Preventing Oral Cancer: a smoking cessation intervention in a dental setting

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Preventing Oral Cancer a smoking cessation
intervention in a dental setting

• Viv Binnie Professor Graham Ogden
• Universities of Glasgow and Dundee Dental Schools

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Why?

• Oral cancer rates have increased 100 over the
  last 15 years.
• Scotland has higher prevalence than England.
• Strong links with deprivation.
• Tobacco smoking is main risk factor.
• Increasing interest in the potential of the
  dental setting in smoking cessation.

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Smoking and Oral Cancer

• 90 are squamous cell carcinomas

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Smoking Cessation and the Dental Team

• The dentist
• Chestnutt Binnie,1995
• John et al, 1997
• The dental hygienist
• Gussy et al,1996.
• Dental practices
• Smith et al, 1998

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PATH grant funds

• Dental staff (hygienists) to deliver smoking
  cessation advice to cohort of patients, recruited
  into a smoking cessation trial.
• Two smoking cessation workshops in Dundee and
  Glasgow.
• timeframe 3 years

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Who and Where?

• Target group
• Patients with potentially malignant oral lesions
• These patients are referred from GMPs and GDPs
  for treatment in the dental hospitals.
• Currently this group get little advice and help
  due to time and resource constraints
• Setting
• Dundee and Glasgow Dental Hospital and Schools

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Potentially malignant lesions Leukoplakia

• buccal mucosa of heavy smoker
• buccal mucosa
• smoker of 2packs/day

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Erythroplakia

• Patient has long history of chronic white and red
  lesions of soft palate
• more likely for malignant transformation than
  white patches

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Aims

• To recruit into a smoking cessation trial, a
  cohort of patients who want further advice and
  help with smoking cessation.
• All smoking patients who attend will be given
  some advice, but we are specifically targeting
  those with the potentially malignant lesions.

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Methods I

• After information and consent from patients-
• Baseline measurements include
• nicotine dependence (FTND)
• readiness motivation to quit,
• quitting history etc.
• Sample of saliva for Cotinine analysis.
• Exhaled air sample for CO analysis.

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Methods II

• Patients randomly allocated to -
• (a) Smoking cessation advice based on the 5As
  (NRT)
• (b) Behaviour Change Counselling (NRT)
• Patients with alcohol issues will be allocated
  into (b)
• Advice given by the trained hygienists.

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Outcomes

• Assessment of quit rates at 3 and 6 months in the
  two groups (5As and BCC)
• Assessment of any changes in smoking behaviour,
  increase in quit attempts.
• Appropriateness of biochemical validation
  methodology.
• Assessment of patients perceptions of the
  services, using qualitative methodology.

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Previous Pilot work

• Dept of Periodontology(Glasgow)
• a randomised controlled trial, using dental
  hygienists to give advice and free NRT
• funded by Smoking Concerns GGHB.
• 118 patients recruited
• Follow-up - 85 at 3m, 62 at 6m.

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Results - Primary Outcomes

• In the Intervention Group
• 17 quit, at 3 months,
• self report biochemical validation.
• In the Control Group
• 12 quit.
• Further analysis underway

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Whats New in Our Study?

• Evaluation of two models of smoking cessation in
  a dental setting.
• Any form of motivational interviewing, or
  derivative has never been used in a dental
  setting
• Biochemical validation- looking at correlation of
  COT and CO.
• Qualitative data from patients undergoing smoking
  cessation advice in a dental setting.

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The End

• BLACK HAIRY TONGUE
• Overgrowth of filiform papillae
• can be black, brown or yellow.
• will disappear on cessation of smoking

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Who is involved?

• Universities of Glasgow and Dundee
• NHS staff at both locations
• Health Promotion

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Survey of GDPs - Glasgow.(Chestnutt and Binnie,
1995)

• 18 routinely recorded smoking status.
• 17 always discussed smoking with patients who
  smoke.
• 64 sometimes discussed smoking with patients who
  smoked.
• 51 always discussed smoking with patients with
  periodontal disease.