette smoking was strongly associated with periodontitis, and there was a relationship with dose and duration of smoking. These findings contributed to the evidence of smoking as a risk factor for periodontal disease and support the importance of dose-response analysis on determining the strength of this association.

Morita I; Sheiham A; Nakagaki H; Yoshii S; Mizuno K; Sabbah W. Is there a relationship between periodontal disease and smoking after adjusting for job classification in Japanese employed males? Oral Health & Preventive Dentistry 9(1): 83-89, 2011. (26 refs.)

Objectives: The objective of this study is to examine whether the well-known association between periodontal disease and smoking persists after adjusting for job classification. Methods: A sample of 16,110 employed Japanese males aged 20-69 years was included in the study. Periodontal examinations were conducted using the Community Periodontal Index. The association between periodontal disease and smoking status was examined using logistic regression adjusting for age, diabetes and job classification. Job classification was based on criteria of the Japanese Ministry of Health, Labour and Welfare. There are nine major job groups: (1) Professional (professionals, specialists), (2) Managers, (3) Office workers (computer operators, clerks, secretaries), (4) Skilled worker (factory workers, construction workers), (5) Salespersons (shop assistants), (6) Service occupations (superintendents, cleaners or car park attendants), (7) Security (guards), (8) Farmers and fishermen, (9) Transport and telecommunication workers (truck drivers). Results: Current and former smokers were more likely to have periodontal disease than non-smokers. Adjusting for job classification attenuated the association between smoking and periodontal disease but did not eliminate the association. The odds ratios for the association between smoking and Community Periodontal Index score 3 or 4 attenuated from 2.25 to 2.04 and from 2.62 to 2.52 for individuals aged 20 to 39 and 40 to 69 years, respectively. The effect of job classification on the association between periodontal disease and smoking was higher among younger participants aged 20 to 39 years. Conclusions: Smoking persisted as an important determinant of periodontal disease after adjusting for job classification in Japanese employed males.

Ndetei DM. Dental complications of chewing khat. (editorial). Substance Abuse 31(1): 74-75, 2010 , 2010. (0 refs.)

Needleman IG; Binnie VI; Ainamo A; Carr AB; Fundak A; Koeber A et al. Improving the effectiveness of tobacco use cessation (TUC). International Dental Journal 60(1): 50-59, 2010. (59 refs.)

This paper includes an update of a Cochrane systematic review on tobacco use cessation (TUC) in dental settings as well as narrative reviews of possible approaches to TUC and a more detailed discussion of referral for specialist TUC services. On the basis of these reviews we conclude that interventions for tobacco users in the dental setting increase the odds of quitting tobacco. However, the evidence is derived largely from patients using smokeless tobacco. Pharmacotherapy (such as nicotine replacements, bupropion and varenicline) is recommended for TUC in medical settings but has received little assessment in dental applications, although such evidence to date is promising. Whether the dental setting or referral to specialist TUC services is the most effective strategy to help people to quit tobacco use is unclear. An effective specialist service providing best available TUC care alone may not be the answer. Clearly, such services should be both accessible and convenient for tobacco users. Closer integration of specialist services with referrers would also be advantageous in order to guide and support oral health professionals make their referral and to maximise follow-up of referred tobacco users. Future research direction may consider investigating the most effective components of TUC in the dental settings and community-based trials should be a priority. Pharmacotherapy, particularly nicotine replacement therapy, should be more widely examined in dental settings. We also recommend that various models of referral to external and competent in-house TUC specialist services should be examined with both experimental and qualitative approaches. In addition to overall success of TUC, important research questions include facilitators and barriers to TUC in dental settings, preferences for specialist referral, and experiences of tobacco users attempting to quit, with dental professionals or specialist services, respectively.

Neff JA; Lynch C; Downs J. Alcohol use, predisposing, enabling, and oral health need variables as predictors of preventive and emergency dental service use. Substance Use & Misuse 45(12): 1930-1947, 2010 , 2010. (35 refs.)

Analyses of the 2002 U.S. National Health and Examination Survey (1,490 adults) examined relationships between alcohol frequency, quantity, and total weekly consumption and preventive and emergency dental service use during the past 12 months. Logistic regression analyses indicated a significant, small percentage of variance in dental service use explained by alcohol use (1%), controlling for predisposing (19%), enabling (18%), or need (4%) covariates. Preventive and emergency service use were associated with higher frequency drinking, but lower total consumption (significant only for preventive services). Limitations and implications for brief alcohol interventions in dental practice are discussed.

O'Donnell JA; Hamilton MK; Markovic N; Close J. Overcoming barriers to tobacco cessation counselling in dental students. Oral Health & Preventive Dentistry 8(2): 117-124, 2010 , 2010. (25 refs.)

Purpose: Tobacco use screening and brief intervention is recognised as an effective available preventive health service; yet, this service is still not routinely offered to dental patients by clinicians, despite dental schools generally providing some form of tobacco cessation counselling (TCC) by including it in their dental curriculum. A pilot study was therefore carried out to more clearly identify barriers that prevented the delivery of this service to tobacco-using patients at the University of Pittsburgh School of Dental Medicine and educational initiatives that might overcome these barriers. Materials and Methods: A survey of faculty and students asked participants to rank their knowledge, preparation and comfort levels in performing TCC as well as their belief as to the importance of such training in the dental curriculum. Six months following training and practice opportunities, surveys were again administered to participants. Each individual's pre- and post-TCC training surveys were reviewed and difference in response to each item was calculated. Results: The results of the present study show that students feel more prepared, that the time required to provide TCC was less than anticipated and that training in TCC is an important part of dental education to a greater extent after the pilot study than before. Conclusions: TCC training and practice opportunities for clinical application were effective in this pilot study in improving students' attitudes towards cited barriers.

Park YD; Patton LL; Kim JH; Kim HY. Smoking prevalence and attitude toward anti-smoking activities among Korean dentists. International Dental Journal 60(6): 383-388, 2010. (34 refs.)

