Dental Student's Awareness and Perception toward Nicotine Replacement Therapy in Riyadh Region Saudi Arabia.

Background: Tobacco use is one of the leading causes of death in the world. Dentists have a greater role in tobacco cessation and counseling. Dental institution is a platform from where they can inculcate the habit of tobacco counseling. Nicotine replacement therapy (NRT) aims to reduce motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms through the delivery of nicotine.
Objectives: The aim of this study is to assess dental students' awareness and perception toward NRT. Materials and
Methods: A cross-sectional study was done on 348 dental students studying in different universities in Riyadh Region, KSA. Questions related to awareness of NRT, perception, and motivation to use NRT were asked. Statistical Analysis: Data were analyzed using descriptive statistics; Chi-square test was used to compare results according to the year of study.
Results: About 74.4% of participants were aware of NRT nearly 50% of students think motivating about NRT is waste of time. About 65.2% of the students think it is difficult to quit smoking.
Conclusion: It is necessary to consider programs giving importance about tobacco cessation and NRT among dental students. Copyright:

INTRODUCTION

Tobacco used in various forms chronically can lead to the death of a significant proportion of the population, attributing different pathologies in individuals globally. The use of tobacco can cost 10 years of their life and also diminishes individuals' health by damaging different systems of the body.[1]

The general health of the patient can be significantly improved by stopping tobacco use, even after using for extended periods in various forms, further smoking cessation prevents negative episodes involving major systems.[2]

Initially, when the patient stops using tobacco, the symptoms are worse with maximum craving, the situation should be complimented by the use of nicotine replacement therapy (NRT), which is available worldwide and very safe to use which substitute nicotine from the cigarette in the initial weeks of tobacco cessation availing buffer time for a patient to overcome the withdrawal symptoms.[34]

The most effective way is to stop smoking with self-motivation and emotional support from family; still, NRT is required for an initial console of individual and it is established fact that failure of smoking cessation after a year is a possibility encouraging the use of NRT for an extended period to assess long-term use.[5]

Many studies have been done to evaluate dental professionals' awareness and perception regarding tobacco abstinence counseling, while there are very few studies which assessed their knowledge and perception toward NRT; hence, the current study was conducted to analyze awareness, acceptance, knowledge, and perception of dental students towards NRT in a teaching institution at Riyadh City, Kingdom of Saudi Arabia. Appreciation and implementation of NRT in dental routine practice by professionals play a very relevant role in encouraging an individual for tobacco abstinence.

Objectives

To assess and compare the awareness and perception of dental students toward NRT

MATERIALS AND METHODS

The survey included 348 dental students studying in the 4th, 5th years and internship in different universities in Riyadh Region KSA.

The need of the study was explained and received consent for the same. The ethical clearance and consent for execution of the study in the institution were achieved through proper means. Based on the detailed analysis of literature, structured questionnaire was framed with the assistance and guidance of panel of academic experts to achieve validated and relevant questionnaire.

The questionnaire composed of ten questions, which were slotted in to three categories to assess awareness about NRT, acceptance toward NRT, implementation of NRT and self-experience toward NRT. Response assessment was carried out to structure the results and to carry out statistical analysis this questionnaire survey was conducted through digital platform using Whatsapp, Snap chat, and Google forms. Subjects were asked to fill the questionnaire and resend without discussing it with anyone. Nature and purpose of the study were explained with a brief introduction.

Response assessment was carried out to structure the results and to carry out statistical analysis.

Statistical analysis

Statistical analysis was performed using IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, N.Y., USA). Chi-square test was used for comparing awareness and perception toward NRT according to the year of the study. Results were expressed as numbers and percentages. P < 0.05 was considered to be statistically significant.

RESULTS

Three hundred and forty-eight dental students were involved in the study and participation response was 100%, and the questionnaire was designed to assess general awareness and knowledge, attitude, and implementation of NRT. About 74.7% of dental students were aware of the existence and use of NRT, while the rest surprisingly was unaware. About 31.3% knew about nicotine gum patches, 27.9% knew about nicotine patches and 17.2% were aware of intranasal spray, which has to be administered with the supervision of professional and 23.6% were certain that any of the above can be used [Table 1].

