A Qualitative Study of Tobacco Dependence Treatment in 19 US Dental Hygiene Programs

Abstract

IntroductionThe US Public Health Service calls for health professionals to provide tobacco dependence counseling for patients. The purpose of this study was to understand how dental hygiene programs make decisions about and provide training for tobacco dependence counseling to help them graduate more fully competent hygienists.MethodsWe conducted interviews (N = 32) with mainly program and clinic directors from 19 US dental hygiene education programs for this qualitative case study. We explored fluoride therapy training and tooth whitening training for comparison. Two analysts summarized the transcripts into a case study for each program.ResultsAll programs reported a similar process of learning about and choosing a method for teaching the topics explored. The programs used a common process, ADPIE (assess, diagnose, plan, implement, evaluate), to structure students’ clinical encounters. Almost all programs train students to ask about tobacco use and to advise quitting, but few programs train students to effectively help patients to quit and only 2 programs evaluated the competence of all students to provide such training. ADPIE shows promise for integrating tobacco dependence treatment more fully into the clinical training of dental hygiene students. Comparison to tooth whitening and fluoride therapy training indicated that complexity of the treatment and alignment with dental hygiene’s mission were themes related to training decisions.ConclusionFull implementation of tobacco dependence counseling into dental hygiene education requires a commitment by dental hygiene educators to train students and faculty in counseling techniques and their evaluation. We identified an existing clinical structure as showing promise for facilitating improvement.

Tobacco Dependence Education in U.S. Dental Assisting Programs’ Curricula

“…Though few dental assisting programs in our study noted the presence of a faculty champion, the program directors appeared to be supportive of TDE and desired more opportunities for faculty training and resources. Koerber et al noted that although it may be helpful to have a faculty tobacco champion, it can be a mixed blessing because if that individual leaves the program, a void in TDE may result 33 . As such, they recommended that all faculty members be trained in tobacco dependence treatment.…”

“…Considering that the American Dental Education Association (ADEA) Competencies for the New General Dentist include the need for graduates to be competent in recognizing and managing substance abuse, dental programs have sought to enhance their tobacco‐related curricula, clinical experience for students, and policies 20 , 29 , 30 . Compared to other health professions schools, dental hygiene programs devote a far greater number of clock hours to TDE, 31 although few of them train and assess on the more complex elements of the 5As 31 – 33 . Additionally, assessment is often informal, and there are minimal standards for TDE across curricula 19 , 34 …”

An assessment of oral cancer curricula in dental hygiene programmes: implications for cancer control

“…Recognition by oral health practitioners of the risks associated with tobacco use has been widely studied, and dental hygienists, in particular, have been assessed regularly for their ability to counsel patients on tobacco use (33)(34)(35). The programmes in Illinois uniformly teach assessment and counselling for tobacco use.…”