Nexus - Spring 2000 Issue     

Helping Patients Kick the Smoking Habit

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Dr. Steven J. Mondre

Tobacco smoking may be the single most important environmental factor associated with periodontal disease. It therefore stands to reason that the dentist's armamentarium should include smoking cessation therapy as an adjunct to periodontal care, as part of a preventive dentistry program, and certainly as part of advanced restorative (i.e., implant dentistry) and periodontal treatment (i.e., tissue regenerative procedures) plans. Indeed, "when smoking is continued, periodontal therapy will ultimately fail.... Helping patients stop using tobacco therefore may be the single most important service that dentists can provide for their patients' health. However, cessation must be viewed as a process and not as an isolated event" (Tobacco Cessation in Dentistry, 1994).

According to Clinical Practice Guidelines (no. 18, U.S. Department of Health and Human Services), the dentist is in a privileged position to help patients kick the smoking habit. "Primary care and other clinicians are uniquely poised to assist patients who smoke, in that they have extraordinary access to this population. At least 50 percent of smokers see a dentist (Hayward, Meetz, Shapiro, et al., 1989; Tomar, Husten, and Manley, 1996). [And] 70 percent of smokers report that they want to quit and have made at least one self-described serious attempt to quit (CDC, 1994)."

The message is clear: Dentists have a responsibility to help their patients stop smoking and to offer them consultation and treatment methods to do so. As dentists, we see our patients regularly, usually more so than their physicians. Oral effects of smoking are very easy for the smoker to see and understand (change in tissue color, red or white lesions, as well as stained teeth and bad breath). Once the oral effects of smoking are pointed out to a patient, he or she is more inclined to stop smoking. Indeed, it has been shown that a discussion initiated by a dentist (about stopping smoking) is often enough to motivate a patient to try to stop smoking.

General guidelines formulated by the U.S. Department of Health and Human Services to help patients quit tobacco use include the following:

  • Identify all smokers (tobacco users).
  • Strongly advise all smokers to quit smoking.
  • Determine a patient's willingness to make an attempt to quit smoking.
  • Provide motivational intervention to patients not willing to commit to quitting in order to promote subsequent quit attempts.
  • Assist patients who are willing to make a quit attempt in setting a quit date; prepare them for the quit date; encourage them to use nicotine replacement therapy if necessary; and provide them with self-help materials and advice.
  • Refer patients to intensive treatment when appropriate (e.g., if the patient has relapsed repeatedly or if the patient prefers such treatments).
  • Schedule follow-up contacts with all patients attempting to quit smoking.

Smoking is a complex chain of psychological and social factors that are linked together by an addiction to nicotine. It is this addiction to nicotine that makes smokers need to smoke as well as want to smoke.

Nicotine replacement therapy currently includes nicotine gum and nicotine patch therapy. Both nicotine gum and transdermal nicotine (the nicotine patch) have been shown to be efficacious in promoting smoking cessation. However, the future of nicotine replacement therapy in smoking cessation programs, especially for dentists, may be nicotine floss, a unique drug delivery system patented by the author in 1991, which is currently awaiting FDA approval.

"When smoking is continued, periodontal therapy will ultimately fail...."

Nicotine floss was devised as a means of helping smokers to quit smoking and to improve their periodontal health. The act of flossing with nicotine floss allows the smoker to manually introduce nicotine directly into the highly vascular periodontal sulcus, thereby alleviating physical cravings for nicotine and, ultimately, reducing nicotine dependence. Moreover, because it stops nicotine cravings while allowing the smoker to control how and when the nicotine is delivered, the use of nicotine floss improves upon nicotine patch therapy, which is administered continuously. Also, since patients who smoke typically do not floss, it substitutes the good habit of flossing for the bad habit of lighting up. In addition, the use of nicotine floss has been shown to promote oral health even after the smoker no longer craves nicotine because people who begin to floss tend to enjoy the feeling of a clean mouth and are less likely to revert to smoking.

The use of nicotine floss has been shown to be effective in helping smokers to kick the habit. But it remains in the early testing stages, and there are currently other ways available for dentists to help patients quit smoking. It is imperative that dentists have the proper training in this area and that they are prepared to offer smoking cessation programs in their practices. It is this type of service -- truly "practicing for life" -- that offers the greatest reward for the dentist, the patient, and the patient's family.

Dr. Mondre is a 1980 graduate of the NYU College of Dentistry.
He practices privately in Manhattan.