Patients who smoke or use tobacco products will reveal their habit in the medical and social histories. Dental team members have a professional and mandatory role to highlight the dangers associated with tobacco use and to offer brief smoking cessation advice and any subsequent sign posting to smoking cessation services. The patient records must include details of all advice and warning given.
In the United Kingdom, around 6,500 cases of oral cancer are diagnosed each year which is around 18 people every day. In 2016, around 4,300 men and 2,200 women were diagnosed with oral cancer. More than 4 in 10 oral cancer cases diagnosed in the UK occur in people aged 65 and over. Oral cancer incidence rates in the UK have risen by a third in the last decade. Around half of patients diagnosed with cancer of the oral cavity will survive their disease for at least five years and their quality of life is very poor with physical, social and emotional implications. Almost three-quarters of oral cancers in men and more than half in women in the UK are caused by smoking. Betel quid is widely used in many parts of Asia and in some Asian communities in other regions. Chewing betel quid with or without tobacco increases oral cancer risk. More than a third of oral cancers in men and almost a fifth in women in the UK are linked to alcohol consumption.
All patient examinations must include lymph node and soft tissue examinations. The patient record must demonstrate that this thorough examination has been carried out at each new course of treatment.
Why should we bother to help stop patients smoking?
6,000,000 die from smoking each year worldwide and in the UK it is over 100,000 annually. Smoking remains the largest single preventable cause of death and disability. There are over 400 chemicals present in cigarettes. These include cyanide, arsenic and carbon monoxide. Nicotine is, of course, the addictive agent. Smoking contributes to around fifty diseases including bronchitis, angina, diabetes and macular degeneration. The oral effects of smoking include staining, halitosis, periodontal disease, early loss of teeth, impaired wound healing and oral cancer. The use of hookah pipes also cause diseases in a similar process and studies suggest the impact is much worse than cigarettes. Nicotine dependence may also result from repeated inhalation of smoke from a water pipe since users receive comparable or higher doses of nicotine compared to cigarette smokers. On average, smokers reduce their life expectancy by 13 years. In the UK it is estimated that around 20 percent of the population are smokers. Studies have found that, on average, people who smoke and drink are up to 50 times more likely to get some types of cancer than people who neither smoke nor drink.
The cessation message
Two-thirds of smokers want to quit. 30% try to quit each year. Without any support, 2-3% will succeed in stopping. Using a stop smoking service means smokers are four times more likely to quit than if they don’t use any support. The barriers to quitting are weight gain, past failure, cravings and stress. Studies show that once patients quit smoking their chances of a heart attack are reduced by half after five years and after ten years the chances of lung cancer are also reduced by half. The benefits of quitting include more money, more control over life and less impact on others i.e. second-hand smoke. Quitting also demonstrates a good role model for children and an improved sense of smell. Smoking during pregnancy will have an impact on the unborn baby and again health messages need to be reinforced at this critical stage. Nicotine is just as addictive, if not more addictive, than heroin or crack cocaine (Royal College of Physicians, 2000). The initial steps are to consider nicotine replacement therapy. This gives a dose of nicotine to reduce cravings which is reduced over time. This can be in the form of patches, gum, lozenges, sublingual tablets, nasal spray or inhalators. They are all available on prescription, over the counter and on general sale. There are no contraindications. Zyban and Champix are tablets taken over 2 months and 3 months respectively. They act by reducing cravings and may be of help where simple nicotine therapy has failed.
Patients do understandably get upset and annoyed when dental team members offer smoking cessation advice as they see yet more interference in their social preferences but it is important to understand our professional duties in relation to patient care.
