Dentists should help smokers quit

Dentists should be given a bigger role in helping smokers quit their deadly habit, a leading member of the British Dental Association (BDA) has said.

Janet Clarke, chairwoman of the BDA's central committee for community and public health, told a meeting on tobacco control that the potential of dentists to spot early signs of mouth and gum cancer and help people quit was often overlooked.

But she said, for the best results, the NHS contract would have to be changed so that dentists could be paid to offer preventive care to stop patients smoking.

Dr Clarke told a fringe meeting at the Labour Party autumn conference in Manchester, organised by the BDA and Cancer Research UK: ‘Tobacco use is a major issue in oral health, and we care about the damage to teeth and mouths as well as overall health.

‘It is a major risk factor for all cancer, and over 90% of people who develop oral cancer smoke or chew tobacco.'

Dr Clarke warned that the prevalence of oral cancer was increasing among the under-50s, who were more likely to have to live with the effects for longer. She said: ‘Dentists want to see much tighter tobacco control. We see the effects of tobacco every day when we look in patients‚ mouths, we see diseased gums, stained teeth, and increasingly cases of oral cancer.'

Dr Clarke, who is a practising NHS dentist in Birmingham, described the potential for dentists to assist in health promotion as a ‘unique opportunity', given the habits of many people to visit a dentist on a regular basis.

She told the meeting: ‘Dentists are well placed to spot signs of early tobacco disease. We can engage patients in smoking cessation activity. There is a role for dentists in giving preventive advice.'

Dr Clarke argued that the new dental contact, which gave primary care trusts the power to commission services, provided a ‘huge opportunity, potentially, for really imaginative commissioning', including the placement of dentists in deprived areas or in schools to boost smoking cessation.

But, she added, paying dentists for completed courses of treatment based on the unit of dental activity (UDA) had led to the setting of ‘unrealistic targets' that created a ‘disincentive' for practitioners to carry out such preventive work.

Dr Clarke said: ‘We need to encourage PCTs to have set contracts with NHS dentists that get away from UDAs and have broad outcome measures linked to delivering more preventive care.' She called for Primary Care Trusts to commission smoke cessation activity from dentists ‘so they can do it and be rewarded for it'.

Turning to Public Health Minister Dawn Primarolo, who also spoke at the meeting, Ms Clarke said: ‘Give us the tools to do the job properly when patients come to see us. Without changing any legislation, we could involve people working at the coalface a lot more.' She added: ‘NHS dentistry is sometimes the forgotten NHS service. Dentists‚ potential can be overlooked. It is time to improve the integration of NHS dentistry in primary care and improve communication between doctors, health authorities and dentists, so our expertise can be used in the battle against smoking.'

Public Health Minister Dawn Primarolo told the meeting that seven out of ten smokers said they wanted to quit. Setting out plans to consider banning brand logos on tobacco packaging and removing cigarettes from public display in shops, she said: ‘We also have to make sure [cessation] services are there reaching out to people in the workplace, in communities, to parents, with advertising, through dentists, local authorities and community groups, so people are having the information provided to them.'

Richard Davidson, of Cancer Research UK, said the restrictions on smoking in workplaces, that came into force in England in July 2007, had resulted in a ‘sea change' in behaviour, with more than 400,000 people quitting the habit in the first year since their introduction. But, he added, 22% of the population still smoked and one in every two smokers would die as a result of a long-term habit.

 Posted on : Thu 23rd - Oct - 2008