In dental school, we learn that smoking causes a variety of health problems, including oral health problems such as oropharyngeal cancers, periodontal disease, gingival recession, caries and tooth staining. Dentists play a critical role in screening for these diseases that stem from tobacco use and are well-trained to help their patients discuss and develop a plan to stop smoking and tobacco use.
According to CDC data collected in 2015, 68% of adult smokers wanted to stop smoking, 55% attempted to quit in the past year, 7% had recently quit smoking, 57% had been advised by a health professional to quit, and 31% used cessation counseling and/or medication when trying to quit. According to the U.S. Public Health Service’s clinical practice guideline, counseling and medication are individually effective in treating tobacco dependence, but using both counseling and medication is far more effective.
Counseling offers problem-solving skills, training and social support during treatment. It can be offered in a variety of settings, including individual, group and telephone counseling. Cognitive behavioral therapy is effective among users who are ready and willing to quit, enhancing motivation and social support, and teaching users to identify and manage nicotine withdrawal symptoms and tempting situations.
Medication is effective with smoking cessation when used with counseling. Three of the most common medications and medication methods include using nicotine-replacement therapy, bupropion (an atypical antidepressant) and varenicline (a selective nicotine receptor partial agonist). According to the ADA, a 2014 summary of 12 Cochrane reviews used meta-analysis to compare the efficacy of these methods for smoking cessation. It found that combination nicotine-replacement therapies (e.g., longer-acting patch plus short-acting inhaler) was most effective for smoking cessation at 31%, followed by use of varenicline (27%), use of bupropion (19%) and singular nicotine-replacement therapy (17%).
Cessation counseling can be tricky for dental students to tackle when in clinic and learning how to communicate with patients for the first time. As a dental provider, identify the patients who use tobacco and consistently advise them to quit when you see them, offering cessation treatment and resources. The U.S. Department of Health and Human Services and the Agency for Healthcare Research and Quality outlines a five-step method to use when engaging with tobacco-using patients. It is called the “5 A’s”:
- Ask: Identify and document tobacco use status for every patient at every visit.
- Advise: In a clear, strong and personalized manner, urge every tobacco user to quit.
- Assess: Is the tobacco user willing to make a quit attempt at this time?
- Assist: For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him/her quit. It may be helpful to work closely with the patient’s primary care physician as well.
- Arrange: Schedule follow-up contact, in-person or by telephone, preferably within the first week after the quit date. Be consistent and proactive with your follow-up.
Discussing smoking cessation with our patients can initially seem daunting. The 5 A’s method is framed in a way to help you create a specific plan before that initial discussion. This method allows room for follow up with the patient. You will want to consistently check in with the patient each time you see them on their progress with smoking cessation. The journey is not a smooth, straight shot, and you should not expect to work through all 5 A’s in one or only a few appointments. Keep your patient notes organized, and consider documenting what step you’re on with the patient’s smoking cessation after each appointment. For many people, smoking cessation is an incredible challenge and some may not be ready to tackle it. Be patient, consistent, open, encouraging, educated and receptive to discussing smoking cessation with your patients. The CDC has a number of resources you can use to help you with these conversations.
~Callista Schulenburg, LECOM ’22, ASDA Immediate Past Editor-in-Chief