Aims: To investigate the smoking habits and attitudes toward anti-smoking activities of Korean dentists according to their smoking status. Methods: A questionnaire was mailed to a random sample of 2,500 currently active Korean dentists in 2008. After 20% of the 1,680 returned surveys (response rate 67.2%) were excluded due to missing data, 1,443 surveys were analysed. Results: Among the 1,443 respondents, most were male (81.8%) and age 40-49 was the most prevalent age group (41.6%). Approximately half of participating dentists were never-smokers, 24.6% were current smokers, and 29% were ex-smokers. Women (95.8%) were significantly more likely to have never smoked than men (35.4%). Prevalence of cigarette smoking of Korean male and female dentists was much lower than that of male and female Korean adults, respectively. Ex-smokers were significantly more likely to show a positive attitude about anti-smoking activities, compared to current smokers (p<.0001). Conclusions: A majority of respondents agreed dentists should encourage their patients to stop smoking. Further effort is needed to encourage smoking cessation among male Korean dentists who smoke so they benefit from a healthier lifestyle and will subsequently be more likely to provide recommendations for smoking prevention and cessation for their patients.

Patel AM; Blanchard SB; Christen AG; Bandy RW; Romito LM. A survey of United States periodontists' knowledge, attitudes, and behaviors related to tobacco-cessation interventions. Journal of Periodontology 82(3): 367-376, 2011. (38 refs.)

Background: Because of the clear causal relationship between smoking and periodontal disease, and the negative effect of smoking on wound healing, it is of great importance to evaluate the tobacco-cessation interventions provided by periodontal practices. The use of tobacco-cessation interventions in clinical practice can be measured by whether the practitioner uses any of the "5 A's" defined by the 2008 United States Public Health Services Clinical Practice Guideline. Methods: Surveys were mailed to 1,000 active members of the American Academy of Periodontology. The surveys assessed the periodontists' demographic information, educational and professional background, knowledge and attitudes about tobacco cessation, and use of interventions in the daily practice of periodontics. Results: Data were collected from 231 periodontists via a self-administered survey. Most (92%) believed that tobacco cessation is a responsibility of the dental profession. A pattern of declining levels of involvement was seen as the providers moved through the suggested "5 A's" for promoting tobacco cessation. Providers with formal tobacco-cessation training were more likely to perform interventions. The primary perceived barriers to providing tobacco-cessation interventions were low patient acceptance of treatment, lack of time, and lack of training. Conclusion: The findings of this study indicate that periodontists believe that tobacco-cessation interventions are a responsibility of the dental profession; however, because of several perceived barriers, reported rates of comprehensive tobacco interventions in periodontal practices are low.

Pau A; Olley RC; Murray S; Chana B; Gallagher J. Dental hygienists' self-reported performance of tobacco cessation activities. Oral Health & Preventive Dentistry 9(1): 29-36, 2011. (37 refs.)

Purpose: Tobacco use is a major risk factor in oral and systemic diseases. Current national guidelines outline activities that positively contribute towards tobacco cessation. Little is known about dental hygienists' role in tobacco cessation activities. This study investigates dental hygienists' performance of tobacco cessation activities in the dental surgery and explores factors associated with this performance. Materials and Methods: Dental hygienists in south-east England on the register of the British Society of Dental Hygiene and Therapy completed a postal questionnaire survey in 2008. Results: A total of 439 (61%) questionnaires were returned, representing both part-time (66.7%) and full-time (33.3%) hygienists working in the private (69.5%) and non-private sectors (30.5%). Most hygienists recorded positive attitudes towards tobacco cessation. Overall, 162 (41.9%) reported performing four or more tobacco cessation activities. The less-commonly performed activities indicated to patients the value of attending NHS Stop Smoking Services for specialised help, with hygienists referring patients to the NHS Stop Smoking Services and offering assistance to those who do not wish to attend NHS stop Smoking Services. Higher reported numbers of tobacco cessation activities performed were statistically significantly associated with a higher number of positive attitudes held (P = 0.004), while socio-demographic and professional attributes were not. Conclusion: Tobacco cessation activities, as recommended by national guidelines, are not always performed by dental hygienists. Efforts are needed to promote the dental hygienist's role in tobacco cessation, especially in relation to referring patients to NHS Stop Smoking services. These efforts should focus on changing the attitudes of dental hygienists, especially on their effectiveness in promoting tobacco cessation.

Pendharkar B; Levy SM; McQuistan MR; Qian F; Squier CA; Slach NA et al. Fourth-year dental students' perceived barriers to providing tobacco intervention services. Journal of Dental Education 74(10): 1074-1085, 2010 , 2010. (48 refs.)

In order to facilitate effective tobacco cessation services within dental school clinics, it is necessary to understand the perceived barriers encountered by dental students while providing these services. The aim of this study was to identify which factors fourth-year dental students perceive to be associated with barriers to providing tobacco intervention services. A written survey was developed and completed by incoming fourth-year dental students (a convenience sample of seventy students) at the University of Iowa College of Dentistry in 2008. The survey assessed the perceived barriers to providing tobacco intervention services and related factors. Descriptive, bivariate, and linear regression analyses were conducted. The response rate was 97 percent. The most frequently reported barriers were patients' resistance to tobacco intervention services (96 percent), inadequate time available for tobacco intervention services (96 percent), and forgetting to give tobacco intervention advice (91 percent). The following variables were significantly (p<0.05) related to greater perceived barriers in providing tobacco intervention services: lower "adequacy of tobacco intervention curriculum coverage of specific topics covered over the previous three years" and greater "perceived importance of incorporating objective structured clinical examination teaching method for learning tobacco intervention." Students probably could benefit from additional didactic training, but most important may be enhanced clinical experiences and faculty reinforcement to facilitate effective practical student learning and adaptation for future delivery of intervention services in private practice settings.

Qu HY; Houston TK; Williams JH; Gilbert GH; Shewchuk RM. Cognitive mapping tobacco control advice for dentistry: A dental PBRN study. American Journal of Health Behavior 35(2): 228-239, 2011. (35 refs.)

Objective: To identify facilitative strategies that could be used in developing a tobacco cessation program for community dental practices. Methods: Nominal group technique (NGT) meetings and a card-sort task were used to obtain formative data. A cognitive mapping approach involving multidimensional scaling and hierarchical cluster analysis was used for data analysis. Results: Three NGT meetings conducted with 23 dental professionals yielded 27 nonredundant facilitative strategies. A 2-dimensional 4-cluster cognitive map provided an organizational framework for understanding these strategies. Conclusion: Views of the target population solicited in a structured format provided clear direction for designing a tobacco cessation intervention.

Rajasundaram P; Sequeira PS; Jain J. Perceptions of dental students in India about smoking cessation counseling. Journal of Dental Education 75(12): 1603-1610, 2011. (19 refs.)