Table 1

Response of the study participants to questions related to nicotine replacement therapy

Question	Response	Frequency (%)
Have you ever heard about NRT?	Yes	260 (74.7)
	No	88 (25.3)
Does smoking cessation includes NRT?	Yes	260 (74.7)
	No	88 (25.3)
NRT can be availed in which of the following form?	Gum patch	109 (31.3)
	Nicotine patches	97 (27.9)
	Intranasal spray	60 (17.2)
	Any of the above	82 (23.6)
Do you think dentist has a role in tobacco cessation?	Yes	253 (72.7)
	No	95 (27.3)
Do young age motivating others for tobacco cessation by saying about NRT?	Yes	142 (40.8)
	No	206 (59.2)
Do you think motivating is waste of time?	Yes	175 (50.3)
	No	173 (49.7)
Have you ever tried for NRT?	Yes	223 (64.1)
	No	125 (35.9)
Is it a difficult task to quit?	Yes	227 (65.2)
	No	121 (34.8)
Media preferred to gather information on NRT?	TV or radio	124 (35.6)
	Internet	174 (50.0)
	Newsletter and books	50 (14.4)

NRT: Nicotine replacement therapy

On the assessment of attitude, it was noted that 72.7% of students thought NRT has a significant role in tobacco cessation, but only nearly half of the students admitted that they motivated to use NRT and 49.7% of the students think its waste of time. About 64% of the students have tried NRT and 65.2% think it is a difficult task to quit smoking and as expected 50% of students prefer Internet to seek information about NRT.

Table 2 shows the comparison of awareness and perception of dental students according to the year of study. There was no statistically significant difference with most of the questions (P > 0.05) except for the questions related to the use of NRT and the opinion that it is difficult to quit smoking (P < 0.05).

Table 2

Comparison of knowledge on nicotine replacement therapy according to the year of the study

Question	χ 2	P	Significance
Have you ever heard about NRT?	0.035	0.902	NS
Does smoking cessation includes NRT?	0.094	0.806	NS
NRT can be availed in which of the following form?	5.067	0.167	NS
Do you think dentist has a role in tobacco cessation?	1.870	0.187	NS
Do you engage motivating others for tobacco cessation by saying about NRT?	0.071	0.828	NS
Do you think motivating is waste of time?	1.154	0.286	NS
Have you ever tried for NRT?	4.43	0.044	Significant
Is it a difficult task to quit?	12.24	0.001	HS
Media preferred to gather information on NRT?	1.023	0.600	NS

NRT: Nicotine replacement therapy, NS: Not significant, HS: Highly significant

DISCUSSION

Smoking tobacco not only diminishes general health and causes pathologies to an individual, it also carries the financial burden to the families depreciating quality of life. Smoking not only affects an individual physically and socially but also financially, smokers spend a significant amount on smoking. Because of the failed past of tobacco abstinence effectively, they generally don't attempt again anticipating disappointment. Further intercepting it as an impossible task to withstand withdrawal symptoms.[678]

Combination of psychological assessment, support, and various pharmacological means have been found to be useful in the cessation of smoking to overcome immediate withdrawal symptoms.[9] NRTs and non NRTs are the two effective, easily available current options to assist patients to withstand symptoms effectively. NRTs available in various forms as nicotine gums, nicotine patches and professionally supervised nasal sprays to inhibit cravings.[10]

Dental schools can be a bridge to impart good knowledge among dental students about tobacco abstinence program to practice regularly during patient management from the beginning of their clinical career. This effective pharmacotherapeutic tool should be known well by the upcoming budding dentists with through knowledge of each aspects, merits and demerits of the same, and also should develop positivity in inculcating and encouraging in patient tobacco abstinence program.[11]

In the present study, dental students were assessed with their general awareness, knowledge, attitude, and implementation of NRT. We received a good response of participation and 74.7% of dental students were aware of the existence and use of NRT, while rest surprisingly was unaware. About 31.3% knew about nicotine gum patches, 27.9% knew about nicotine patches and 17.2% was aware of intranasal spray, which has to be administered with the supervision of professional and 23.6% were certain that any of the above can be used. On the assessment of attitude it was noted that 72.7% of students thought NRT has a significant role in tobacco cessation but only nearly half of the students admitted that they motivated to use NRT and 49.7% of the students think its waste of time. About 64% of the students have tried NRT and 65.2% think it is a difficult task to quit smoking and as expected 50% of students prefer Internet to seek information about NRT.

Minimal understanding, lack of awareness and confidence in dentists regarding encouragement of patient for tobacco abstinence program is complimented by difficulties like resistance and inhibitions exhibited by patients and lack of time.[12] Only 14.4% seek information on NRTs through books, newsletter, and professional publications, indicating a lack of interest on printed study material leading to screen dependency. Lack of awareness and knowledge among dental students and dental practitioners to encourage tobacco cessation through the conception of NRT professionally and morally by consoling a patient indicates there is a need of inculcating thorough knowledge about NRTs in the dental curriculum and educating dentists through the continuous education program.[13]

CONCLUSION

The present study reveals 74.7% of dental students were aware of NRT but lacks about knowledge of how it is delivered. Motivating others by the use of NRT was considered by 40.8% of the students only. There is need of implementation of guidelines to set more knowledge and awareness among dental students. As the current study involved only dental students, further study needs to be conducted among practicing dentists and postgraduate students to assess their general awareness, acceptance, self-experience, and implementation of NRT.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.