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Smoking – breaking free safely and effectively

Johnson & Johnson Ltd. is delighted to bring you this article, with the aim of supporting the ongoing Enhanced CPD needs of dental healthcare professionals in improving and maintaining the oral health of their patients.

This article is equivalent to one hour of Enhanced CPD. To provide feedback on this article, please contact dentalcpd@its.jnj.com

Learning outcomes

A,C,D

Aims and objectives

The aim of this article is to explore how dental professionals may be able to help patients quit smoking using Very Brief Advice and to consider the evidence base regarding the use of e-cigarettes.

On completing this Enhanced CPD session, the reader will:

Understand the prevalence of tobacco use in the UK and the health implications

Understand the role of the dental team in helping patients to quit smoking

Understand the use and efficacy of Very Brief Advice in dental practice

• Understand the current evidence base regarding e-cigarette use.

 

Smoking – breaking free safely and effectively

This article explores how dental professionals may be able to help patients quit smoking.

In 1948, a team of researchers came together to consider the health implications of smoking, at which time the UK had the highest prevalence of smoking in the world – among the over 16s, 82% of men and 41% of women were using some form of tobacco product. Given what we know today, it is no surprise that they found that smoking could cause very serious health problems.1

Between then and now, many tools have been employed to reduce tobacco use in the UK, resulting in a significant drop.1 For instance, NHS data for 2019 indicates that 14.4%  of adults in England are classified as smokers, which equates to about 5.9 million people.2

The role of the dental team

In 2019, Chaffee wrote: ‘The dental professional is well positioned to address tobacco use in clinical practice. Through frequent recall appointments, team-based care, and trusting patient partnerships, evidence-based tobacco cessation and prevention interventions delivered by dentists and other members of the dental care team are both effective and associated with enhanced patient satisfaction.’3

Offering a UK perspective, Ahmed and colleagues (2018) stated: ‘Tobacco smoking has several detrimental effects on oral health including oral cancer, periodontitis, poor wound healing and tooth staining. Dental professionals are in an ideal position to offer smoking cessation advice (SCA) to a large proportion of the population. This is especially true in countries such as England and Wales where over three-quarters of dentate adults reported visiting the dentist at least once every 2 years. There are also often tangible prompts that can be used when discussing the consequences of smoking with patients e.g. tooth staining, mobile teeth or tooth loss.’4

Time is of the essence

Many primary care health practitioners have limited time in which to deliver the care each patient needs, including smoking cessation support.1,4

Helping to overcome this challenge, NICE guidance (NG92) recommends the delivery of Very Brief Advice (VBA) to patients who smoke, which takes less than 30 seconds to impart.1

The ‘AAA’ framework of VBA consists of:1

1. Asking patients about smoking to establish their smoking status and recording it

2. Advising patients on how they can stop smoking

3. Acting by offering help to support them to quit. This includes referring patients to stop smoking services or prescribing pharmacotherapy with brief advice.

 

It has been reported that when VBA is given by a health professional, it will help about 2% of smokers to quit successfully, over and above those who manage to do it alone. This may, at first sight, seem like a small number, however, when translated into a population estimate, it represents around 63,000 people quitting.5

The e-cigarette conundrum

With around 2.9 million users of e-cigarettes in the UK, dental professionals are very likely to encounter patients who use or are considering using e-cigarettes. There is an expectation that dental team members are able to discuss the potential health implications of their use.3,4

Recently, there have been reports of vaping resulting in lung illness in the USA, linked to 2,000 illnesses and 40 deaths, however there is limited evidence as to the underlying cause of this serious health problem, as well as their effect on the oral cavity.6,7,8

For the time being, current evidence suggests that using an e-cigarette is ‘almost certainly less dangerous than smoking a cigarette.’3

However, as Chaffee (2019) states: ‘What remains contentious is: 1) how much less harmful an e-cigarette may be to the user; and 2) the net impact of widespread e-cigarette availability on society as a whole. Both sides of the e-cigarette debate have been fuelled with impassioned language. The arrival of e-cigarettes has been hailed as “one of the greatest public health wins of all time” and, alternatively, “an emerging public health epidemic.”’3

Offering an overview of the current situation, Chaffee (2019) adds: ‘For the dental patient interested in trying e-cigarettes as a method of quitting combustible tobacco, above all, the clinician should encourage and reinforce that desire to quit.’3

He continues: ‘Specific to e-cigarettes, clinicians should send the clear message that no form of tobacco or nicotine is safe. The healthiest long-term goal is to live completely nicotine and tobacco free. However, patients should also understand that combustible cigarettes are more dangerous than e-cigarettes. Limited evidence suggests that e-cigarettes might help some smokers to quit, but at this time, the consistent, high-quality studies needed to reach a scientific consensus are lacking. E-cigarettes are not harmless, and their long-term health risks are unknown.’3

Offering a final perspective, Chaffee (2019) states: ‘In this rapidly changing landscape, the dental provider has a responsibility remain informed as new evidence and new products emerge, with the potential for e-cigarettes regulation and practice guidelines in the future.’3

Facing the future

Summarising the role of the dental team in smoking cessation in practical terms, Papadakis and McEwen (2018) wrote: ‘Dental professionals have a unique opportunity to address smoking with patients in a manner that will make a difference and won’t damage your relationship with patients.’ 9

They added: ‘Brief advice from a dentist or member of the dental team has been shown to increase your patient’s motivation to quit and can double a patient’s success with quitting.’ 9

Finally, they stated, ‘Addressing tobacco use with patients should be a priority for all members of the dental team and will result in improved oral health and outcomes for patients. It is important for dental professionals to be aware of simple techniques for motivating your patients who smoke to quit and informing them of the availability of evidence-based treatments such as quit smoking medications and counselling support.’9

 

Very Brief Advice on smoking9

30 seconds to save a life

QUESTIONS: 

References

  1. Smoking cessation in primary care. A cross-sectional survey of primary care health practitioners in the UK and the use of very brief advice. Cancer Research UK, March 2019

  2. Statistics on Smoking. England: 2019. National Statistics, July 2019

  3. Chaffee BW. Electronic cigarettes: trends, health effects and advising patients amid uncertainty. J Calif Dent Assoc 2019; 47(2): 85-92

  4. Ahmed Z et al. Dental professionals’ opinions and knowledge of smoking cessation and electronic cigarettes: a cross-sectional survey in the north of England. BDJ 2018; 225(10): 947-952

  5. Beaglehole RH, Watt RG. Helping smokers stop. A guide for the dental team. NHS Health Development Agency and British Dental Association, 2004

  6. Dingle M, Travers A. Letters to the editor. BDJ 2020; 228(3): 137-138

  7. Kumar P et al. Living under a cloud. Electronic cigarettes and the dental patient. JADA 2020; 151(3): 155-158

  8. Shahab L et al. The need for an evidence-based and rational debate on e-cigarettes. The Lancet 2020; 395: 688

  9. Papadakis S, McEwen A. Very Brief Advice on smoking for dental patients. NCSCT 2018