Understanding dental practitioners' knowledge and practices of smokeless tobacco: South Texas Oral Health Network study

Objective: This study, conducted by the South Texas Oral Health Network, evaluated dental practitioners' knowledge, attitudes, and practice behaviors regarding cultural forms of smokeless tobacco (SLT) use and effects, using the 5As (Ask, Advise, Assess, Assist, and Arrange) framework. Methods: Chi-squared tests examined associations between dental practitioners’ characteristics, self-confidence, knowledge, attitudes, and practices. The 5As tobacco cessation intervention steps were analyzed using the Wilcoxon rank sum test to measure changes in the frequency of use between successive steps. Results: The study finds that higher knowledge scores about SLT forms (chewing tobacco, snuff, dip, paan, betel quid, gutka areca nut) were linked to greater adherence to the Assess and Assist of the 5As cessation intervention steps. However, adherence rates to the 5As declined progressively from Ask to Arrange, representing a gap in SLT cessation practice among active dental practitioners. Dental practitioners were found to be more familiar with conventional SLT forms (e.g., snuff) and less with cultural SLT forms (e.g., paan). Conclusion: These findings underscore the need for improved culturally relevant training to enhance practitioner awareness concerning cultural SLT forms and increase progression through the 5As cessation intervention. Practice implications: We anticipate that our findings will highlight the critical need for dental practitioners to be aware of diverse cultural forms of SLT and their associated oral and systemic effects to support cessation efforts effectively, primarily due to the growth of culturally diverse communities in the United States and the corresponding rise in the use of previously unrecognized forms of SLT in dental practices. This study is designed to understand the cultural nuances the practitioner needs to develop and communicate the health hazards and importance of cessation of SLT use in the immigrant and refugee populations. Clinical significance: This study is significant because it highlights the importance of understanding diverse cultural forms of SLT and cessation practices among dental practitioners. Understanding this will enhance awareness and guide training to improve SLT cessation efforts, improve oral health outcomes, and address disparities in diverse patient populations, particularly amidst increasing immigration trends.