Where are we on smoking and implants? Dr Nik Sisodia, implantologist at Ten Dental FacialFeatured Products Promotional Features
Posted by: The Probe 20th February 2019
National No Smoking Day was first held on Ash Wednesday in 1984, at a time when an estimated 39% of the adult population smoked.[i]This event now takes place annually on the second Wednesday of March, helping to raise awareness of the effects of smoking, and encouraging people to kick the habit for good. As people have become more conscious of how harmful smoking can be to general health, the prevalence of cigarette smoking has continued to decrease in the last few decades.[ii],[iii]However, approximately 19.7% of people aged 25-34 in Britain still smoke, with almost 100,000 smokers dying every year from smoking-related causes.[iv],[v]It is estimated that the direct cost of smoking to the NHS each year amounts to about 5% of its total budget.[vi]
Cost. In the UK tobacco is taxed heavily with a duty of 16.5% of the retail plus £4.57, with a further 20% in VAT added to a pack of 20 cigarettes (£7.04 gets added to a 30g packet of hand rolled tobacco).[vii]Government policy has been to raise this duty annually by 2% above inflation. As a result, 80-90% of what consumers pay for cigarettes is tax, making purchasing cigarettes in Britain among the most expensive in the world.[viii]However, this is still far below the measures taken by the Australian government, which currently adds about $0.81 per cigarette, and has announced this rate will increase annually by 12.5% until at least 2020.[ix]At present a pack of 25 cigarettes in Australia costs about $34 (£19) and will be at around $50 (£28) in just a couple of years.[x] While some have argued that we may be reaching the point where further increases to cost see diminishing returns, the consensus is that with most smokers beginning during their teens, making tobacco prohibitively expensive should see continued reductions.[xi]In Australia the high taxes appear to have delayed and reduced the uptake of smoking as intended, but over 12% of the population continue to smoke.[xii]
Statistically people who are unemployed or on lower incomes are substantially more likely to smoke than those with greater disposable income.[xiii]This would suggest that while the cost is burdensome, it is not enough to force people to quit under most circumstances. Smoking temporarily reduces feelings of anxiety, depression and fatigue, so we might speculate that rather than making the product prohibitively expensive to people who are financially insecure, it may to some extent drive consumption by further reducing their available funds and exacerbating psychological stress.[xiv],[xv]
Bans. The introduction of legislation to ban smoking inside workplaces and public buildings came into force UK-wide in 2007 (England was the last to implement it, after the devolved parliaments of Scotland, Wales and Northern Ireland had already enacted it). While initially controversial, surveys indicate the move is now broadly accepted, with around 75% of people opposing overturning the ban and only 12% in favour of getting rid of it.[xvi]The extent to which the ban has helped reduce smoking is difficult to discern, given that other factors such as taxation, the economic crash and the rise of vaping have been at play over the same period. At a minimum, it will have reduced exposure to second-hand smoke within buildings (passive smoking).
The above measures in concert with improved education on the effects of smoking have seen a substantial decline in tobacco usage from its peak. However, there are still millions of smokers and eliminating the practice is unlikely for the foreseeable future.
Oral Health Effects
With regard to oral health, smoking increases a patient’s risk of dental caries, periodontal disease, and oral cancer.[xvii]It can also cause halitosis, impair taste and smell, stain natural teeth and restorations, as well as delayed wound healing after extractions, periodontal procedures, and orthognathic surgery.[xviii]A ten-year study of smokers found that smoking increased the incidence of periodontal disease and loss of periodontal bone height.[xix]
Smoking can negatively affect the outcomes of almost all therapeutic procedures performed in the oral cavity, including dental implant treatment. Studies report a higher rate of implant failure for smokers compared to non-smokers (5.6% compared to 3.5%), the quantity of cigarettes used correlating with a higher failure rate. Passive smoking was also found to increase the risk of implant failure.[xx]Numerous studies and reviews have found that though smoking does adversely affect osseointegration and healing, increasing the failure rate of implants, it should not be considered a contraindication to treatment.[xxi],[xxii],[xxiii]Patients should of course be informed about the harmful effects of smoking, and should be advised to stop for at least two weeks prior to surgery and during the initial healing phase at a minimum.[xxiv]
If you encounter a complex implant case, perhaps exacerbated by the patient’s smoking, or you are simply inexperienced in the required treatment – Ten Dental can help. Ten Dental provides an exceptional implant referral service, dealing with cases of all levels of complexity from single teeth to full mouth restorations and bone grafts. As a history of smoking is not always a contraindication for implants, Ten Dental can consult and ensure the best treatment is found for your patient.
While progress has been made, clinicians will be seeing patients who smoke for many years to come. However, this does not have to exclude them from the benefits of implants.
For more information visit www.tendental.comor call on 020 33932623
[i]NHS. Statistics on Smoking – England, 2007. NHS Digital. 2007. https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-smoking/statistics-on-smoking-england-2007. December 20, 2018.
[ii]ONS. Opinions and Lifestyle Survey. Office of National Statistics. 2014. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/compendium/opinionsandlifestylesurvey/2015-03-19. December 19, 2018.
