Never stop urging smokers to stop: It's time again to remind smokers to quit

May 11, 2015
It's time again to remind smokers to quit

It's time again to remind smokers to quit

BY Pam Thomas, RDH

As health-care professionals, it is our duty to care for our patients' health. For this reason, we must recommend patients discontinue smoking and all tobacco use. Patients must be informed of all of the health risks, which include heart disease, hypoxia, COPD, lung and esophageal cancer, bronchitis, and allergies.


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Important dental health issues linked to smokers include generalized periodontal bone loss on maxillary and mandibular teeth. Smoking has also been linked to osteoporosis.

Patients with periodontal disease display a notable difference in the amount of bone loss in smokers vs. nonsmokers. I repeatedly note generalized bone loss in smokers vs. localized bone loss in nonsmokers.

The positive effects of smoking cessation with patients are numerous:

• Day 1 - Blood pressure drops to normal, carbon monoxide in your body decreases, and oxygen levels increase to normal (CDC, 2004), and your risk for heart attack decreases.

• Day 2 - Your sense of smell and taste increase (Cleveland Clinic).

• Day 3 - Nicotine will be completely out of your system.

• After 2-3 weeks - Lungs will feel clear; breathing will be easier, and exercising will be comfortable to your body (AHA 2012, Healthline2013).

Many Americans are smokeless tobacco users. Chewing tobacco, snus, and snuff all contain nicotine, which is as addictive as heroin or cocaine. It is well known that this form of nicotine addiction is most difficult to quit, as nicotine enters the bloodstream from the mouth and nose. Nicotine from chewing tobacco is carried in the bloodstream throughout the body, which affects the heart and blood vessels, hormones, metabolism, and the brain. It has been found in amniotic fluid and umbilical cord blood of newborn infants (American Cancer Society, 2014).

With this habit, patients will notice white patches in their mouths (leukoplakia), which can turn into oral cancer of the gums, tongue, and cheek, and puts patients at a greater risk of esophageal and pancreatic cancer. Users also are susceptible to tooth loss, bone loss, abrasion (occlusal wear), tobacco site recession, discolored teeth, and bad breath (American Cancer Society, 2014).

Tougher enforcement against tobacco

Tobacco use is prevalent throughout the world, and has been recorded back to ancient times - even depicted in archaeological art of the Mayans of Mexico. Throughout the world, nations have banded together with the Centers for Disease Control and Prevention (CDC) to limit tobacco use by enforcing laws. In 2010, Bhutan became the only country to ban use, cultivation, harvesting, production, and sale of tobacco. In 2012, Brazil became the first country to ban flavored tobacco, including menthols, and permits only eight ingredients to avoid many carcinogens.

Throughout the United States and Europe, smoking bans in public areas and the workplace are a huge deterrent. Many users have knowledge of adverse effects to their health, and these limitations have led to increased health and fewer trips to the doctor. Due to corporate policies, many smokers have discontinued smoking due to the stigma of smoking in the workplace environment. The increased cost of tobacco with added taxes also contributes. It has been recorded to cost $200 per month to be a Marlboro Man in 2015. This is a pack-per-day smoker of Marlboro Red bought at a convenience store/gas station in Texas, according to the Chantix calculator.

Studies of secondhand smoke report close proximity to passive tobacco smoke can affect us all. University of Dundee research (2006) on Bar Workers' Health and Environmental Tobacco Smoke Exposure Study found significant improvement in lung function of 5% to 15%, as well as for inflammatory markers, allergies, and asthma. The Journal of the American Medical Association reported that the smoking ban "has led to a rapid and marked improvement in the health of bar workers." The average length of employment of each bar worker - all nonsmokers - was nine years. Among 77 employees, 20% were asthmatics. A nicotine reduction in bar workers' bloodstream in markers of 5% to 10% was noted one month after Ireland began this ban.

This research is important in gaining momentum for the world to follow the lead of Scotland and Ireland. This knowledge has a direct effect on the lives of people who suffer from allergies, inflammation, and bronchitis. This will have a future effect on saved lives, hospital visits, and exposure to needless carcinogens.

In Sweden, the smoking ban led to the use of snus, an alternative to smoking. This trend has risen steadily since that nation's smoking ban. Sweden began to use pouches, which look like small tea bags. These pouches fit under the upper lip, and there is no need to spit after usage. The country's effective anti-smoking policies have led to Sweden accomplishing the World Health Organization's goals for cigarette smoking. The Swedish version of smokeless tobacco is frequently credited for its role in reducing health risks associated with tobacco.

