Use of the ‘5As' (Ask, Advise, Assess, Assist, Arrange) preventive practices for tobacco and alcohol risk reduction in dental practice settings among dentists and dental hygienists: Implications for screening and brief interventions for alcohol abuse in dental practice

Screening and Brief Intervention (SBI) protocols for alcohol abuse have been used in various medical practice settings and have been shown to reduce levels of alcohol use as well as to increase treatment utilization. As a majority of U.S. adults report a dental visit annually, implementation of SBI protocols in dental settings may be useful. Further, while tobacco cessation has been promoted in dental settings (eg., the U.S. PSTF 5 A's: Ask, Advise, Assess, Assist, and Arrange or ADHA's 3A's), there has been little discussion of parallel protocols for alcohol reduction. Descriptive data are examined regarding the frequency of 5A preventive practices regarding both tobacco and alcohol reduction from a purposive statewide sample of 257 dental practitioners (164 dentists; 93 dental hygienists) participating in an anonymous web-based survey. ANOVA's comparing dentists and dental hygienist/assistants ratings on 14 variables designed to assess the percentage of patients for which 5A practices are used for tobacco and alcohol indicated: 1) more frequent 5A practices for smoking than alcohol (roughly 75% vs. 28 – 39% for ASK), 2) less frequent use of more ‘advanced' than ‘initial' 5A practices for both tobacco and alcohol (ASK: 75% vs. 35%; ADVISE: 82% vs. 27%; ASSESS: 62% vs. 19%; ASSIST: 33% vs. 7%; ARRANGE: 18% vs. 8%) and 3) more frequent 5A practices by dental hygienists than dentists, though only for tobacco--neither was heavily involved in alcohol reduction activities. Findings suggest using dental hygienists as interventionists as well as building SBI for alcohol upon established tobacco cessation protocols.