Impact of a novel oral health promotion program on routine oral hygiene among socioeconomically disadvantaged smokers: results from a randomized semi-pragmatic trial

Abstract

Smokers are at high risk of oral disease and report sub-optimal oral hygiene. Improving smokers' oral hygiene could reduce their future disease risk. The purpose of this study is to assess the effects of a novel, multi-modal oral health promotion program (Oral Health 4 Life; OH4L) targeted to socioeconomically disadvantaged smokers and delivered through state-funded tobacco quitlines. Smokers (n = 718) were randomized to standard quitline care or standard care plus OH4L. OH4L recipients received a comprehensive behavioral intervention and were advised of the benefits of routine oral hygiene, encouraged to brush and floss daily (for better oral health and to manage cigarette cravings), and provided a toothbrush and floss. Participants were followed for 6 months to assess the intervention effects on routine oral hygiene (brushing and flossing) and changes in motivation and self-efficacy. Data were collected between 2015 and 2017. At 2-month follow-up, OH4L participants were more likely to meet the American Dental Association (ADA) recommendations for brushing twice daily (adjusted RR = 1.15 [1.04, 1.27], p = .006), flossing daily (adjusted RR = 1.20 [1.03, 1.39], p = .02), and for both brushing and flossing (adjusted RR = 1.33 [1.10, 1.61], p = .003). Daily flossing was more likely at 6-month follow-up (adjusted RR = 1.21 [1.04, 1.42], p = .02) among OH4L participants. The change in self-efficacy and motivation for daily flossing from baseline to 2 months was significantly greater among OH4L participants and mediated the intervention effect on flossing at 6 months. Integrating oral hygiene promotion with standard tobacco quitline services improved oral health self-care.

Keywords: Flossing; Oral health; Oral hygiene; Self-efficacy and Motivation; Smoking; Tooth brushing.

Fig 1

Study CONSORT diagram. ¹Excludes people known to be ineligible per Quitline intake data (n = 1,072). ²Primary reasons were: No internet access (n = 2,283), seen dentist in prior 6 months (n = 1,051), lost all natural teeth (n = 693), prior diagnosis with psychosis (n = 373), no text messaging capacity (n = 351), unwilling to discuss oral health (n = 303), dental appointment already scheduled (n = 233), and planning to move in next 6 months (n = 170). ³Individuals ineligible and mistakenly randomized. Immediately removed from sample, not offered treatment, and not followed for data collection. Reasons for ineligibility were not mutually exclusive and included: enrolled in another study already (n = 1), lived with an enrolled participant (n = 1), did not own cell phone/could not receive text messages (n = 2), already quit smoking (n = 4), not eligible per state’s change to eligibility criteria for multi-call quitline program (n = 12). ⁴Reasons for loss to follow-up were not mutually exclusive and include failure to reach participants at either 2 or 6 months. Reasons include: deceased at time of contact (n = 2), too ill to participate (n = 4), refused participation (n = 28), and unable to be reached (n = 213).