Understanding the Impact of Tobacco Use
Research shows that patients are receptive to being educated by the dental team.
In any discussion about the synergy between oral and systemic health, tobacco use is a clear case in point. New evidence and research continue to shed light on the many ways that tobacco—including smokeless tobacco—undermines health.
Recently, the National Institute of Dental and Craniofacial Research (NIDCR) announced funding for research on Dental Practice-Based Tobacco Interventions, stating, “While sound science-based clinical guidelines for tobacco control are available, and a body of research indicates the significance of tobacco use to oral diseases and dental treatment outcomes, a majority of U.S. dental clinicians are not yet implementing effective tobacco control approaches.” 1 This initiative will support the development and testing of interventions to increase their use within dental educational or practice settings.
The dental office visit is an especially favorable environment for tobacco intervention efforts. According to the National Cancer Institute, there are aspects specific to dental appointments that are conducive to cessation counseling initiatives2:
- Because most patients are scheduled for prophylaxis, they are already in a prevention frame of mind and may be more receptive.
- Most patient visits are not for acute care, allowing more opportunity for the oral healthcare professional to concentrate on the health effects of smoking.
- Dental appointments are routinely scheduled at longer intervals than medical appointments (30-60 minutes versus 15 minutes).
- Patients reported that they expected to receive this counseling in a dental practice.
An Overview of Tobacco-Related Oral Conditions
According to the American Academy of Periodontology (AAP), ongoing research is underscoring the major risk factor that tobacco represents in developing periodontal disease.3
People who use tobacco are more likely to exhibit calculus, damage to tooth-supporting bone and tissue, and eventually loss of teeth. In addition, chemicals in tobacco undermine the healing process and the predictability of treatment such as dental implants and periodontal therapy.3
Tobacco contains compounds that are carcinogenic, toxic, or mutagenic. The NIDCR reports that approximately 90% of oral cancer deaths are attributable to smoking.4 Smokeless tobacco, cigars, and pipes are also causally linked to oral and pharyngeal cancers and premalignant mucosal lesions. (More than 30 carcinogens have been identified in smokeless tobacco.)
Other harmful effects include:
- Oral malodor
- Tooth discoloration
- Hypogeusia (loss of taste)
- Oral ulcers and tobacco-associated lesions
Tobacco dependence is a chronic disease that often requires multiple, sustained interventions by healthcare professionals.5 Patient education materials are widely available and can be downloaded from various websites (Figure 1) for distribution and discussion. A clear, personalized approach—by the entire dental team—should be systematically offered to every tobacco-using patient at every visit.
1. Translational Research in Dental Practice-Based Tobacco Interventions. National Institute of Dental and Craniofacial Research website. http://www.nidcr.nih.gov/GrantsAndFunding/See_Funding_Opportunities_Sorted_By/ConceptClearance/ArchivedCC/TransResearch.htm. Accessed June 27, 2011.
2. Recruitment and Training of Practicing Physicians, Dentists and Their Office Staff. Monograph 5: Tobacco and the Clinician: Interventions for Medical and Dental Practice. National Cancer Institute website. http://cancercontrol.cancer.gov/tcrb/monographs/5/index.html. Accessed June 28, 2011.
3. Tobacco Use and Periodontal Disease. American Academy of Periodontology website. http://www.perio.org/consumer/smoking.htm. Accessed June 27, 2011.
4. The Effects of Tobacco on Oral Health. National Institute of Dental and Craniofacial Research website. http://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/sgr/boxes/box102.htm. Access July 1, 2011.
5. Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Quick Reference Guide for Clinicians. Rockville, MD: U.S. Department of Health & Human Services. Public Health Service. April 2009. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/clinic/tobacco/tobaqrg.htm. Accessed June 28, 2011.