The CDC has set up preventive guidelines for reducing usage in the United States, including the familiar Surgeon General's warnings on packaging. Similar wording is used throughout many countries.

Smoking has always been used for stress relief and enjoyment. Marketing efforts have increased usage among young adults for cigarettes, cigars, clove cigarettes, and hookah. The smokeless e-cigarettes have become popular in workplaces with tobacco bans. Although the majority of smokers realize smoking is not good for their health, the enjoyment outweighs the health issues. In 2006, the CDC reported 45 million American smokers; 8 million continued smoking with a serious illness caused by smoking; and 438,000 deaths annually as a result of tobacco use in America.

Encouraging cessation

What must dental professionals do to encourage quitting? This is continually on our hearts as we want our patients to be healthy. We need to ask the hard questions. When was the last time they thought about quitting? How many cigarettes are they smoking per day? When was the last time they tried to quit? Did they quit cold turkey or have any medical help?

This is a chance to open the door to a new way of thinking. It is good to set goals for each individual, depending on how many cigarettes or cans of tobacco are used per day.

I have talked with many who have quit smoking. Sometimes leaving a full, unopened pack or can in their pocket works - just knowing it's there and they have made the choice to stop is helpful. For others, the temptation is too great. Whether to stop for one day, one week, or one month, it is good to come up with an idea for a reward that would benefit the individual. This could be using the tobacco money for a new pair of jeans, a ticket to the theater, or an overnight away with a significant other.

Encourage patients to consider what would work for them. The challenge is finding something to do with their hands if they are smokers. It is good to substitute. Sometimes, carrying a pencil or pen to twiddle in their fingers helps. Many go for a walk or substitute another form of exercise to fill the gap.

Medical assistance in quitting

Since quitting is difficult, many companies have alternatives. Nicotine patches, lozenges, and gum can aid in cessation. Herbal mint dips can also help. Many natural alternatives are on the market and have been tested, and these are non-nicotine products. With emotional, physical, and mental dependence on tobacco, many side effects can occur. Anxiety, depression, jitters, an intense need for more nicotine, and inability to concentrate are some of these. After two to three hours, the need for nicotine is intense, and at two to three days, these symptoms peak.

Intraorally, after two to three weeks, the leukoplakia resolves. Gum tissue turns pink and appears healthy. Also, nervousness and withdrawal symptoms disappear.

Successful quitters have more choices with prescription medications. Chantix is regarded as the newest choice, approved by the Food and Drug Administration in 2006. It is a nicotine-free pill that reduces the need for nicotine. A feel-good chemical called dopamine is released in the brain while smoking. Chantix is believed to attach to nicotine receptors, so nicotine can't attach. It releases dopamine, so patients feel good, without the craving for nicotine. As these levels remain constant, the need for nicotine subsides. The results of studies after three-month usage have a 44% success rate according to the manufacturer's website (Pfizer 2014).

Zyban, a GlaxoSmithKline product, has also been used for many years to decrease withdrawal symptoms. It is twice as effective as the placebo. Since it is an antidepressant, it is believed to curb nicotine cravings. Its use in smoking cessation began in 1985, according to the FDA.

Many people also stop using nicotine-based products on their own. Approximately 90% of smokers go cold turkey (no outside help), and usually have noted it takes three or more times of trying to quit before success. Success rates after one year are in the 4% range, according to QuitSmokingSupport.com, last updated in 2014. Some national organizations that can give immediate support to smokers include:

• Centers for Disease Control and Prevention, cdc.gov/tobacco

• 1-800-QUIT-NOW

• killthecan.org has online information that suggests natural alternatives

• The American Cancer Society has its "Quit for Lif e" program, or for help with cancer related questions: (800) 227-2345

Public smoking bans, quit-smoking support websites, and evidence-based research about increased health and reduction of secondhand smoke in public places have helped many discontinue tobacco use, which is healthier for everyone. A smoke-free environment leads to decreased toxins, decreased cancer, and saved lives. This is something health-care professionals can be very excited about. Anything we can do to make the public more aware of increased oral and overall health is a win-win situation. RDH

Pam Thomas, RDH, received her degree in 1986 from Cypress College. She has been a hygienist for 29 years, with experience in both general and periodontal dental hygiene. She is also a writer, artist, and serious continuing-education buff. She is a current and longstanding member of the ADHA. To reach her by email, please send comments to [email protected].