This is a randomized, controlled trial (RCT) to test the efficacy of an internet continuing dental education intervention designed to increase tobacco cessation counseling in dental practices. The intervention involves surveying practices regarding preventive care, surveying adult patients about their tobacco habits and preventive care provided by dental practice and training/educating the dentist and office staff on tobacco cessation. With patients who smoke and indicate that they have quit, we followed up with testing their saliva for the presence of cotinine. We have enrolled general dentists and periodontists who practice in the Southeastern United States.

Tobacco use has been described as the number one behavioral health problem of our time with a projected 8.4 million total smoking related deaths worldwide by the year 2020. Current clinical practice guidelines entitled "Treating Tobacco Use and Dependence" provide a summary of evidence-based recommendations. Despite the evidence of tobacco risk and the efficacy of tobacco control interventions, 30% of current smokers report that they have never been advised to stop smoking by a healthcare provider. Nearly half (47.9%) of dentists report they have never intervened to assist tobacco users in quitting. Our intervention is designed to improve the rate of tobacco cessation advice delivered in dental practices.

This proposal is in response to the request for applications "Translational Research in Dental Practice-based Tobacco Control Interventions" (RFA: DE-03-007). Our exploration of barriers and facilitators will assist in clarifying processes that influence translation of tobacco-related knowledge into clinical dental practice. Our trial will integrate theoretically grounded methods of provider behavior change, medical informatics, and tobacco control research to translate guidelines into dental clinical practice. We will avoid a "one-size-fits-all" approach by tailoring strategies for tobacco cessation counseling to individual practices. The intervention will be longitudinal, with updates and continuous access for dentists and dental staff over 2 years. Our evaluation will extend from processes of care to patient outcomes. Ancillary analyses will assess differences in tobacco counseling rates associated with practice, provider, and patient-level variables including disparities in counseling by race. To assess the relative impact of various components of the multi-modal intervention, we will conduct secondary analyses of the association of amount of use of each specific component with frequency of tobacco cessation counseling within the intervention group.

Inclusion Criteria:

• general dental practices that have internet access
• Periodontal practices that have internet access
• patients of participating dental or periodontal practices

Exclusion Criteria:

• patients who were 18 years of age and younger