TOBACCO CESSATION WITH A TWIST

BY KAREN DAVIS, RDH, BSDH

Chronic tobacco use equals periodontal disease and tooth loss. Motivating patients to actually consider or give up tobacco habits brings with it many challenges -- not the least of which is the fact that many patients don't think of tobacco use in terms of tooth loss. When asked if they are aware of the greatest reason for adult tooth loss, patients often incorrectly reply, "Old age."

Supporting tobacco cessation in the dental office isn't new. But perhaps it is time to consider a few twists regarding the dental professional's role. We routinely see the evidence of tobacco use related to increased risk and severity of periodontal disease and the increased risk of implant failure.

Review a few startling facts about tobacco that should serve as a motivator to increase our roles regarding tobacco cessation:

• Nicotine has been shown to be as addictive as heroin or cocaine¹
• Each day over 3,800 youths under 18 years of age start smoking²
• Of every three young smokers, only one will quit, and one of those remaining smokers will die from tobacco-related causes²
• The average age of first time smokeless tobacco user is 10³
• On average, smokers die 13 to 14 years earlier than nonsmokers⁴
• 69% of current smokers say they want to quit⁵
• 80% of smokers who attempt to quit on their own return to smoking within one month⁶
• Effective tobacco cessation programs utilized in dental offices have been shown to achieve quit rates of 10-15%⁷
• Within five years of quitting smoking, the risk of cancer of the mouth, esophagus, and bladder are cut in half¹

In lieu of facts that remind us how deadly tobacco use can be and how cessation can reduce risks and save lives, below are three suggestions to increase successful outcomes for dental professionals involved in tobacco cessation.

1. Motivational interviewing -- Motivational interviewing is a method of counseling by health care professionals that was first utilized with problem drinkers but has direct application for dental professionals supporting patients in deciding to quit tobacco use. Psychologists William Miller and Stephen Rollnick have written a very intriguing book titled "Motivational Interviewing for Health Care Professionals." Motivational interviewing is nonjudgmental and nonconfrontational. It includes a patient-centered interviewing style, helps patients explore and resolve ambivalence, and evokes change from within.

While professionals interested in implementing this effective style of communication with patients regarding behavior change will benefit from reading the book, the following questions incorporate the concepts of motivational interviewing. Imagine how you might customize this style of communication to assist your patients.

• Would you mind if we spend a few minutes talking about the impact of smoking on oral health?

Offer two to three concise facts, such as:

√ Smokers are 7 times more likely to have gum disease, which is the leading cause for tooth loss, than those who don't smoke.

√ 70 of the 7,000 chemicals and compounds in cigarettes are carcinogens, while other toxins contribute to inflaming the lining of the airways, and increasing risks for blood clots

• Were you aware of this?
• How do you feel about this information?
• On a scale of one to five with one representing "ready" and five representing "not ready," how ready are you today to consider stopping smoking?
• What concerns do you have about making a decision to quit?
• What do you think it would take for you to consider stopping smoking?
• Here are some options for smoking cessation support. What do you think would work best for you?

During motivational interviewing, the role of the dental professional is to increase the patient's awareness of potential problems and consequences of their behavior but to meet the patient where they are, and help reduce ambivalence. In addition, the goal is to help patients identify what obstacles or concerns they have regarding tobacco cessation, and provide support to assist with those obstacles.

2. Provide cessation resources -- Patients who receive social support and encouragement are more successful in quitting than going "cold turkey" on their own. Patients who have identified a readiness to quit should ask family, friends, and coworkers for support. They should also get individual, group, or telephone counseling. 1-800-QUIT-NOW or www.smokingstopshere.com are resources we should be prepared to provide. These resources provide free quit lines with counselors trained specifically to help smokers quit.

Patients wanting to learn more about FDA approved nicotine replacement products should go to www.fda.gov and type "Smoking Cessation Products" into the search bar. Generally, the most successful tobacco cessation involves a combination strategy of social support and professional support coupled with nicotine replacement products. Patients need to be well informed about the pros and cons of various products shown to assist in decreasing nicotine dependence.

A smartphone app is available from www.smokefree.gov/apps for a free Quit Guide that can be downloaded to a phone for information and support. A resource for patients seeking natural and nicotine-free replacement products can be found at www.quitsmokinghub.com. Providing tobacco cessation resources to tobacco users shows genuine concern for their well-being, and lessens the burden for them to have to seek them out on their own.

3. Provide incentives -- Tobacco users are often concerned about yellowing stains on their teeth due to chronic use; therefore, offering an incentive of complimentary in-office whitening once they have achieved and sustained three months' tobacco free is a tangible incentive to help support them through the difficult first few weeks and months of quitting. Or, for many tobacco users, they have already been diagnosed and treated for accompanying periodontal disease, so another incentive would be to provide complimentary periodontal maintenance for one year following three months of being tobacco free, provided they sustain it.

While incentives alone will not generate a rise in tobacco cessation with your patients, it does show good faith in their efforts and an opportunity to celebrate their accomplishments. Essentially, this equals a small investment from their dental professional in their long-term health.

Providing tobacco cessation support is a realistic goal once teams are informed of the facts, know how to participate in appropriate communication, and provide cessation resources to patients. Hopefully, lives saved and cancer prevented is the outcome for your tobacco users as you participate in tobacco cessation with a twist. RDH

References

1. www.cancer.org.

2. http://www.surgeongeneral.gov/library/reports/preventing-youth-tobacco-use/exec-summary.pdf Accessed May 7, 2012.

3. National Cancer Institute.

4. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses--United States, 1995–1999. Morbidity and Mortality Weekly Report 2002;51(14):300–303.

5. Centers for Disease Control and Prevention. Quitting Smoking Among Adults -- United States, 2001–2010. Morbidity and Mortality Weekly Report 2011;60(44):1513-1519.

6. Benowitz N. Nicotine addiction. J Engl J Med 2010;362:2295-2303.

7. Warnakulasuriya S. Effectiveness of tobacco counseling in the dental office. J Dental Ed 2002;66(9):1079-1087.