Tobacco Use Education in the Dental Office
The most important source of preventable morbidity and premature mortality in the
United States is tobacco use, especially cigarette smoking. Tobacco use is
responsible for one in five deaths, primarily from cardiovascular diseases, lung cancer,
other types of cancer and respiratory diseases.1 The social costs are enormous,
both to tobacco users directly and to nonsmokers, who are affected by environmental or
secondhand tobacco smoke. Passive smoking is particularly devastating to children who are
at higher risk of respiratory tract irritations and infections, middle ear problems and
increased severity of asthma symptoms.1
Healthy, young nonsmoking adults exposed to second hand smoke show the same vascular
abnormalities as active smokers of the same age. These vascular abnormalities are
associated with atherosclerotic heart disease and may contribute to the thousands of
deaths associated with exposure to passive smoke. 2
Tobacco use cessation carries immediate health benefits for patients, increasing overall
life expectancy and reducing the risk of tobacco related diseases.3 A
comprehensive approach to tobacco education can include preventive information, especially
for children and adolescents, education on the health effects of tobacco use, counseling
and analysis of the behavioral and addiction components of tobacco use, and nicotine
withdrawal therapy.4 As health care providers, dental professionals are in a
unique position to identify the visible consequences of tobacco use and help patients
understand.
Tobacco use counseling and cessation programs are an obvious addition to the other
preventive services routinely offered in a dental practice.5 Patients are seen
on a regular basis for routine dental care; cessation programs follow similar patterns and
are easily incorporated into the oral care delivery system.
The tobacco use counseling process in the dental office can begin during review of the
medical and dental history, when information can be elicited about tobacco use behaviors.
The patient should also be advised of any existing health problems that may have a
relationship to tobacco use. Most tobacco users are aware that their habit can have
detrimental effects, but they do not acknowledge how tobacco has created changes in their
own health. Tobacco use is related to many medical problems, including cancers of the
larynx, esophagus, pancreas and bladder. Other more common conditions associated with
tobacco use include cardiovascular diseases, chronic obstructive pulmonary disease,
chronic bronchitis and other respiratory diseases, gastric ulcers, low birth weight babies
and spontaneous abortions.6 During initial oral examination procedures, tobacco
related oral conditions can be identified and the visible effects of tobacco use can be
shown to the patient. Oral effects of tobacco use can include increased incidence and
severity of periodontal diseases,7 tooth loss, necrotizing ulcerative
gingivitis, halitosis, tooth staining, delayed healing, precancerous changes in soft
tissue, and cancers of the oral cavity and pharynx.9,10 When these types of
conditions are specifically identified in a patient's mouth, they can be an additional
motivating factor to seek further information about tobacco use cessation.
Motivation and support of patients who exhibit an interest in tobacco use cessation can be
incorporated into comprehensive dental treatment plans. Studies show that when even simple
encouragement to quit is offered by respected health care professionals, cessation rates
increase.11 The best cessation rates are produced when a professionally
directed program including education, counseling and psychological support is combined
with nicotine withdrawal therapy administered via nicotine patches or gum.5
Tobacco use cessation programs administered by dental professionals have been shown to
have excellent cessation rates and the American Dental Association, along with other
dental organizations have acknowledged the need for tobacco education programs and
cessation programs within the dental office. Education programs that teach dental
professionals to develop and implement comprehensive tobacco education programs into their
practice are available and include training in the physiological and psychological issues
of tobacco use.12 Dental professionals have an ethical obligation to educate
the tobacco dependent patient on the hazards of tobacco use, and they have a unique
opportunity to help the tobacco dependent patient improve their health and well-being by
quitting.
