Is Tobacco Oral Healthcare's Unwinnable War?

Often dominating a top spot in New Year's resolutions, tobacco is a long known public health crisis. As it turns out, there is quite a lot dentists can do to help patients in their quest to stop smoking.

By Susan Richards

With a highly contagious virus dominating the headlines for the past two years, it can get lost in the noise that one of the largest threats to public health in the world remains the tobacco epidemic. The World Health Organization (WHO) reports that tobacco kills more than 8 million people globally each year, and according to the Federal Drug Administration (FDA), it leads to 480,000 deaths in the U.S.

It’s also shown to be the leading preventable cause of disease, disability, and death in our country.

Tobacco Use by the Numbers: CDC

  • 34 million (or 14% of all) American adults smoke cigarettes as of 2019
  • Over 4.5 million students in middle and high school use at least one tobacco product
  • Almost every human organ is harmed by smoking
  • 1 in 3 cancer deaths in the U.S. is connected to smoking
  • Each year, smoking-related illnesses cost the U.S. almost $400 billion in medical care and lost productivity
  • Although tobacco companies were ordered to stop advertising on television in 1970, the industry still spends more than $8 billion marketing cigarettes and smokeless tobacco. And that figure doesn’t even include electronic products which have risen in popularity in recent years. Whether through cigarettes, smokeless tobacco, vape pens, hookahs, or cannabis – smoking remains a big business.

The First Witness

Among the first to witness the effects and damage from tobacco and other nicotine products is the dentist professional. The line connecting tobacco use to oral-related diseases is direct and clearly recognized. According to the Centers for Disease Control (CDC), more than 16 million adults in the U.S. have a disease linked to cigarette smoking that includes the following oral health conditions:

  • Oropharyngeal cancer
  • Gum disease and recession
  • Tooth decay
  • Bone and tooth loss
  • Implant failure

The risk of periodontal disease increases with tobacco use in any form, and 43% of smokers over 65 had lost all their teeth from 2011-2016. Smokeless tobacco – also known as chew, snuff, or dip – is not only highly addictive, but the many chemicals it contains can also lead to cancer of the mouth, esophagus, and pancreas, among other health risks.

With the growing legalization in many states (no pun intended), dentists are seeing the effects of cannabis use in patients. While marijuana smokers sometimes have overlapping factors such as alcohol and tobacco use, studies show an increase in conditions including xerostomia, gingival enlargement, and inflammation of the oral mucosa, all of which can contribute to poor oral health.

With so many potential danger signs at a dental appointment, what can dentists and hygienists do to support their patients who partake in any of the aforementioned habits? And will it help with the much bigger problem?

Damage Control

Because dental professionals are in a unique position to recognize tobacco use, they also have the opportunity to prevent, advise, and ultimately help patients quit. Inhaled nicotine reaches the brain in 20 seconds, making it comparable to the addictive nature of opioids and alcohol, therefore, simply advising the patient who notes tobacco use on their intake form that smoking is bad for them isn’t likely to be successful.

Dentists and their teams need to take a more proactive role when addressing this aspect of their oral and general health.

According to the WHO, many smokers don’t understand the specific health risks as dental and medical professionals do, but when they’re informed, they’re more motivated to quit. Unfortunately, only 4% of those attempts to quit are successful if there is no cessation support. Reports show that professional help and proven methods can double their chances of quitting successfully.

In a 2016 review by the Journal of Clinical and Experimental Dentistry, the effectiveness of the dentist’s intervention in smoking cessation was investigated in 35 studies. In conclusion, they found that the proven value of smoking cessation programs in dentistry was complemented by pharmacological treatment, as well as the participation of the entire dental team.

One protocol that is used to train dentists about the techniques necessary to support cessation is called the 5 As:

  1. ASK patients about their smoking habits.
  2. ADVISE smokers on how to quit.
  3. ASSESS treatment progress.
  4. ASSIST smokers who want to give up smoking.
  5. ARRANGE a follow-up.

There are both behavioral therapies and FDA-approved medications available for the motivated patient, including nicotine replacement therapy, or NRT. Research shows that a combination of these efforts will increase success rates over little or no interventions.

Cessation plans should be personalized where possible, as people who use nicotine will be driven by different reasons and rewards. For example, one patient might be more motivated to quit because of discolored teeth than the fear of periodontal disease. Because some treatments may take place out of the dental office, it’s important to pay attention to the assessment and follow-up factors of the 5 As.

Calling All Dentists

While the health benefits for the dental patient who quits smoking or other addictive nicotine habits are evident, a recent report from the ADA Clinical Evaluators Panel (ACE) showed a surprisingly low number of dentists who offer cessation counseling, treatment, or both. Among 283 ACE members, 49% offered neither, and interestingly, a fourth of those indicated they were current or past users of cigarettes, vaping products, or smokeless tobacco.

A full 90% of the dentists who did offer counseling or treatment said they were personally involved in conversations with their patients, and many were willing to prescribe pharmacologic agents to help them quit.

Indeed, the Surgeon General’s 2020 report on smoking cessation states that quitting at any age will improve health, increase life expectancy, and enhance quality of life. For those reasons, our patients should come to expect their dentist or hygienist to ask about nicotine use and to be advised on the impact it has on their oral health.

While they may not be successful in their first – or 20th – attempt to quit, dental professionals can increase their patients’ chances with a renewed investment in their total health.

Check this link for many more tips, tools, and resources.


Author: Susan Richards is a staff writer at DOCS Education. With over 20 years of experience in local journalism and business marketing, Susan’s career includes award-winning feature writing, as well as creating content with context for a wide variety of industries.

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