Smoking kills 900,000 people every year in India. Many studies have shown that counseling from a health professional is an effective method of helping patients quit. The aim of this study was to evaluate the knowledge and attitudes of dental students in Karnataka, India, towards smoking cessation counseling. A questionnaire study was conducted among a convenience sample of 329 dental students comprised of III year and IV year students and interns in three dental colleges in Karnataka, India. Of the 329 students who completed the questionnaire, twenty-two (7 percent) were current smokers, and fifteen (5 percent) were ex-smokers. Although 94 percent responded they were giving antismoking advice to their patients, only 47 percent said they had been taught antismoking advice suitable for patients. While a majority (95 percent) planned to advise patients about tobacco use in their professional careers, significantly fewer (66 percent) indicated that such counseling would help patients to quit. This study of dental students and interns found that a majority intended to provide smoking cessation counseling in their professional career and agreed it is part of their professional role.

Rifkind J. What should I look for when treating an alcoholic patient (current or recovered) in my office? Journal of the Canadian Dental Association 77: e-article b114, 2011. (12 refs.)

The author outlines the dimensions of alcohol problems and the implications for dental health.. It provides a review of the effects of chronic heavy alcohol use, not only in respect to dental health but also general physical health. Alcoholic patients frequently consume more than 50% of their daily caloric intake in the form of alcohol. Also between 30% and 80% of those with cirrhosis results in swelling of the parotid gland decreasing salivation, a condition conducive to periodontal disease and caries. The role of nutritional deficiences also associated with chronic alcohol use are outlined. The author briefly reviews the systemic effects of chronic heavy drinking, as well as withdrawal syndromes and alcohol-drug interactions. The author concludes that many of these patients may only seek dental treatment in emergency situations. Thus it is important that dentists have open lines of communications with medical and dental specialists so that treatment can be provided in a timely and effective manner to control infection, diagnose disease and alleviate pain.

Rintakoski K; Ahlberg J; Hublin C; Lobbezoo F; Rose RJ; Murtomaa H et al. Tobacco use and reported bruxism in young adults: A nationwide Finnish Twin Cohort Study. Nicotine & Tobacco Research 12(6): 679-683, 2010. (20 refs.)

Introduction: Higher levels of smoking, leading to increased levels of nicotine and dopamine release, may be more strongly related to bruxism, although this relationship has remained unclear. Thus, the aim of the present study was to investigate the possible effect of cumulative tobacco use on bruxism in a large sample of young adults. Methods: The material of the present study derives from the FinnTwin16, which consists of five birth cohorts born in 1975-1979. A total of 3,124 subjects (mean age 24 years, range 23-27 years) provided data in 2000-2002 on frequency of bruxism and tobacco use. Multinomial logistic regression was used to explore the relationships of frequency of bruxism with smoking and smokeless tobacco use while controlling covariates (alcohol intoxication, alcohol problems [Rutgers Alcohol Problem Index, RAPI], illicit drug use, psychological distress [General Health Questionnaire], and coffee use). Results: Based on subjective response and multivariate analyses, weekly bruxers were more than two times more likely to report heavy smoking than never bruxers (odds ratio [OR] 2.5, 95 % CI 1.8-3.4). The significant association between heavy smoking and bruxism held when the effects of other tobacco use and multiple covariates were controlled. In addition, the use of smokeless tobacco emerged as an independent risk factor for bruxism. Discussion: Given the observed associations with both heavy smoking and smokeless tobacco and a dose-response relationship, the present results support our hypothesis of a link between nicotine intake and bruxism.

Robbins JL; Wenger L; Lorvick J; Shiboski C; Kral AH. Health and oral health care needs and health care-seeking behavior among homeless injection drug users in San Francisco. Journal of Urban Health 87(6): 920-930, 2010. (37 refs.)

Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N=340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self reported needs for physical and oral health care and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care In bivariate analysis, being in methadone treatment was associated with care-seeking behavior In addition, being enrolled in Medi Cal California's state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi Cal's adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics

Rosa EF; Corraini P; de Carvalho VF; Inoue G; Gomes EF; Lotufo JPB et al. A prospective 12-month study of the effect of smoking cessation on periodontal clinical parameters. Journal of Clinical Periodontology 38(6): 562- 571, 2011. (51 refs.)

Aim: The aim of this 12-month prospective study was to assess the adjunctive effect of smoking cessation in non-surgical periodontal therapy of subjects with severe chronic periodontitis. Materials and methods: Of the 201 subjects enrolled from a smoking cessation clinic, 93 were eligible and received non-surgical periodontal treatment and concurrent smoking cessation treatment. Periodontal maintenance was performed every 3 months. Full-mouth periodontal examination in six sites per tooth was performed by a calibrated examiner, blinded to smoking status, at baseline, 3, 6 and 12 months after non-surgical periodontal treatment. Furthermore, expired air carbon monoxide concentration measurements and interviews based on a structured questionnaire were performed in order to collect demographic and smoking data. Results" Of the 93 eligible subjects, 52 remained in the study after 1 year. Of these, 17 quit smoking and 35 continued smoking or oscillated. After 1 year, only quitters presented significant clinical attachment gain (p=0.04). However, there were no differences between the groups regarding clinical attachment level, probing depth, bleeding on probing and plaque index after 1 year (p > 0.05). Conclusion" Smoking cessation promoted clinical attachment gain in chronic periodontitis subjects from a smoking cessation clinic after 1 year of follow-up.

Rosseel JP; Hilberink SR; Jacobs JE; Maassen IM; Plasschaert AJM; Grol RPTM. Are oral health complaints related to smoking cessation intentions? Community Dentistry & Oral Epidemiology 38(5): 470-478, 2010 , 2010. (44 refs.)

