Who says no one loves a quitter? Dentists do! – Rachel Pointer – Tandex

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  Posted by: The Probe      8th December 2018

The devastating impact of smoking on oral health and ways to support patients with quitting – these are topics that dental practitioners will and shouldkeep returning to.

The good news? There are less adult smokers in the UK than ever before. Action on Smoking and Health (ASH) reports that fewer than one in five UK adults are smokers; 19 per cent of men and 15 per cent of women.[i]Statistics on Smoking, published by NHS Digital in 2018 and focused on England only, confirmed the trend and found that 14.9 per cent of adults can be classed as “current smokers” (based on the latest year of data available[ii]), down from 15.5 per cent from 2016 and 19.8 per cent in 2011.

The not-so-good news? Although numbers are down overall, millions of adults are yet to quit. According to the NHS Digital report, nearly 78,000 deaths in England are attributable to smoking. Hospital admissions for smoking-related conditions (2016/17) are also up slightly on the previous year and the percentage of mothers who were smoking at the time of delivery (10.8 per cent) is above the national ambition of 6 per cent.[iii]

Statistics on Smoking is a highly useful tool due to the breadth of data included. For example, it covers things like affordability of tobacco (many packs of 20 cigarettes now cost over £10) and local comparisons. Historically, there are always more smokers in poorer areas, so will we see positive benefits of making cigarettes prohibitively expensive? The impact of e-cigarettes is also outlined. Nearly three million people vape in the UK and most are ex-smokers.[iv]There are several viewpoints to take regarding the vaping phenomenon. Generally, the profession views it positively; anything that supports cessation (or, at the very least, cutting down on tobacco use) should be welcomed. But some worry about the “gateway” effect, particularly among younger users, and that using e-cigarettes may reinforce habitual behaviour. Because they contain nicotine, e-cigarettes cannot be recommended as nicotine replacement therapy either.

What is certain is that dentists and dental hygienists must play a proactive role in helping patients to stop, and stay stopped. The dangers of smoking to general health are well known; simply repeating them to a patient who longs to quit may not be the most effective approach. Dental practitioners can come in from a different angle and talk about things like staining and how tobacco can impede salivary flow, which will lead to dry mouth and related conditions such as halitosis. Smoking is a cause of tooth loss[v]and will also compromise the stability of implants.[vi]Oral cancer is on the rise among men and women; educating patients about its relationship to smoking is essential because the prognosis is good if it’s caught early.[vii]

Supporting patients and helping them stay stopped is important because, after quitting, it can take time to regain a healthy mouth. Just as there is a long-term impact from smoking on other parts of the body, the same can be said for oral health. Staining from tobacco can be severe and permanent; a patient may want to discuss treatment to improve the look of their teeth. A smoking habit may have caused soft tissue changes,[viii]meaning the patient is more susceptible to bleeding and sensitivity around the gingiva. There is a risk reduction for oral cancer (including cancer of the neck) after cessation, but it can take years to reach the level of someone who has never smoked.[ix]Therefore, both patient and practitioner must continue to be mindful of any changes in the mouth that could indicate early signs of the disease long after a tobacco habit has ended. Symptoms include things like ulcers that don’t heal, pain that doesn’t go away, the presence of abnormal patches and difficulty swallowing.

Tell your patients that you are a powerful ally if they want to stay stopped. Dental practitioners have regular access to the mouth and can help patients keep away from tobacco for good. While the mouth is recovering from a smoking habit, teach them how to clean properly. This means cleaning gently yet effectively, using high-quality tools, such as the brushes, interdental brushes and adjunctive products from the TANDEX range. The benefits of a deep clean are an important part of your on-going support, because once they know what clean reallyfeels like, they will hopefully not want to put toxins in their mouths again.

There are still too many people smoking; it has a devastating and often permanent impact on oral and general health. Dentists have a key role to play in smoking cessation and with helping the mouth to rehabilitate itself afterwards. Proper cleaning, alongside regular appointments – with the dentist anddental hygienist – are key to monitoring the long-term impact of smoking, and helping your patients to stay stopped.  

 

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REFERENCES
[i]ASH. Smoking Statistics. Link: http://ash.org.uk/information-and-resources/fact-sheets/test-download-for-fact-sheets/(accessed July 2018).
[ii]NHS Digital. Statistics on Smoking. England: 2018. Published 3 July 2018. Link: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2018/content(accessed July 2018).
[iii]NHS Digital. Statistics on Smoking. England: 2018
[iv]ASH. Large national survey finds 2.9 million people now vape in Britain: For the first time over half don’t smoke, 8 May 2017. Link: http://ash.org.uk/media-and-news/press-releases-media-and-news/large-national-survey-finds-2-9-million-people-now-vape-in-britain-for-the-first-time-over-half-no-longer-smoke/(accessed July 2018).
[v]Oral Health Foundation. Smoking and oral health. Link: https://www.dentalhealth.org/tell-me-about/topic/sundry/smoking-and-oral-health(accessed July 2018).
[vi]Goutam M, Singh M, Patel D. A literature review on effects of smoking on the success of dental implants. Journal of Dental Implants. 2013 Jan 1; 3 (1):46.
[vii]Cancer Research UK. Oral cancer statistics. Link: http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/oral-cancer#heading-One(accessed July 2018).
[viii]Watt RG, Daly B, Kay SE. Prevention. Part 1: smoking cessation advice within the general dental practice. British Dental Journal. 2003 Jun 28; 194 (12): 665.
[ix]Marron M, Boffetta P, Zhang ZF, Zaridze D, Wünsch-Filho V, Winn DM, Wei Q, Talamini R, Szeszenia-Dabrowska N, Sturgis EM, Smith E. Cessation of alcohol drinking, tobacco smoking and the reversal of head and neck cancer risk. International Journal of Epidemiology. 2009 Oct 5; 39 (1): 182-96.
 


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