A randomised controlled trial of 'brief' smoking cessation advice and NRT, delivered by dental hygienists, to patients in a dental setting
The role that dental team members can play in the smoking cessation field is largely unevaluated. The work of this PhD thesis encompasses two phases, the first was to develop a means of determining smoking status, using analysis of continine, a nicotine metabolite. The second phase looked at the efficacy of dental hygienist-delivered smoking cessation advice in a dental setting. The aim of the first study was to compare continue levels in different biological fluids collected from both smokers and non-smokers, and to relate the findings to self-reported smoking status. Patients recruited to the study were asked to provide samples of urine, blood and saliva (both stimulated and unstimulated). Data collected from patients by questionnaire included information on smoking behaviour, such as daily number of cigarettes smoked, and environmental exposure to smoke. Following sample collection, patients were asked to rate the acceptability of each sampling method. Samples were analysed using enzyme immunoassay (EIA) kits. In total, 80 patients participated, with 49 smokers and 31 non-smokers. There was clear differentiation between smokers and non-smokers (p<0.001) for all the different samples in terms of cotinine concentration. A significant relationship was seen between cotinine levels and daily number of cigarettes for both salivas and urine (all p < 0.001) but not for serum. Participants found serum and urine collection methodologies 'very acceptable' (67% and 66%, respectively) whereas 9% found collection of stimulated saliva 'not at all acceptable'. Thus, continine, as analysed by EIA kits, whatever the collection method, shows good differentiation between smokers and non-smokers. Salivary samples have the advantage of being non-invasive. However, collection methodology is important, as continine levels may vary.