Objective: Smoking influences oral health in several ways (such as the occurrence of periodontitis, teeth discolouration and oral cancer); therefore, smoking behaviour should be addressed in dental care. Dentists can play a role in primary and secondary prevention of tobacco dependence. They see their patients repeatedly over time. This study investigates whether oral health complaints can be seized as an opportunity to start smoking cessation counselling. Methods: A structured patient questionnaire in a sample of 1101 smokers (52.1% women, mean age 40.4 years) in a convenience sample of 87 primary care dental practices. The I-change model was used to describe factors influencing behavioural change. Dependent factors such as intention to quit smoking and related factors (attitude, social support and self-efficacy) were analysed in relation to independent factors such as oral health complaints (gingiva problems, gingiva inflammation, oral cancer and discoloured teeth) using a general linear model (univariate analysis), multinomial logistic regression analysis and multiple linear regression analysis. Results: A total of 56.3% had discoloured teeth, 27% of the smokers had a problem with their gums and 15.7% had gingiva inflammation. We found no direct relation between oral health complaints and the intention to quit smoking. However, teeth discolouration was positively related to attitudes towards smoking cessation [beta, Confidential interval (95%); 1.92 (1.45-2.40 for advantages and -0.86(-1.18 to -0.53) for disadvantages] and negatively to self-efficacy regarding quitting [-2.69 (-3.49 to 1.88)]. Conclusions: We found no direct relation between oral health complaints and the intention to quit smoking, but oral health complaints and especially teeth discolouration were related to factors influencing the quit intention. Patients with discoloured teeth are more likely to have a positive attitude towards smoking cessation but are uncertain to persist smoking cessation. It is suggested that teeth discolouration can be a good entrance for addressing smoking cessation in daily dental practice.

Sanders AE; Slade GD; Beck JD; Agustsdottir H. Secondhand smoke and periodontal disease: Atherosclerosis Risk in Communities Study. American Journal of Public Health 101(1, supplement): S339-S346, 2011. (37 refs.)

Objectives. We investigated the relationship between secondhand smoke and periodontal disease in nonsmokers. Methods. We undertook a cross-sectional analysis of the Atherosclerosis Risk in Communities study with 2739 lifetime nonsmokers aged 53-74 years, unexposed to other sources of tobacco, who received a complete periodontal examination at visit 4. Exposure was reported as average hours per week in close contact with a smoker in the preceding year. We defined severe periodontitis as 5 or more periodontal sites with probing pocket depth of 5 millimeters or more and clinical attachment levels of 3 millimeters or more in those sites. Other outcomes were extent of periodontal probing depths of 4 millimeters or more and extent of clinical attachment levels of 3 millimeters or more. Results. In a binary logistic regression model, adjusted odds of severe periodontitis for those exposed to secondhand smoke 1 to 25 hours per week increased 29% (95% confidence interval = 1.0, 1.7); for those exposed to secondhand smoke 26 hours per week, the odds were twice as high (95% confidence interval = 1.2, 3.4) as for those who were unexposed. Conclusions. Exposure to secondhand smoke and severe periodontitis among nonsmokers had a dose-dependent relationship.

Sarna L; Bialous SA; Sinha K; Yang Q; Wewers ME. Are health care providers still smoking? Data from the 2003 and 2006/2007 tobacco use supplement-current population surveys. Nicotine & Tobacco Research 12(11): 1167-1171, 2010. (27 refs.)

Introduction: Smoking by health care professionals poses a barrier to interventions with patients. This study reports smoking status changes among health care professionals using the Tobacco Use Supplement-Current Population Surveys (TUS-CPS). Methods: TUS-CPS self-reported smoking status (current, former, and never) identified by occupation (physicians, physician assistants, registered nurses [RNs], licensed practical nurses [LPNs], respiratory therapists, dentists, and dental hygienists), were analyzed for the 2003 (N = 4,095) and 2006/2007 (N = 3,976) cohorts. Quit ratios among U. S. health care professionals were calculated by dividing the number of former smokers by the number of ever-smokers using weighted estimates. Results: In 2006/2007, LPNs (20.55%) and respiratory therapists (19.28%) had the highest smoking prevalence. Physicians (2.31%), dentists (3.01%), pharmacists (3.25%), and RNs (10.73%) had the lowest prevalence. Data from 2006/2007 indicate that physicians, pharmacists, dentists, and physician assistants had the highest quit ratios; all groups had quit ratios higher than the general public, except LPNs (. 52 vs. .46, respectively). Current smoking varied by group but did not significantly decline from 2003 to 2006/2007. The majority of health care professionals were never-smokers. Conclusions: These data indicate that only 4 health care professional groups met the Healthy People 2010 goal of 12% smoking prevalence. LPNs were the only group with quit ratios lower than the general population. The lack of significant decline in smoking rates among health professionals was similar to the "flat" rate seen among adults in the United States. This is of concern as smoking among health care professionals limits their interventions with smokers and their involvement in tobacco control.

Segura-Egea JJ; Castellanos-Cosano L; Velasco-Ortega E; Rios-Santos JV; Llamas-Carreras JM; Machuca G et al. Relationship between smoking and endodontic variables in hypertensive patients. Journal of Endodontics 37(6): 764-767, 2011. (32 refs.)

Introduction: The aim of this study was to investigate the relationship between smoking and the prevalence of apical periodontitis and root canal treatment in hypertensive patients. Methods: In a cross-sectional study, the records of 100 hypertensive patients, 50 smokers and 50 nonsmokers, were examined. Periapical status of all teeth was assessed by using the periapical index score. Results: Apical periodontitis in 1 or more teeth was found in 92% of smoker patients and in 44% of nonsmoker subjects (P =.000; odds ratio [OR], 16.8; 95% confidence interval [Cl], 4.6-61.3). One or more root-filled teeth were found in 58% and 20% of smoker and nonsmoker subjects, respectively (P <.01; OR, 5.5; 95% Cl, 2.3-13.5). Among smoker hypertensive patients, 6% of the teeth had apical periodontitis, whereas in the nonsmoker subjects, 2% of teeth were affected (P <.01; OR, 3.3; 95% Cl, 2.0-5.4). The percentage of root-filled teeth in the smoker and nonsmoker groups was 3.6% and 1.2%, respectively (P <.01; OR, 2.9; 95% Cl, 1.6-5.5). Conclusions: The prevalence of apical periodontitis and root canal treatment was significantly higher in smoker hypertensive patients compared with nonsmoker subjects.

Shelley D; Jannat-Khah D; Wolff M. Tobacco-use treatment in dental practice How Healthy People 2020 aligns federal policy with the evidence. (editorial). Journal of the American Dental Association 142(6): 592-+, 2011. (26 refs.)

Shepherd S; Young L; Clarkson JE; Bonetti D; Ogden GR. General dental practitioner views on providing alcohol related health advice: An exploratory study. British Dental Journal 208(7): e13, 2010. (36 refs.)

