A smoking cessation and oral cancer screening program will be implemented at the UDM dental clinic to reduce oral cancer risk among patients. The program will involve screening for oral cancer, education on smoking cessation, and promoting sustainable oral self-exams. Short term outcomes include improved knowledge of oral cancer and decreased smoking. Long term outcomes aim to reduce oral cancer incidence through early detection and prolonged smoking cessation. The intervention is supported by high level evidence from systematic reviews demonstrating the effectiveness of combined smoking cessation counseling and oral cancer screening in dental settings.

1. Oral Cancer Prevention
Group 21
Group Members - Maryan Al Khauri,
Hasanain Alani, Myung Jin Maria
Cho, Kala Mapes, Kyubo Yoon
Community Dentistry
DSD8430

2. Public Health Problem: Oral Cancer
● Includes cancers of the lips, tongue, oral cavity and pharynx.
● Responsible for 2-3 % of all cancer deaths in the United States.
● Among the most debilitating and disfiguring of all cancers.
● The sixth most common cancer type among U.S. white males and the fourth most
common among African-American males.
● 30,000 new cases are diagnosed annually with more than 8,000 deaths occur
annually.
● 5 years survival rate is only 52 %.
● About one- half of cases and majority of deaths occur in people 65 years of age
or older.
● The primary risk factors in the United States include:
– Tobacco
– Alcohol
– Exposure to the sun for lip cancer.
– Human papilloma virus.

3. PICO Question
In the Detroit inner city, how does a tobacco cessation program compared
to oral screenings for disease reduce the risk of oral cancer?

4. Literature Review
1) Smoking Cessation in the Dental Setting.
❖ The authors assessed interventions for smoking cessation (smokeless tobacco
and cigarette smokers) in a dental setting, community school, and college
setting. They found that behavioral counseling conducted by an oral health
provider, including an oral exam, in all settings increases the rate of tobacco
abstinence in prevention of oral cancer.
Level of Evidence: Systematic Review - high

5. Literature Review
2) Intervention Study For Primary Prevention of Oral Cancer Among 36,000 Indian
Tobacco Users.
❖ The authors describe a cohort prospective study, involving tobacco chewers and smokers that were
selected from 3 rural districts in India. These individuals were interviewed for their tobacco habits and
were examined for the presence of oral leukoplakia and other precancerous oral lesions, first in a
baseline survey, and then annually for a 5 year period.
❖ By personal advice and via the mass media they were encouraged to quit or reduce their smoking habits.
A control cohort was provided by parallel study conducted earlier in the same areas with the same
methodology but on different individuals and without any educational intervention.
❖ In two districts, the 5 year age adjusted incidence rate of leukoplakia and other precancerous conditions
in the intervention group was significantly less than the control, and the reduction was consistent across
all tobacco habits and both sexes.
❖ This study demonstrates that changes in tobacco habits of rural population in general can be achieved
through educational effort and that such changes will lead to primary prevention of oral cancer.
Level of Evidence: Cohort Prospective Study- medium

6. Literature Review
3) Dentists’ Perception of the Role they Play in Early Detection of Oral Cancer
❖ This study asked 3 things to dentists in Malaysia - general information on dentist,
early detection of oral cancer, and risk habits associated with oral cancer. The
main result of this study was that there was a significant association between the
levels of confidence with respect to how often a dentist would give advice to
their patients on risk habit cessation.
Level of Evidence: Meta-analyses - high

7. Literature Review
4) Smoking cessation as a part of oral health care delivery – Patient's perceptions:
❖ A descriptive study was conducted in August 2011 using self administered
questionnaire checked for face and content validity by experts. Four groups of 86
patients each who visited dental college and hospital. Descriptive statistics were
done to analyze the data from the questionnaire. There was a noteworthy
variance in the knowledge of smokers and non-smokers about the effects of
smoking and tobacco on oral cancer and aging. Patients had positive insight
about the role of dentists in smoking cessation methods and advice. If advised by
their dentist, patients showed willingness to quit smoking.
Level of Evidence: Cohort Study - Medium

8. Literature Review
5) An Alarming Lack of Public Awareness towards Oral Cancer.
❖ To assess public awareness and knowledge of oral cancer, particularly its
association with tobacco and alcohol use, the authors carried out a survey of
adults over the age of 16 years. The result highlighted a general lack of
awareness among the public about oral cancer and a lack of knowledge about its
causation. It was indicated that oral cancer was one of the least heard of cancers,
and only a low percentage of people were aware of the link between smoking
and oral cancer.
Level of Evidence: Random Omnibus Survey - low

9. Intervention
Article: Interventions for tobacco cessation in the dental setting
INTERVENTION: A Smoking Cessation Program with Oral Cancer Screening
RATIONALE: Tobacco use is the primary risk factor for oral cancer. Oral
cancer screening is a preventive measure for the disease.
LEVEL OF EVIDENCE: High Level of Evidence since our main study was a
systematic review and there was a large volume of data in support of oral
cancer prevention using these methods.

