“COMPARISON OF SMOKERS AND NON-SMOKERS KNOWLEDGE AND AWARENESS OF SMOKING EFFECTS ON GENERAL and ORAL HEALTH

1. College of Dentistry, Taibah University of Medina. 2. College of Dentistry, Taibah University of Medina. 3. Associate Professor of Periodontology and Oral Medicine BDS (University of Alexandria), MSc. (University of Alexandria), Ph.D. (University of Khartoum) FSMSB, (Sudan Medical Specialization Board). ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 5(1), 2054-2060 2055 Smoking has been established as a risk factor for death from several systemic diseases, including lung cancer, respiratory diseases, and cardiovascular disease. 1,2 Smoking has also been demonstrated to affect the oral health of smokers in a variety of way ranging from cosmetic effects, such a teeth staining or discoloration, to potentially harmful life-threating conditions such as oral cancer. 1,3 Some of the reported effects of smoking on oral health include increased susceptibility to periodontal disease, reduced response to both surgical and nonsurgical periodontal therapies, 4,5 .Also there is an increased risk of dental implant failure 6 and a higher risk for cancer and precancerous lesions. 7,8 In susceptible patients, the clinical effects of smoking depends on number of cigarettes smoked daily and the duration of habit. 9 Passive smoking includes inhalation of smoke from smoker's cigarette to anther individual and it can cause increased allergic reaction against specific allergens, reduced lung function and increased asthmatic attacks in patient with asthma. Despite the above established adverse effects of smoking on oral health, few studies examining dental patient's knowledge and awareness of such effects are available. 10,11 Moreover, the available studies have focused mainly on oral cancer and only a very few have examined the awareness regarding other oral health aspects, affected due to smoking. The aim of this study is to assess the awareness of smoking's effects on oral and general health among smoker and non-smoker dental patients.

Study objectives:-
To assess the differences in knowledge and awareness of dental patient to the effects of smoking on oral and general health between smokers and non-smokers.

Study design:-
A cross-sectional analytic study using a self-administered questionnaire was given to patients attending the dental clinics in College of Dentistry at Taibah University.

Sample size:-
The new patients attending the dental clinics in College of Dentistry during 2015 were 11,303. Using the Roasoft sample size calculator1. with a marginal error expected of 5%, 95% confidence level and a response distribution of 50%.Itwas calculated that the sample size would be 372 with an additional 10% expected drop out the total sample size was calculatedas 418 participants.

Patient selection:-
Systemic random sample, a list patient in ascending manner in three days a week for two months and will be chosen patient number (1-3-5-7….)

Inclusion criteria:-
Smoker and non-smoker attending to dental clinics in College of Dentistry at Taibah University 2. Data will be collected coded and locked in a password-protected computer at the principal investigator office to ensure confidentiality and privacy of patient data.
Statistical Analysis:-Data entry and analyzes of results will be done using the Statistical Package for Social Sciences (SPSS) ver 21 for Windows software2. Descriptive statistics such as mean and standard deviation (SD) for continuous variables and frequency and percentage for categorical variables will be determined. Inferential statistics will then be followed using parametric and non-parametric test for univariate analysis followed by multivariate analysis using logistic regression. The level of significance is set at p< 0.05.

Results:-
The present study was a cross-sectionaldescriptive study conducted to assess perception of dental patients visiting Dental College and Hospital about comparison of smokers and non-smokers awareness of smoking effects on oral health as a part of oral health care delivery. All 418 subjects completed the questionnaire, with response rate of 100%. of 418 subjects, 51.9% were smoker, 48.1% were nonsmoker.
A cross-sectional analytic study using an online anonymous self-administered participant filled in the appropriate responses. The study was conducted among patients attending the Dental clinics at Taibah University in Al-Medina Al-Munawarah.
A total of 418 respondents responded to be enrolled in the survey. Out of the 418 respondents, 51.9% were smokers and 48.1% were not ( Table 1).
The comparison between smoker and non-smoker with age group, the smokers group was higher between (31-50) 57.1%, also as compared betweensmokers and non-smokers in avoidreading about the hazards of smoking in newspapers, magazines and Emailssmokers who totally agree was totally agree64.5% ( Table 2).
The difference in knowledge between participants about the background on the diseases that may result from smoking.82.4% of smokersstated yes while 63.5% of non-smokers stated yes ( Table 3).
The difference in knowledge between participants about the smoking causes lung cancer. 88.4% of smokers stated yes while 94% of non-smokers stated yes ( Table 3).
The difference in knowledge between participants about the smoking causes heart disease.90.7% of smokers stated yes while 89.5% of non-smokers stated yes ( Table 3).
The difference in knowledge between participants about the smoking causes discoloration of the teeth.89.8 of smokers stated yes while 94% of non-smokers stated yes ( Table 4).
The difference in knowledge between participants about the smoking causes a foul odour of the mouth. 67.8% of smokers stated yes while 94.5% of non-smokers stated yes ( Table 4).
The difference in knowledge between participants about the smoking causes tooth decay. 52.1% of smokers stated yes while 69.7% of non-smokers stated yes ( Table 4).
The difference in knowledge between participants about the smoking causes gum disease.47% of smokers stated yes while 91% non-smokers stated yes ( Table 4).
The difference in knowledge between participants about the smoking causes cancer diseases, including oral cancer. 63.9% of smokers stated yes while 90% of non-smokers stated yes (Table 4).