Objective To identify salient beliefs of general dental practitioners (GDPs) regarding their role in the identification of alcohol misuse and the provision of an alcohol related health message in the primary dental care setting. Method: A convenience sample of 12 GDPs practising in the North Highland region of Scotland underwent semi-structured interview. An inductive approach was used with subsequent basic thematic content analysis performed on the transcripts. Results GDPs universally agreed that alcohol consumption plays a role in both oral health and general health but this did not translate into effective communication about alcohol during dental consultation. Current knowledge of recommended safe alcohol consumption guidelines was poor - evidence of potential GDP training requirements. The primary barriers related to disruption of the clinician-patient relationship, embarrassment or the perceived irrelevance to the clinical situation. GDPs expressed low confidence in approaching alcohol related problems. Conclusions: GDPs felt that alcohol based discussions in primary care would not be relevant and would inevitably lead to disruption of the patient-clinician relationship. Further research is necessary to more fully understand the attitudes, behaviour and knowledge of GDPs regarding the provision of alcohol related health advice. The results of this study have informed the design of a paper postal survey for wider distribution.

Shetty V; Mooney LJ; Zigler CM; Belin TR; Murphy D; Rawson R. The relationship between methamphetamine use and increased dental disease. Journal of the American Dental Association 141(3): 307-318, 2010. (46 refs.)

Background. Methamphetamine (MA) use has been linked anecdotally to rampant dental disease. The authors sought to determine the relative prevalence of dental comorbidities in MA users, verify whether MA users have more quantifiable dental disease and report having more dental problems than nonusers and establish the influence of mode of MA administration on oral health outcomes. Methods. Participating physicians provided comprehensive medical and oral assessments for adults dependent on AM (n = 301). Trained interviewers collected patients' self-reports regarding oral health and substance-use behaviors. The authors used propensity score matching to create a matched comparison group of nonusers from participants in the the Third National Health and Nutrition Examination Survey (NHANES III). Results. Dental or oral disease was one of the most prevalent (41.3 percent) medical cormorbidities in MA users who otherwise were generally healthy. On average, MA users bad significantly more missing teeth than did matched NHANES Ill control participants (4.58 versus 1.96, P < .001) and were more likely to report having oral health problems (P < .001). Significant subsets of MA users expressed concerns with their dental appearance (28.6 percent), problems with broken or loose teeth (23.3 percent) and tooth grinding (bruxism) or erosion (22.3 percent). The intravenous use of MA was significantly more likely to be associated with missing teeth than was smoking MA (odds ratio = 2.47; 95 percent confidence interval = 1.3-4.8). Conclusions. Overt dental disease is one of the key distinguishing comorbidities in MA users. MA users have demonstrably higher rates of dental disease and report long-term unmet oral health needs. Contrary to common perception, users who smoke or inhale MA have lower rates of dental disease than do those who inject the drug. Many MA users are concerned with the cosmetic aspects of their dental disease, and these concerns could be used as behavioral triggers for targeted interventions. Clinical Implications. Dental disease may provide a temporally stable MA-specific medical marker with discriminant utility in identifying AM users. Dentists can play a crucial role in the early detection of MA use and participate in the collaborative care of AM users.

Shibly O. Effect of tobacco counseling by dental students on patient quitting rate. Journal of Dental Education 74(2): 140-148, 2010. (27 refs.)

Tobacco use has widespread, devastating effects on the body, including the oral cavity. Today's dental professional must be trained to counsel patients on tobacco cessation, but dental health professionals and students do not feel confident in their counseling, abilities. The University at Buffalo School of Dental Medicine (SDM) established the Tobacco Counseling Cessation Protocol (TCCP), which vas implemented in the dental curriculum, and dental Students were trained in its use. The goal of this project vas to assess the effectiveness of the TCCP by surveying both patients and dental students. Students and patients were contacted to determine the effect of the TCCP on the quitting rate. Third- and fourth-year dental students were surveyed through the school c-mail system and asked to report on their tobacco cessation counseling, practices. Patients who received TCCP received follow-up telephone calls to obtain their input on the program and also to determine if they had quit. According to the follow-up survey, 14 percent of patients reduced the number of cigarettes smoked per day, and 22 percent quit entirely. Fifty-one percent of those who received the TCCP made a commitment to quit at the lime of the intervention; 32 percent of those receiving the TCCP were still smoke-free at six months, but 19 Percent had returned to smoking. If predoctoral students receive appropriate training, they call he effective in motivating patients to quit smoking. Dental students are generally receptive to the educational material on tobacco use and smoking cessation counseling, yet only half report routinely implementing the TCCP More needs to be done to incorporate tobacco cessation counseling into routine dental care. The culture of dentistry must be changed to view tobacco use as a dental problem.

Succar CT; Hardigan PC; Fleisher JM; Godel JH. Survey of tobacco control among Florida dentists. Journal of Community Health 36(2): 211-218, 2011. (22 refs.)

Cigarette smoking contributes to the largest number of preventable deaths with a recent report estimating that nearly 5 million annual deaths worldwide and 400,000 in the United States were attributed to cigarette smoking. Dentists, in particular, are in a unique position to educate their patients about the health effects of tobacco. Tobacco cessation knowledge, behaviors, and compliance of Florida dentists were assessed using survey methodology. The survey was administered to a random sample of 6,000 dentists, which was provided by the Florida Department of Health. The survey inquired about (1) general demographic information, (2) Ask, Advise, Assess, Assist, and Arrange behaviors, (3) barriers to the incorporation of tobacco cessation activities, and (4) willingness to participate in further training. A large majority of dentists (88%) are not familiar with the concept of the Ask, Advise, Assess, Assist, and Arrange behaviors when asked directly. When asked about each individual component of this approach, however, dentists had much higher response rates. Dentists were best at routinely asking (59%), advising (46%), & assessing (32%) their patients about their smoking. However, they were much less helpful when assisting and arranging follow-up (70% stated that they never arrange follow-up). This study discovered that the majority of dentists who counsel patients spend only 1-4 min. Sixty-six percent of the dentists surveyed were willing to receive specific training, with 50% preferring an online course and 42% preferring a continued education course.

Tanaka K; Miyake Y; Arakawa M; Sasaki S; Ohya Y. Household smoking and dental caries in schoolchildren: The Ryukyus Child Health Study. BMC Public Health 10: article 335, 2010. (27 refs.)

