The tobacco‐using periodontal patient: role of the dental practitioner in tobacco cessation and periodontal disease management

Abstract

Although the prevalence of tobacco use has declined in some parts of the world, tobacco use remains a persistent and, in some cases, growing problem that will continue to be a fundamental challenge facing dental practitioners in the decades ahead. The dental practitioner has a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. In this article, the current non-invasive, evidence-based approaches are presented for the dental practitioner to help patients avoid tobacco initiation, to encourage and assist patients’ in tobacco cessation, and to address tobacco-induced damage to periodontal supporting tissues.

Smoking cessation and response to periodontal treatment

“…The odds of achieving smoking cessation are higher for patients willing to quit than for patients unwilling to quit or patients leaving it for a later time. Based on the US Public Health Service clinical practise guideline Treating Tobacco Use and Dependence, health professionals should follow the ‘5 R's’ approach for the last two groups of patients prior to deciding initiation of a smoking‐cessation programme . The ‘5 R's’ approach consists of encouraging the patient to indicate why quitting is personally relevant (relevance), asking the patient to identify potential negative tobacco consequences (risks), potential quitting benefits (rewards) and barriers or impediments (roadblocks) as well as repeat the motivational intervention in each dental appointment of the unmotivated patient (repetition) .…”

“…The ‘5 R's’ approach consists of encouraging the patient to indicate why quitting is personally relevant (relevance), asking the patient to identify potential negative tobacco consequences (risks), potential quitting benefits (rewards) and barriers or impediments (roadblocks) as well as repeat the motivational intervention in each dental appointment of the unmotivated patient (repetition) . This helps the patient to become more receptive to a future tobacco‐cessation programme . Modified forms of the initial ‘5 A's’ approach have been adopted in other international guidelines…”

“…It may entail several failed attempts, which discourage the patient. Repeated behavioural interventions during the dental visits, encouragement, reinforcement, motivation, reminding the patient of the detrimental oral effects of smoking that they have already experienced or may experience, reminding them of the oral benefits of cessation, as well as suggesting individually tailored cessation strategies are often required by the dentist to assist the patient's effort . Therefore, data suggests that dentists may play a key role in achieving successful smoking cessation and smoke‐free patients .…”

Leveraging Electronic Dental Record Data to Classify Patients Based on Their Smoking Intensity

“…6 As a result, dental clinicians routinely assess and record their patients' detailed smoking status such as smoking intensity and duration (cigarettes or packs smoked per day/year). 7,8 They use this information to assess their patients' risk of developing oral diseases, and the prognosis of treatment provided. 8,9 With the increased use of electronic dental record (EDR) to document patient care, clinical information including patients' detailed smoking histories are available electronically.…”

Impact of Smoking and Smoking Cessation on Periodontal Health: A Review

“…The overall goal of addressing the problem of tobacco use and periodontal disease should not be a reduction in tobacco use, but an effective long-term tobacco cessation program. 69 At a minimum, these three primary cessation interventions should be included in a comprehensive tobacco control programme.…”