Periodontal disease and oral health-related quality of life
: smoking cessation adventures in primary dental care

  • Karen Emslie

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Much of the workload of primary dental care teams in remote-rural Scotland consists of treating periodontal disease, an inflammatory condition for which smoking is a proven risk factor.

    This thesis sought to ascertain the effectiveness of a smoking cessation intervention applied in a primary care dental setting and employed a narrative literature review to explore periodontal disease, smoking and smoking cessation interventions. This literature review informed the design of a randomised controlled trial which failed due to lack of recruitment.

    The Medical Research Council Framework for the Development and Evaluation of Complex Interventions was employed to provide structure to the modelling of a feasibility trial likely to succeed in evaluating the benefit of smoking cessation provision in rural dental settings.

    A systematic literature review was undertaken to evaluate evidence regarding prevalence of periodontal disease, tobacco use and the effectiveness of tobacco cessation interventions applied in remote-rural areas. This identified a dearth of robust evidence particularly in relation to smoked tobacco. In order to model a feasibility study better adapted to the current study population, a prevalence study exploring the smoking attitudes and behaviours, the oral health-related quality of life and periodontal status of 398 dental patients was undertaken at the two study locations.

    Twenty three percent of the participants were found to be smokers and periodontal health was significantly poorer in those who smoked. Both smokers and non-smokers strongly agreed that dentists should be involved in provision of smoking cessation activities.

    The willingness of smokers to quit was not related to the degree of periodontal disease they experienced, suggesting that periodontal health is not valued sufficiently to factor into a decision to stop smoking. However periodontal health and smoking status both impacted greatly on oral health-related quality of life.

    It is recommended that a feasibility trial be undertaken in remote-rural primary dental care of a smoking cessation intervention which forms an integral part of periodontal care and focuses on improving quality of life parameters rather than periodontal measures.
    Date of Award2014
    Original languageEnglish
    SponsorsNHS Education for Scotland
    SupervisorRuth Freeman (Supervisor) & Andrew Hall (Supervisor)

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