Background: Secondhand smoke exposure (SHSe) is perhaps one of the most important toxic exposures in childhood. However, epidemiological studies on the relation between SHSe and dental caries are limited and have yielded inconsistent results. The present cross-sectional study examined the potential association between SHSe at home and the prevalence of dental caries in children. Methods: Subjects were 20,703 schoolchildren aged 6 to 15 years in Okinawa, Japan. Information on SHSe at home and potential confounding factors was obtained through questionnaires. Data on dental caries were obtained from school records. Children were classified as having decayed and/or filled teeth (DFT) if a dentist diagnosed these conditions. Additionally, we analyzed decayed teeth (DT) and filled teeth (FT) separately. Adjustment was made for sex, age, region of residence, toothbrushing frequency, use of fluoride, sugar intake, and paternal and maternal educational level. Results: The prevalence of DFT was 82.0%. Compared with never smoking in the household, former and current household smoking were independently associated with an increased prevalence of DFT (adjusted prevalence ratios [95% confidence intervals] for former household smoking and current light and heavy household smoking were 1.03 [1.00-1.05], 1.04 [1.02-1.05], and 1.04 [1.03-1.06], respectively); when analyzed separately there was an increased prevalence of DT (adjusted prevalence ratios [95% confidence intervals] for former household smoking and current light and heavy household smoking were 1.06 [1.02-1.11], 1.10 [1.06-1.13], and 1.10 [1.07-1.14], respectively) but not FT. A statistically significant dose-response relationship between cumulative smoking in the household and the prevalence of DFT and DT (P for trend < 0.0001), but not FT, was observed. In an analysis of 2 subgroups, subjects who had at least 1 deciduous tooth and subjects who had at least 1 permanent tooth, household smoking exposure was associated with an increased prevalence of DFT and DT not only in those with deciduous but also those with permanent dentition. Conclusion: Our findings suggested that household smoking might be associated with an increased prevalence of dental caries in children.

Tong EK; Strouse R; Hall J; Kovac M; Schroeder SA. National survey of US health professionals' smoking prevalence, cessation practices, and beliefs. Nicotine & Tobacco Research 12(7): 724-733, 2010. (35 refs.)

Tobacco dependence treatment efforts have focused on primary care physicians (PCPs), but evidence suggests that they are insufficient to help most smokers quit. Other health professionals also frequently encounter smokers, but their smoking prevalence, cessation practices, and beliefs are less well known. The study included 2,804 subjects from seven health professional groups: PCPs, emergency medicine physicians, psychiatrists, registered nurses, dentists, dental hygienists, and pharmacists. Outcomes included self-reported smoking status, smoking cessation practices, and beliefs. Multivariate regression was used to examine factors associated with health professionals (except pharmacists) self-reportedly performing the "5 A's": asking, advising, assessing, assisting, or arranging follow-up about tobacco. Health professionals have a low smoking prevalence (< 6%), except nurses (13%). Many health professionals report asking (87.3%-99.5%) and advising (65.6%-94.9%) about smoking but much less assessing smokers' interest (38.7%-84.8%), assisting (16.4%-63.7%), and arranging follow-up (1.3%-23.1%). Controlling for health professional and practice demographics, factors positively associated in the multivariate analyses with self-reportedly performing multiple components of the 5 A's include awareness of the Public Health Service guidelines, having had cessation training, and believing that treatment was an important professional responsibility. Negative associations include the health professional being a current smoker, not being a PCP, being uncomfortable asking patients if they smoke, believing counseling was not an appropriate service, and reporting competing priorities. U.S. health professionals report not fully performing the 5 A's. The common barriers and facilitators identified may help inform strategies for increasing the involvement of all health professionals in conducting tobacco dependence treatments.

Turp JC; Lunsch H; Radlanski RJ. Interdental spacing and orthodontic treatment in competitive athletes: Clues to doping with growth hormones? Journal of Orofacial Orthopedics 71(5): 373-382, 2010 , 2010. (24 refs.)

The aim of this report is to examine clues of a suspected link between the artificial ingestion of human growth hormone (rhGH) and resulting interdental spaces in adult athletes. We conducted an electronic search in the German-language versions of the search engines Google and Google Scholar as well as in the database PubMed. While no explicit articles could be identified in PubMed, the search in Google and Google Scholar produced 1370 and 6 hits, respectively. Original quotes from 20 sources show that in the media the wearing of orthodontic multibracket appliances among athletes is largely attributed to changes in tooth position as a consequence of the illegal ingestion of rhGH. On the other hand, there are few references to the possibility that orthodontic treatments with fixed appliances might be carried out for reasons unrelated to doping. Conclusion: A definitive assessment of this issue is not possible at present. In view of its major importance of the subject, the relationships depicted here should be investigated in greater depth.

Uju DE; Obioma NP. Anticariogenic potentials of clove, tobacco and bitter kola. Asian Pacific Journal of Tropical Medicine 4(10): 814-818, 2011. (25 refs.)

Objective: To investigate three tropical plant materials - clove seeds [Syzygium aromaticum (S. aromaticum)], bitter kola fruits [Garcinia kola (G. kola)] and tobacco leaves (Nicotiana species) as potential targeted killers of Streptococcus mutans (S. mutans), a cavity causing bacterium (gram positive, facultative anaerobe) that resides in a multispecies microbial community (dental plaque) for the treatment of dental caries (tooth decay). Methods: Thirty one (31) teeth samples were collected from patients with obvious signs of tooth decay (swollen gum, weak or fallen tooth, etc.) using sterile swab sticks. These samples were collected from two major dental clinics in Nsukka, Enugu State, Nigeria and investigated by spread inoculation onto sterile blood agar and Mueller Hinton agar (MHA) respectively and incubated at 37 degrees C, for 24 h. The discrete colonies obtained were further re inoculated onto sterile Mitis salivarius agar (MSA) plates and incubated as above. The isolates were characterized by gram staining and catalase test. Tobacco leaves, clove seeds and bitter kola fruits were ground into powder, extracted with three different solvents (n-hexane, hot water and ethanol), filtered, dried and stored in clean containers, corked and kept until used. The plant extracts were investigated for phytochemistry, minimum inhibitory concentration (MIC), minimum cidal concentration (MCC) and compared with some conventional antibiotics commonly used against tooth decay. Antibiotic sensitivity test was also carried out. The results were statistically analyzed. Results: The extracts showed varied phytochemical composition but most abundantly the flavonoids. Our result also shows that females (16) have more tooth decay than males (15) and that 16 samples were very bloody while 15 were slightly bloody. The microbial characterization showed that 18 samples were catalase positive indicating the presence of S. mutans while 13 were catalase negative suspected to be Staphylococcus spp. The Gram reaction confirmed 13 Gram negative and 18 Gram positive organisms. The n-hexane extract had the best antimicrobial activity followed by the ethanol and lastly hot water. MIC showed that n-hexane clove extract had the largest inhibition zone diameter, followed by bitter kola extract and lastly tobacco extract. The antibiotic sensitivity test credited ciprofloxacin the best because it exhibited broad spectrum of action. Conclusions: Since the n-hexane extract of clove seeds demonstrated preferential growth inhibitory activity against the causal cariogenic pathogens (S. mutans) in dental caries, we therefore, report here that clove extract be henceforth considered as a potential ingredient in toothpaste preparation.

