How can smoking influence my patient’s oral wellbeing?

People are aware that smoking is terrible for their wellbeing. It can lead to a wide range of clinical issues and, at times, deadly infections. Nonetheless, many individuals don’t understand the harm that smoking does to their mouth, gums and teeth. As a dentist, it is our duty to inform patients about the effect smoking and tobacco has on their oral well being. We must ourselves know of the frequently asked questions by our patients to satisfy them of their doubts and queries regarding this addiction.

Smoking can prompt tooth staining, periodontitis, tooth mobility, and in serious cases, oral malignancy.

Why does smoking stain teeth?

One of the impacts of smoking is staining on the teeth which occurs because of the nicotine and tar in the tobacco. It can make teeth yellow in an extremely brief time frame, and weighty smokers frequently whine that their teeth are practically brown following quite a while of smoking.

Smoking affects gingiva and teeth – for sure.

Smoking can prompt gingivitis. Individuals who smoke are bound to create bacterial plaque, which initiates gingivitis, and get converted to periodontitis. The gingiva is impacted in light of the fact that smoking causes an absence of oxygen in the circulatory system, so the tainted gums don’t recuperate. Smoking makes individuals accumulate more dental plaque and converts gingivitis to periodontitis more rapidly than in non-smokers. Gingivitis is the most widely recognized reason for tooth mobility in grown-ups.

How is smoking connected with disease?

The vast majority realize that smoking can cause lung and throat malignancy, yet many patients actually don’t realize that it is one of the primary drivers of oral cancers as well. Consistently large number of patients bite the dust from mouth malignant growth welcomed on by smoking, a definite risk factor.

Are there unique dental items that smokers can utilize?

There are unique toothpastes for patients who smoke. They are in some cases somewhat more abrasive than common toothpastes and ought to be utilized with care. There are a few ‘brightening’ toothpastes available. Despite the fact that they don’t influence the normal shade of teeth, they might be viable at eliminating staining, and subsequently may work on the general appearance of teeth.

And mouthwashes?

Patients who smoke might find they are bound to have awful breath compared to non-smokers. Fresh breath items, for example, mouthwashes might assist with camouflaging the issue temporarily, however won’t fix it, unless regular scalings are done and the habit is slowed down.

How frequently should a smoker visit you compared to a non smoker?

Regular full mouth assessments is necessary so that any premalignant lesions can be spotted early.

Depending on how heavy the habit is, bi- annual visits are a must. Patients who smoke are bound to have stained teeth, and subsequently may require scalings as frequently as every quarter-yearly, i.e every 4 months

Your role as an oral physician – tobacco cessation programs

• Dental surgeons can start Tobacco Cessation Programs (TCP) in their private dental practice since they are rightly, the ‘oral physicians’. There are various programs organised by national apex level dental associations of every country, register in one and become a tobacco cessation oral specialist.
• The 5 A’s are the evidence based framework for structuring tobacco cessation in a dental clinic. It is a five to fifteen minutes research based counselling tool, which you can utilise in your clinic.

1. Step 1-Ask (history of any suspected smoking case)
2. Step 2-Advise (clearly, strongly, in a personalised manner)
3. Step 3-Assess (determine the willingness to quit)
4. Step 4-Assist (those willing to quit with a ‘5 day plan to quit’ – sample plan given below)
5. Step5-Arrange (schedule a follow up to reinforce)

• Speak with authority in the community about the dangers of tobacco use. For example, the need to curb tobacco use in public and educate children about the dangers of tobacco use.
• Behavioral & cognitive therapy or strategies are mainly advised to deal with cravings while quitting tobacco. You can advise these to your patients during a counselling session. Some of the behavioral & cognitive strategies are as follows:

—Dealing with cravings

1. Delay
2. Deep Breathing
3. Drink water
4. Distract

—Remember the 3R’s

1. Remind
2. Rehearse
3. Reward

• Every tobacco user is unique and one cessation method will not work for everyone. Remember to let the patient chose the method that is suitable for them.

—Non pharmacological cessation methods

1. Tapering: Cut down the number of cigarettes/beedis smoked (or smokeless tobacco) each day until the patient find they are no longer using it. Tapering involves counting the number of cigarettes/beedis smoked each day and then reducing that amount by a fixed number over a given amount of time. This method involves setting a quit date by which patient will have tapered down to the point that they are no longer using tobacco.
2. Cold Turkey: Abruptly stopping all smoking. Best for patients who smoke two packets of cigarettes a day or less.

—-Pharmacological cessation methods

Drugs can be used for treating tobacco dependence. They interfere with the nicotinic receptors in the central segmental area of the brain and consequently cause release of dopamine. Drugs include:

1. Nicotine Replacement Therapy – patches, chewing gums, inhalers, sprays
2. Bupropion
3. Verenicline

• On every follow-up of smoker patients, conduct a complete normal assessment to ensure that the teeth and gums and entire mouth are sound – not only the area of chief complaint.
• Analyse their cheeks, tongue and throat for any indications of pre malignant lesions that might require more examination or intervention like biopsy.
• If a tobacco cessation program is not in your immediate priority list for your private practice, refer them to a non-dental entity which helps them quit. Keep in touch with local rehab centres and search for contacts in associations and self-improvement gatherings who can assist your smoker patients who wish to seriously quit.

A sample 5 day plan to quit smoking

Here is a sample 5 day plan you can share with your patients to help them quit the habit.

“The first step to quitting is to decide to quit. Next, make an appointment with me, your dentist, to discuss the options for treatment and to get a ‘quit date.’

—Quit day minus 5—

• List all the reasons to quit
• Tell your family, friends about your plan
• Stop buying cartons of beedis/cigarettes/smokeless tobacco

—Quit day minus 4—

• Pay attention to why and when to use tobacco
• Think new ways to relax
• Think new ways to holding something in mouth and in hand instead of tobacco
• Think of habits or routine you want to change

—Quit day minus 3—

• Make use of things you could do with the extra money you save
• Think whom to reach when you need help

—Quit day minus 2—

• Clean your clothes to get rid of smell of smoke

—Quit day minus 1—

• Think of a reward you will get for yourself after you quit
• Get your teeth cleaned (scaling and polishing) by the dentist
• Throw away all your tobacco products

—Quit day—

• Keep yourself busy
• Change your routine when possible
• Do activities which don’t remind you to use tobacco”