Discussion:-
In Saudi Arabia, the use of tobacco is a common in the form of cigarettes and shisha. Cigarettes smoking affects oral health in a variety of ways ranging from staining to various serious conditions like oral cancer. Between these two extremities, there are various effects of smoking on oral health which thought not as a severe oral cancer still present potential for significant oral health morbidity and tooth mortality (1) .
In the current study, the awareness among patients about the difference in knowledge between participants about the smoking causes lung cancer. 88.4% of smokers stated yes while 94% of non-smokers stated yes. Was good in comparison with the study of Poonam Sood, Ridhi Narang, 82.8% of smokers stated yes, and 91.4% of non-smokers stated yes.However less compared with M. Terrades, 97.2% of smokers stated yes, and 99.2% of non-smokers stated yes (2), (3) .
The knowledge about relationship of smoking and heart diseases, 90.7% of smokers stated yes, and 89.5 of nonsmokers stated yes. Was also higher in comparison with the study of Poonam Sood, Ridhi Narang, 71.7% of smokers stated yes, and 73.6 of non-smokers stated yes. However less compared with M. Terrades, 92.3% of smokers stated yes, and 95% of non-smokers stated yes (2), (3) .
The higher knowledge may be because many campaigns and advertisements have focused on smoking causative factors for lung cancer and heart diseases The difference in knowledge between participants about the smoking causes discoloration of the teeth.89.8 of smokers stated yes while 94% of non-smokers stated yes. Was good in comparison with the study of Poonam Sood, Ridhi Narang, 80.8% of smokers stated yes, and 84.16% of non-smokers stated yes.However less compared with M. Terrades, 93,1% of smokers stated yes and 99.2% of non-smokers stated yes (2), (3) .
The difference in knowledge between participants about the smoking causes a foul odor of the mouth. 67.8% of smokers stated yes, while 94.5% of non-smokers stated yes. Was less in comparison with the study of Poonam Sood, Ridhi Narang, 89.8% of smokers stated yes, and 95% of non-smokers stated yes . also less compared with M. Terrades, 87.5% of smokers stated yes, and 99.2% of non-smokers stated yes (2), (3) .
The difference in knowledge between participants about the smoking causes tooth decay. 52.1% of smokers stated yes while 69.7% of non-smokers stated yes.When this association has never been proved. 2059 answered that there is no such association. It was good in comparison with M. Terrades, only 10.5% correctly responded that there is no such association (2), (3) .
The difference in knowledge between participants about the smoking causes gum disease.47% of smokers stated yes while 91% non-smokers stated yes. It was good in comparison of non-smokers with M. Terrades, 85.1% stated yes and the study of Poonam Sood, Ridhi Narang 67.7% stated yes. While less in comparison of smokers with M. Terrades, 74.6% stated yes and the study of Poonam Sood, Ridhi Narang 58.5% stated yes (2), (3) .
The difference in knowledge between participants about the smoking causes cancer diseases, including oral cancer. 63.9% of smokers stated yes while 90% of non-smokers stated yes. It was good in comparison of non-smokers with M. Terrades, 89.3% stated yes and the study of Poonam Sood, Ridhi Narang 82.5% stated yes. While less in comparison of smokers with M. Terrades, 78.9% stated yes and the study of Poonam Sood, Ridhi Narang 67.6% stated yes (2), (3) .
This study suggests that smoking cessation should be stressed upon to improve periodontal health and reduce tooth loss among smokers. Dental health campaigns must run awareness programs on the well-proved association of smoking and periodontal diseases Reference. Moreover, dental practitioners should play a crucial role regarding advising and supporting the patients in quitting during regular dentist visits .
The dental team could identify the patients willing to stop smoking and guide them to specialist smoking cessation advice centers. It is recommended to conduct further surveys among the general population covering different age groups and comparative studies in other populations to determine the validity of these results.

Limitations:-
The present study reflects the perceptions of patients attending a dental hospital, so the results should be interpreted carefully as it may not reflect the perceptions of the general populations. Also, hospital setups encourage one to respond favorably. The presence of friends and relatives can have an effect on responses. The patients may not admit their actual smoking status in the presence of relative or friends The favorable responses may social desirability bias.

Conclusion:-
It can be concluded from this study that 1. The dental patients had a sound knowledge about the general and oral effects of smoking. 2. Smokers exhibited a willingness to follow the dentists' advice about quitting smoking.

Recommendations:-
1. It is recommended to conduct such surveys among general population covering different age groups. 2. Dentist should inform their patients about the effects of smoking and strongly advice and help them in quitting and take up a more active role in such activities.