Underwood B; Fox K; Manogue M. Tobacco, alcohol and drug use among dental undergraduates at one English university in 1998 and 2008. (editorial). British Dental Journal 208(4): 164-165, 2010. (0 refs.)

Objective: To estimate the prevalence of tobacco, alcohol and drug use among dental undergraduates at one English university in 2008, and compare these with prevalence in 1998. Design Cross-sectional survey using an anonymous self-report questionnaire. Subjects and methods In 2008 all 384 dental undergraduates at one English university were sent a questionnaire in order to obtain data on the frequency and amount of tobacco, alcohol, cannabis and other illicit drugs used before and during their time as a dental undergraduate. The same survey had been conducted on dental undergraduates at the university 10 years earlier. Results: Tobacco smoking was reported by 27% of males and 13.5% of females, a reduction from 1998 (42% of males and 32% of females) being significant among females. 63% of males and 69.5% of females reported drinking alcohol: significantly fewer than in 1998 (82% males and 90% females). Binge drinking was reported by 69.5% of males compared to 56% in 1998. In females 66% binged compared to 58.5% in 1998. The increase in males was significant. 62% of males and 68% of females had never used cannabis compared to 38% in males and 50.5% of females in 1998, a significant reduction. A significant reduction in amphetamine use was reported among both male and female undergraduates in 2008 compared to 1998 and a significant increase in amyl nitrate use was reported by females. Reported illicit drug use was associated with alcohol drinking, and particularly with tobacco use. Conclusion Dental undergraduates at one English university in 2008 when compared to those in 1998 are reported to be significantly less likely to drink alcohol, use cannabis and amphetamines. If female, they are significantly less likely to smoke tobacco and overestimate the number of units of alcohol they can safely consume in a week, but more likely to use amyl nitrate. If male, those who drink alcohol are significantly less likely to drink at a level of increased risk, but more likely to binge drink.

Uti OG; Sofola OO. Smoking cessation counseling in dentistry: Attitudes of Nigerian dentists and dental students. Journal of Dental Education 75(3): 406-412, 2011. (27 refs.)

The study was aimed at assessing the awareness, attitude, practices, willingness, and perceived barriers of dental students and dentists in Lagos University Teaching Hospital, Lagos, Nigeria, in relation to smoking cessation in the dental care setting. An anonymous self-administered questionnaire that contained questions relating to attitudes, views, and perceived barriers to smoking cessation activities in the dental clinic was hand-delivered to all dentists and clinical dental students in 2007. One hundred and thirty-six respondents took part in the study (response rate=81.9 percent). Although 95 percent of the respondents believed that smoking affects the dental management of the patient, only 65 percent always ask their patients about their smoking habits, and only 30 percent have heard about smoking cessation programs. A significantly higher proportion of students always ask patients about their smoking habits compared with dentists (p=0.0017). Also, a significantly higher proportion of dentists (97 percent) advised their patients against tobacco use compared with 77 percent of students (p=0.0000). Only 2 percent and 3 percent agreed that it is their professional responsibility to educate or encourage patients to quit smoking, respectively. Also, 98 percent strongly disagreed that it is within the scope of dental practice to ask about tobacco use, and 86 percent disagreed that tobacco counseling can be effective in helping patients quit tobacco use. Perceived barriers reported were lack of time (88 percent), lack of necessary materials (81 percent), and lack of knowledge of smoking cessation (74 percent). However, 81 percent of the respondents said they are willing to undergo training in tobacco use cessation. Since most of the dentists and dental students had poor attitudes and negative perceptions of smoking cessation activities, possibly due to lack of training and resources to carry it out in the clinics, there is need to include smoking cessation training in the dental curriculum in Nigeria.

Vered Y; Livny A; Zini A; Shabaita S; Sgan-Cohen HD. Dental students' attitudes and behavior toward smoking cessation as part of their professional education. Teaching and Learning In Medicine 22(4): 268-273, 2010 , 2010. (15 refs.)

Background: Dental professionals have a major role in promoting tobacco use cessation (TUC). Purpose: The objective is to assess dental students' knowledge, attitudes, behavior, and perception regarding their potential expected role. Methods: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. Results: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. Conclusions: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

Vogel J; Heard KJ; Carlson C; Lange C; Mitchell G. Dental pain as a risk factor for accidental acetaminophen overdose: A case-control study. American Journal of Emergency Medicine 29(9): 1125-1129, 2011. (12 refs.)

Patients frequent take acetaminophen to treat dental pain. One previous study found a high rate of overuse of nonprescription analgesics in an emergency dental clinic. Objectives: The purpose of this study is to determine if patients with dental pain are more likely to be treated for accidental acetaminophen poisoning than patients with other types of pain. Methods: We conducted a case-control study at 2 urban hospitals. Cases were identified by chart review of patients who required treatment for accidental acetaminophen poisoning. Controls were self-reported acetaminophen users taking therapeutic doses identified during a survey of emergency department patients. For our primary analysis, the reason for taking acetaminophen was categorized as dental pain or not dental pain. Our primary outcome was the odds ratio of accidental overdose to therapeutic users after adjustment for age, sex, alcoholism, and use of combination products using logistic regression. Results: We identified 73 cases of accidental acetaminophen poisoning and 201 therapeutic users. Fourteen accidental overdose patients and 4 therapeutic users reported using acetaminophen for dental pain. The adjusted odds ratio for accidental overdose due to dental pain compared with other reasons for use was 12.8 ( 95% confidence interval, 4.2-47.6). Conclusions: We found that patients with dental pain are at increased risk to accidentally overdose on acetaminophen compared with patients taking acetaminophen for other reasons. Emergency physicians should carefully question patients with dental pain about overuse of analgesics.

Warnakulasuriya S; Dietrich T; Bornstein MM; Peidro EC; Preshaw PM; Walter C et al. Oral health risks of tobacco use and effects of cessation. (review). International Dental Journal 60(1): 7-30, 2010. (222 refs.)

