Dentists can play important role in helping smokers quit

Signs of smoking can easily be seen on the teeth, allowing dentists to start a conversation on quitting the habit with their patient. — 123rf.com

Millions of Malaysians are affected by oral diseases such as dental caries, gum problems and oral cancer.

Many of these conditions share a common risk factor, namely, tobacco smoking.

Research has shown that nicotine affects the metabolism of certain bacteria linked to dental caries and disturbs the mouth’s ecological balance, making teeth more susceptible to developing dental caries.

Studies have found increased destruction of tooth-supporting bone in smokers, compared to non-smokers, leading to premature tooth loss in the former.

Smoking also stains the teeth and tongue, and adversely affects taste and smell.

These health conditions ultimately result in reduced quality of life due to pain, impaired function, disfigurement, social isolation, and emotional suffering, among others.

Tobacco use is the leading cause of preventable disease and premature death globally.

The World Health Organization (WHO) reported last May (2020) that this habit results in over eight million deaths every year.

It, along with the treatment of related diseases, lays an enormous health and economic burden on countries worldwide, including Malaysia.

The 2019 National Health and Morbidity Survey (NHMS) reported that over one in five (21.3%) Malaysians aged 15 years and above was using some form of smoked tobacco product.

Less than half of them (48.9%) had made any effort to quit smoking in the past one year, despite compelling evidence that doing so provides substantial health benefits.

Kicking the habit can be difficult for many smokers due to the wide array of cravings and withdrawal symptoms they experience while abstaining from nicotine.

Smokers smoke in large part because of the addictive effects of this chemical, and generally, the more addicted the person is to nicotine, the more severe their withdrawal symptoms will be.

Dental visits offer a strategic platform for the dental team to be involved in smoking cessation efforts.

The repeated nature of dental visits for many patients provides a unique opportunity to build a rapport with patients who smoke and to discuss their quitting process regularly.

Unfortunately, not all dental practitioners routinely ask about tobacco use or advise smokers to quit.

Dentists have the potential to recognise patients who are smokers by identifying the signs of tobacco use in the mouth, such as nicotine stains on the teeth, severe gum recession, smoker’s palate and so on.

It is vital to document a patient’s tobacco use in their medical and dental history records.

Oral health professionals have a duty to inform patients of these tobacco-induced signs and enquire whether they wish to stop, as well as advise on the options available to them.

Patients may be more receptive to cessation advice if their health concerns can be related to their use of tobacco.

It is noteworthy that not all smokers have considered quitting.

According to the 2016 National E-Cigarette Survey, two-thirds of smokers indicated they had no intention to quit within the next six months.

For this group of smokers, it is imperative to help them begin to think seriously about stopping by educating them about the effects of smoking and increasing their motivation to quit.

All oral health providers should at least be able to deliver a brief intervention using the 5As approach:

• Ask about the patient’s smoking status
• Advise current smokers to quit
• Assess their willingness to quit
• Assist with quitting through a quick three to five-minute advice session, and
• Arrange to follow up as necessary.

This simple and quick intervention can be implemented without the need to disrupt the dental routine.

However, those who are uncomfortable counselling their patients in this matter can help those who wish to quit by referring them to the nearest tobacco cessation service.

Editor's note: Smokers interested in quitting can visit the nearest Health Ministry mQuit Centre. Those who stay in Bedong, Kedah, can also visit the Tobacco Cessation Clinic at the AISMT Dental Hospital.

Associate Professor Dr Hasnah Hashim is a lecturer with the Dental Public Health department at AIMST University. For more information, email [e-mail]. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.