[iii]ONS. General Lifestyle Survey, 2011. Office of National Statistics.2013. https://webarchive.nationalarchives.gov.uk/20160106020741/http://www.ons.gov.uk/ons/rel/ghs/general-lifestyle-survey/2011/index.html. December 20, 2018.
[iv]ONS. Adult smoking habits in the UK: 2017. Office of National Statistics.2018. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017December 20, 2018.
[v]British Heart Foundation. UK Factsheet. British Heart Foundation. 2018. https://www.bhf.org.uk/-/media/files/research/heart-statistics/bhf-cvd-statistics—uk-factsheet.pdfDecember 20, 2018.
[vi]Ekpu V., Brown A. The economic impact of smoking and of reducing smoking prevalence: review of evidence. Tobacco Use Insights.2015; 8: 1-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4502793/December 20, 2018.
[vii]Tax on shopping and services: alcohol and tobacco duties. GOV.UK. 2018. https://www.gov.uk/tax-on-shopping/alcohol-tobaccoDecember 20, 2018.
[viii]Tobacco taxation in the UK. Tobacco Manufacturers’ Association. 2016.http://www.the-tma.org.uk/wp-content/uploads/2017/02/TMA-Taxation_Briefing_final.pdfDecember 20, 2018.
[ix]Australian Taxation Office. Excise rates for tobacco. Australian Government.2018. https://www.ato.gov.au/Business/Excise-and-excise-equivalent-goods/Tobacco-excise/Excise-rates-for-tobacco/December 20, 2018.
[x]Cigarette Prices in Australia. AussiePrices.2018. https://www.aussieprices.com.au/misc/cigarette-prices/December 20, 2018.
[xi]Bader P., Boisclair D., Ferrence R. Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis. International Journal of Environmental Research and Public Health. 2011; 8(11): 4118-4139. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228562/December 20, 2018.
[xii]National drug strategy household survey 2016 key findings. Australian Government Department of Health. 2018. http://www.health.gov.au/internet/publications/publishing.nsf/Content/tobacco-control-toc~survey-findingsDecember 20, 2018.
[xiii]ONS. Adult smoking habits in the UK: 2017. Office of National Statistics.2018. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2017December 20, 2018.
[xiv]Juliano L., Fucito L., Harrell P. The influence of nicotine dose and nicotine dose expectancy on the cognitive and subjective effects of cigarette smoking. Experimental and Clinical Psychopharmacology. 2011; 19(2): 105-115.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3660849/December 20, 2018.
[xv]Roberts R., Golding J., Towell T., Weinreb I. The effects of economic circumstances on British students’ mental and physical health. Journal of American College Health. 1999; 48(3): 103-109. https://doi.org/10.1080/07448489909595681December 20, 2018.
[xvi]Triggle N. Pub smoking ban: 10 charts that show the impact. BBC News.2017. https://www.bbc.co.uk/news/health-40444460December 20, 2018.
[xvii]Arora A., Reddy M., Mhatre S., Bajaj A., Gopinath P., Arvind P. Comparative evaluation of effect of smoking on survival of dental implant. Journal of International Oral Health. 2017; 9(1): 24-27. http://www.jioh.org/text.asp?2017/9/1/24/201094December 20, 2018.
[xviii]Rad M., Kakoie S., Brojeni F., Pourdamghan. Effect of long-term smoking on whole-mouth salivary flow rate and oral health. Journal of Dental Research, Dental Clinics, Dental Prospects. 2010; 4(4): 110-114. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3429961/December 20, 2018.
[xix]Bergström J., Eliasson S., Dock J. A 10-year prospective study of tobacco smoking and periodontal health. Journal of Periodontology. 2000; 71(8): 1338-1347. https://onlinelibrary.wiley.com/doi/abs/10.1902/jop.2000.71.8.1338December 19, 2018.
[xx]Twito D., Sade P. The effect of cigarette smoking habits on the outcome of dental implant treatment. PeerJ. 2014; 2: e546. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157230/December 20, 2018.
[xxi]Arora A., Reddy M., Mhatre S., Bajaj A., Gopinath P., Arvind P. Comparative evaluation of effect of smoking on survival of dental implant. Journal of International Oral Health. 2017; 9(1): 24-27. http://www.jioh.org/text.asp?2017/9/1/24/201094December 20, 2018.
[xxii]DeLuca S., Habsha E., Zarb G. The effect of smoking on osseointegrated dental implants. Part I: implant survival. International Journal of Prosthodontics. 2006; 19(5): 491-498. https://www.researchgate.net/publication/6482155_The_effect_of_smoking_on_osseointegrated_dental_implants_Part_I_Implant_survivalDecember 20, 2018.
[xxiii]Kasat V., Ladda R. Smoking and dental implants. Journal of International Society of Preventive and Community Dentistry. 2012; 2(2): 38-41. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3894084/December 20, 2018.
[xxiv]Arora A., Reddy M., Mhatre S., Bajaj A., Gopinath P., Arvind P. Comparative evaluation of effect of smoking on survival of dental implant. Journal of International Oral Health. 2017; 9(1): 24-27. http://www.jioh.org/text.asp?2017/9/1/24/201094December 20, 2018.
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