The purpose of this paper is to review the epidemiologic evidence for the effects of tobacco use and tobacco use cessation on a variety of oral diseases and conditions. Exposures considered include cigarette and bidi smoking, pipe and cigar smoking, and smokeless tobacco use. Oral diseases and disorders considered include oral cancer and precancer, periodontal disease, caries and tooth loss, gingival recession and other benign mucosal disorders as well as implant failure. Particular attention is given to the impact of tobacco use cessation on oral health outcomes. We conclude that robust epidemiologic evidence exists for adverse oral health effects of tobacco smoking and other types of tobacco use. In addition, there is compelling evidence to support significant benefits of tobacco use cessation with regard to various oral health outcomes. Substantial oral health benefits can be expected from abstention and successful smoking cessation in a variety of populations across all ages.

Warren CW; Sinha DN; Lee J; Lea V; Jones N; Asma S. Tobacco use, exposure to secondhand smoke, and cessation counseling training of dental students around the World. Journal of Dental Education 75(3): 385-405, 2011. (18 refs.)

The Global Health Professions Student Survey (GHPSS) has been conducted among third-year dental students in schools in forty-four countries, the Gaza Strip/West Bank, and three cities (Baghdad, Rio de Janeiro, and Havana) (all called "sites" in this article). In more than half the sites, over 20 percent of the students currently smoked cigarettes, with males having higher rates than females in thirty sites. Over 60 percent of students reported having been exposed to secondhand smoke in public places in thirty-seven of forty-eight sites. The majority of students recognized that they are role models in society and believed they should receive training on counseling patients to quit using tobacco, but few reported receiving formal training. Tobacco control efforts must discourage tobacco use among dentists, promote smoke-free workplaces, and implement programs that train dentists in effective cessation-counseling techniques.

Wasilewski MDA; Takahashi MK; Kirsten GA; de Souza EM. Effect of cigarette smoke and whiskey on the color stability of dental composites. American Journal of Dentistry 23(1): 4-8, 2010. (33 refs.)

Purpose: To evaluate the effect of cigarette smoke and whiskey on the color stability of resin composites. Methods: Disk-shaped specimens (8 mm x 1 mm) were prepared with five composites in two different shades (n=10). After light-curing, the specimens were stored in dark containers with artificial saliva at 37 C for 24 hours. Baseline color was measured by CIEL*a*b* using a colorimeter (Easy-Shade, VITA). Half of the specimens were subjected to a discoloration process in a cigarette smoking machine (SM) and the other half to an immersion in whiskey (WH) for 24 hours. Another color measurement was performed for discolored specimens. The samples subjected to smoking were immersed in whiskey (SM/WH) and those subjected to whiskey immersion were subjected to cigarette smoking (WH/SM) followed by another color measurement. Color changes (Delta E*) were calculated and submitted to repeated measures 4-way ANOVA and Tukey tests (P < 0.05). Results: The most significant color change was observed after WH/SM (Delta E* = 22.8-31.5) discoloration process, followed by SM (Delta E* = 7.0-18.0), SM/WH (Delta E* = 4.9-16.5) and WH (Delta E* = 2.0 to 9.5). Translucent shades were more susceptible to discoloration than enamel shades. All the groups, with the exception of two, showed a significantly high perceptible color change (Delta E* > 3.3). Based on the results, the color stability of dental composites was affected by the discoloration process and was material and shade dependent.

Yagoubian B; Akkara J; Afzali P; Alfi DM; Olson L; Conell-Price J et al. Nicotine nasal spray as an adjuvant analgesic for third molar surgery. Journal of Oral and Maxillofacial Surgery 69(5): 1316- 1319, 2011. (14 refs.)

Purpose: To determine the efficacy of preoperatively administered nicotine nasal spray (3 mg) for analgesia after third molar (TM) surgery. Materials and Methods: A single-center, prospective, randomized, double-blind, crossover trial was conducted. The study population consisted of 20 nonsmoking patients referred to the Department of Oral and Maxillofacial Surgery of Columbia University College of Dental Medicine for extraction of all 4 TMs. Each patient received nicotine nasal spray or placebo spray before TM surgery. At a subsequent visit the contralateral TMs were removed with prior administration of the alternate treatment. For an hour postoperatively, subjects reported information on pain and nausea, and hemodynamic variables were recorded at 15-minute intervals. Telephone follow-up was recorded for 5 days postoperatively, where patients reported information on pain, nausea, and use of hydrocodone/acetaminophen as rescue analgesia. Results: Nicotine treatment was associated with a highly significant decrease in pain reported during the 5 days after TM surgery. There was no difference in the amount of hydrocodone/acetaminophen used or amount of nausea reported. There was a small but significant increase in heart rate after nicotine treatment compared with placebo during the first hour after surgery. There was no difference in blood pressure between groups. Conclusion: Pain is well controlled by hydrocodone/acetaminophen in most patients after TM surgery. However, there is significant variability in pain reported. Nicotinic agonists represent a new class of analgesic that can be considered for patients who are expected to have significant opioid-resistant pain after TM surgery. Caution should be used with patients in whom a small increase in heart rate would be deleterious.

Zadik Y; Zusman SP; Galor S; Dinte AF. Dental attendance and self-assessment of dental status by Israeli military personnel according to gender, education, and smoking status, 1998-2006. Military Medicine 174(2): 197-200, 2009. (19 refs.)

Objective: The goal of the study was to analyze dental attendance and self-assessment of dental status among Israeli military personnel, according to gender, education, and smoking status. Methods: Data were analyzed from a computerized questionnaire on dental attendance and dental status, completed by military personnel who attended one medical clinic for the required periodic medical examination between 1998 and 2006. Results: For 60% of the respondents, the last dental visit was within the previous 12 months. The last dental visit was for scheduled treatment for 49.8%, a dental examination for 21.5%, and emergency dental treatment for 12.2%. College graduates rated their dental self-care higher than non-college graduates, and nonsmokers rated their self-care higher than smokers. Of the participants, 50.9% considered their own dental status good or excellent and 7.2% considered their oral health status poor. No significant differences were found according to gender. Conclusions: The findings indicated high dental attendance but low self-perception of dental status in Israeli military personnel in comparison with the Israeli general population and low attendance in comparison with U.S. Army personnel. A compulsory periodic dental examination among Israeli military personnel, similar to the required periodic medical examination, is recommended.