Engaging with still-smokers: oral health practitioners must use positivity and their superpowers 

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  Posted by: Dental Design      17th March 2022

It is well-known that smoking is the biggest preventable cause of cancer and it’s becoming more widely understood that it’s a risk factor for other diseases that impact quality of life and shorten life expectancy. Smoking can also affect skin texture, leading to a prematurely aged facial appearance.[i]

Smoking has been banned in enclosed public spaces in the UK for the best part of 15 years; you won’t get much change from £10 if you buy a packet of cigarettes (or £15, for the most expensive brands), either. The latest available figures show that, overall, smoking prevalence has fallen, putting it at around 14% of adults (approximately 6.9 million people).[ii] In 2020, during the first national lockdown, research suggested a rise in the number of young adults who smoke, possibly as a stress-reliever; the rate of “risky drinking” increased too.[iii] But in the same period, more smokers did manage to stop. 

Engaging with the millions

Smoking drastically impacts health, is expensive and no longer socially acceptable. The government has announced its intentions for England to be smoke-free by 2030 and to reduce disparities in smoking rates. Wales also plans to be smoke-free by 2030; Scotland has set a date of 2034. National No Smoking Day is looming and, with hopefully no more bumps in otherwise positive figures for cessation, we must ask: who are these nearly 7 million still-smokers? And how can oral health practitioners support those who want to quit?

Someone who lives in a poor area, in a rented property or social housing, is unemployed or has a manual occupation, is disproportionally more likely to smoke than a home owner on a higher income who has a professional or managerial job.[iv] The pandemic laid bare the huge health inequalities across the UK and, some would say, deepened them. It’s not just smoking prevalence linked to socioeconomic disadvantage; it’s a determinant for obesity, for alcohol misuse, for an individual developing a mental health problem; smoking rates are also high among people experiencing mental illness. [v],[vi],[vii],[viii] This is not an exhaustive list and the vicious, challenging circle we face is plain to see.

Oral health practitioners… assemble!

Kindness, empathy and understanding are our superpowers. When you ask a patient their smoking status, you might find they are desperate to stop but don’t know how, or want to bother their GP. You may have others who know cigarettes are bad for their health as well as bank balance, but are clinging to the ‘pleasure’ they get from them. We’ve lived through an era dominated by rules and, for some people, there will be a strong desire to forget about the ‘shoulds’ and ‘should nots’ and to simply savour that five-minute smoke. There is always an appealing element to risky behaviour that challenges authority.

Discussing smoking status gives us an opportunity to identify potential quitters. Every successful quitter is a victory – people who are around smokers are more likely to smoke themselves and we can help break the chain. Oral health practitioners must be positive. Yes, it’s hard, but it’s possible and no, you are not here to judge.

Have a plan. When you work with your patients to create a plan, you will help them visualise success and build in safety nets, in case they go off track. Ask them about triggers, then come up with ideas for what they could do instead. If one is alcohol, maybe they could change their usual drink. That might be better received than telling them to quit alcohol too! If someone might benefit from smoking cessation therapy, local services are stretched but with your support and persistence, they can get the ball rolling. In late 2021, it was announced e-cigarettes could be prescribed on the NHS in England, making it the first country in the world to offer them as a stop-smoking aid.[ix] ‘Vaping’ has had a mixed press; google ‘Is vaping safe?’ and you’ll get over 70,000,000 hits. The official line is that e-cigarettes are significantly less harmful than products containing tobacco, to the user and to people around them. It should also be noted that in the UK, the e-cigarette industry is more tightly regulated than in some other countries.

A healthy mouth, that is fresh and clean, can be another incentive; creating a pause so a smoker thinks again about putting a cigarette in it. Maintaining excellent oral hygiene, via an elevated daily routine, is easy to achieve with your guidance and quality products. Premium brand TANDEX has a range of brushes, interdental tools and other adjuncts to keep your patients smiling during the process of quitting, and beyond.

Smoking is a habit in decline, from the heady days when nearly half the UK population smoked. We have more understanding about the dangers of tobacco, and resources to help people quit, but socioeconomic factors present an ongoing challenging for engagement with still-smokers. Our job is to support, to listen and to empower the would-be quitters into taking the small first steps towards ditching tobacco for good.


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[i] Cho YH, Jeong DW, Seo SH, et al. Changes in skin color after smoking cessation. Korean J Fam Med. 2012;33 (2):105-109. doi:10.4082/kjfm.2012.33.2.105

[ii] Office for National Statistics. Adult smoking habits in the UK: 2019. Link: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2019#data-on-smokers-who-have-quit-and-smokers-who-intend-to-quit-great-britain-1974-to-2019 (accessed December 2021).

[iii] Number of young smokers rose by a quarter in first lockdown, England study shows. Guardian, 25 August 2021. Link: https://www.theguardian.com/society/2021/aug/25/number-of-young-smokers-rose-by-a-quarter-in-first-lockdown-england-study-shows (accessed December 2021).

[iv] Who are the smokers that haven’t quit? BBC, 24 July 2019. Link: https://www.bbc.co.uk/news/health-48472828 (accessed December 2021).

[v] Richardson S, McNeill A, Brose LS. Smoking and quitting behaviours by mental health conditions in Great Britain (1993–2014). Addictive Behaviors. 2019 Mar 1; 90:14-9.

[vi] Mayor S. Socioeconomic disadvantage is linked to obesity across generations, UK study finds BMJ 2017; 356: j163 doi:10.1136/bmj.j163.  

[vii] Beard, E., Brown, J., West, R. et al. (2019) Associations between socio-economic factors and alcohol consumption: A population survey of adults in England. PLoS One, 14 (2). e0209442. ISSN 1932-6203

[viii] Inequalities in oral health in England: summary. Public Health England, 19 March 2021. Link:https://www.gov.uk/government/publications/inequalities-in-oral-health-in-england/inequalities-in-oral-health-in-england-summary(accessed December 2021).

[ix] E-cigarettes could be prescribed on the NHS in world first. Gov.uk. 29 October 2021. Link: https://www.gov.uk/government/news/e-cigarettes-could-be-prescribed-on-the-nhs-in-world-first (accessed December 2021).

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