10. Prevention Program
What?
• An ongoing program involving smoking cessation instruction and oral screening
when a patient visits the clinic (our article supports combined program of these
two).
• Pre and post-intervention questionnaires
• Patient compliance follow-up conducted on next dental visit
• Promote sustainable programs to patients - Mouth Self-Examination (MSE)
• Continuing education for dental health providers

11. Prevention Program
Where? UDM Clinic

12. Prevention Program
How?
• Self-assessment of patients - questionnaires and Mouth Self-Examination (MSE)
• Discussion with patients regarding smoking (tobacco, smokeless tobacco,
marijuana, etc.) and the health effects of them
• Describe smoking cessation program we provide at the school
• Suggest medications for smoking cessation such as patches, gum, lozenge, nasal
spray (all nicotine based) + non-nicotine based medications
• Community class or presentation with many visuals, utilize both dental students
and faculty members in education of patients.
• Reward patients if they bring friends, family members, etc.
• Educate dental students how to address smoking cessation program to patients
with smoking habits.
• Analyze data from questionnaires and observation to see things in community
level. Can utilize the result of data to make the program more strategic and
effective

13. Program Outcome
SHORT TERM OUTCOMES:
• Improve the knowledge of oral cancer
• Raise oral cancer awareness
• Decrease smoking habits of patients (give motivation to patients)
LONG TERM OUTCOMES:
• Prolonged smoking cessation
• Improved oral cancer literacy in the community
• Improved oral health care literacy
• Early detection of oral cancer will reduce incidences of further oral
cancer progression in the community
• Give patients active role via Mouth Self-Examination

14. Bibliography
1. Carr, AB, Ebbert, J. (2012). Interventions for tobacco cessation in the dental setting. Cochrane Database
Systematic Reviews, 6, CD005084. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916957/
2. Civljak, M, Sheikh, A, Stead LF, Car J. (2010). Internet-based interventions for smoking cessation. Cochrane
Database of Systematic Reviews. 2010, Issue 9. Art. NO: CD007078.
http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007078.pub3/ful
3. Cruz, G., Ostroff, J., Kumar, J., & Gajendra, S. (2005). Preventing and detecting oral cancer: Oral health care
providers' readiness to provide health behavior counseling and oral cancer examinations. Journal of the
American Dental Association, 594-601.
4. Gupta, P. C., J. J. Pindborg, R. B. Bhonsle, P. R. Murti, F. S. Mehta, M. B. Aghi, D. K. Daftary, H. T. Shah, and P.
N. Sinor. (1986). Intervention Study For Primary Prevention of Oral Cancer Among 36000 Indian Tobacco Users.
The LANCET, 327 (8492): 1235–1239.
5. Horowitz, A. M., T. F. Drury, H. S. Goodman, and J. A. Yellowitz. (2000). Oral Pharyngeal Cancer Prevention
and Early Detection. Dentists’ Opinions and Practices. The Journal of the American Dental Association, 131(4):
453-462.

15. Bibliography
6. Majmudar, V., Mishra, A., Kulkarni, V., Dusane, R., & Shastri, S. (2015). Tobacco-related knowledge, attitudes, and
practices among urban low socioeconomic women in Mumbai, India. Indian J Med Paediatric Oncology, 36(1), 32-27.
Retrieved April 21, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4363848
7. Saleh, A., Kong, Y., Vengu, N., Badrudeen, H., Zain, R., Cheong, S. (2014). Dentists’ Perception of the Role
they Play in Early Detection of Oral Cancer. Asian Pacific Journal of Cancer Prevention, 15, 229-237.
8. Sood, P., Narang, R., Swathi, V., Mittal, L., & Jha, K. (n.d.). Smoking cessation as a part of oral health care
delivery – Patient's perceptions. Journal of Pierre Fauchard Academy (India Chapter), 129-134.
9. Warnakulasuriya, S., Sutherland, G., & Scully, C. (2005). Tobacco, oral cancer, and treatment of dependence.
Oral Oncology, 41. 244-260.
10. Warnakulasuriya, K., Harris, C., Scarrott, D., Watt, R., Gelbier, S., Peters, T., & Johnson, N. (1999). An
alarming lack of public awareness towards oral cancer. British Dental Journal, 319-322.