Smoking cessation

Smoking cessation

Smoking* is a widely-accepted risk factor for periodontitis and the risk is dose-related.^{16, 17} Individuals who smoke:

• are more likely to develop periodontal disease;
• do not respond to periodontal treatment as well as non-smokers;
• are more likely to lose teeth when compared with non-smokers. 

Tobacco use is also a risk factor for oral cancer and is related to a number of other medical problems (e.g. cardiovascular disease and lung cancer). 

Both the Delivering Better Oral Health toolkit (DBOH)⁷ and the BSP implementation of European S3 – level evidence-based treatment guidelines for stage I-III periodontitis in UK clinical practice (BSP-S3) guideline⁶ note that there is moderate certainty evidence that interventions for smoking cessation improve periodontal health³⁶ and include strong recommendations that such interventions should be implemented as part of periodontal treatment. Dentists and dental care professionals have been identified as being well-placed to help patients stop smoking due to the large proportion of the population that visit for regular check-ups, including key groups such as teenagers and those who are pregnant. 

Dental professionals are not expected to provide detailed specialist support, as this is available from smoking cessation services, delivered by trained smoking cessation counsellors and within pharmacies. Dental professionals should provide brief advice, encouraging patients who smoke to consider the risks of smoking and the benefits of stopping. Evidence suggests that quit rates achieved by dental professionals in primary care following smoking cessation interventions are similar to other healthcare professionals.³⁴

The use of tobacco in non-combustible forms is also of concern. Smokeless oral tobacco products (widely used by some minority ethnic groups) increase the risk of oral cancer.⁴⁴ 

While vaping devices (e-cigarettes) do not contain tobacco, they do contain nicotine and other substances and evidence of the impacts on health is still emerging. For current tobacco users, vaping is a significantly less harmful alternative.^{45, 46} However, these devices are not risk-free and may have the potential to cause harm. These devices should only be used for stopping smoking and avoiding relapse to smoking.⁴⁷ They are not products for children or non-smokers.

Details of an intervention to encourage smoking cessation, based on a tool developed by the National Centre for Smoking Cessation and Training is provided in Supporting tools.⁴⁸ This Very Brief Advice intervention can be used when discussing smoking cessation with patients. Individuals may take several attempts to stop smoking or to stop using other nicotine-based agents and it is recommended that tobacco use is regularly reviewed with patients.

* Although the terms ‘smoking’ and ‘patients who smoke’ are used here, the advice/information also applies to other forms of tobacco use.