The Role of the Oral Professional in Promoting Tobacco Cessation
Although smoking prevalence has decreased dramatically over the past 25 years, the number of people who currently smoke remains substantial given the health dangers and the level of public awareness of those dangers. Tobacco use has long been identified as the leading preventable cause of illness and death, a fact established by the most substantial body of scientific knowledge ever amassed linking a product to disease. Tobacco claims one life every 8 seconds and kills one of ten adults globally. In the United States alone, cigarette use accounts for one of every five deaths and is responsible for more than 435,000 deaths each year.
Oral healthcare professionals should be concerned with their patients’ use of tobacco products. Smoking may be responsible for more than half of the cases of periodontal disease among adults in this country. Tobacco use is, therefore, one of the most significant risk factors in the development and progression and successful treatment of periodontitis. Current smokers are approximately four times more likely than people who have never smoked to develop advanced periodontal disease. Even in adult smokers with generally high oral hygiene standards and regular dental care habits, smoking accelerates periodontal disease.
Oral Ramifications of Tobacco Use
Tobacco use has been directly implicated in numerous oral morbidities, including oral cancer, stomatitis, oral leukoplakia, gingival recession, and soft tissue defects. Tobacco use causes an increase in tooth staining, and can delay healing following oral surgery. Smoking is associated with an increased prevalence of vertical bone loss with an associated increase in severity. Tobacco exposure also exerts a strong, chronic, and dose-dependent suppressive effect on gingival bleeding on probing.
Researches also have found that the following complications occur more often in people who use tobacco products:
- Discoloration and staining;
- Hard and soft tissue loss;
- Loss of taste;
- Reduced periodontal and implant success;
- Oral sores; and
- Facial wrinkling.
Despite major efforts to educate the public on the dangers of smoking over the past 40 years, the general populace seriously underestimates the magnitude of the harm that tobacco causes. Perhaps even more alarming is that major knowledge gaps exist in what smokers themselves believe to be true about the risks associated with smoking compared the actual realities of tobacco-related disease and death (Table). As many as one third of smokers think that certain activities such as exercise and taking vitamins "undo" most of the detrimental effects of smoking. Experts believe these misperceptions may prevent smokers from trying to quit and successfully utilizing proven smoking cessation treatments.
The most important message professionals can communicate to tobacco users is that it is never too late to quit. Even for long-term smokers, quitting smoking carries major and immediate health benefits for men and women of all ages. Benefits apply to healthy people and to those already suffering from smoking-related disease. Tobacco cessation represents the single most important step that users can take to enhance the length and quality of their lives. Smokers who quit – even after age 63 – start repairing their bodies immediately.
The efficacy of even brief tobacco dependence counseling has been well established and is also extremely cost-effective relative to other medical and disease-prevention interventions. Smokers cite a health professional’s advice to quit as an important motivator for attempting to stop smoking. With effective education, counseling and support (rather than condemnations and warnings about dangers of smoking), oral healthcare professionals can provide an invaluable service. Helping someone overcome a tobacco addiction may be the most broad-reaching healthcare intervention an oral healthcare professional can achieve.
Most dental professionals have the occasion to visit with patients more frequently than other healthcare providers, which provides increased opportunity to communicate the importance of tobacco cessation. Diagnostic technologies have further improved within the industry, allowing clinicians to easily diagnose oral cancers and abnormalities. Proper diagnosis does not, however, supersede prevention. By clearly communicating with patients who report tobacco usage during each visit, the dental team can begin to guide patients toward cessation, thus improving not only their oral, but their systemic health as well.