By Mohammed Ismail Farook, Manas Dave and Paul Coulthard

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©Alina Naumova/iStock/Getty Images Plus

Smoking remains one of the primary public health challenges in the United Kingdom, directly contributing to over 74,000 annual deaths and imposing a substantial financial burden on the NHS.1 With regular patient contact, the oral healthcare team is uniquely positioned to contribute meaningfully to smoking cessation efforts. This article explores the detrimental effects of smoking, cessation strategies, available NHS resources and the practical role of dental professionals in promoting smoking cessation.

Adverse effects of smoking on general and oral health

Cigarette smoking is a major risk factor for systemic diseases, including lung cancer, cardiovascular disease, stroke and chronic obstructive pulmonary disease.1,2 Globally, tobacco use accounts for over 8 million deaths annually, including over one million deaths attributed to second-hand smoke exposure.3

The oral health consequences of smoking are equally severe. In brief, tobacco smoke contains over 7,000 chemicals, at least 70 of which are carcinogenic.4 Consequently, smokers experience a 5- to 10-fold increased risk of developing oral cancers affecting predominantly the tongue, floor of the mouth, and lips.5 Periodontal disease is also significantly more prevalent among smokers, with a 2- to 7-fold increased incidence.6 Additionally, periodontal disease prevalence is 2- to 7-fold greater amongst smokers due to impaired immune responses, reduced gingival vascularity, accelerated tissue destruction and compromised wound healing. It has been observed that there are increased complications, such as alveolar osteitis (dry socket), following dental extractions and dental implant success is reduced in smokers.7 Furthermore, tooth staining, persistent halitosis, diminished taste and olfactory acuity, smoker's melanosis, smoker's palate and potentially malignant oral disorders are also concerns.8,9

While tobacco is consumed in various forms, including smokeless products and electronic nicotine delivery systems (ENDS), this article specifically addresses cigarette smoking.

Methods of smoking cessation

Smoking cessation refers to the process of quitting tobacco use. Effective smoking cessation strategies integrate both behavioural and pharmacological support.

Behavioural support

Dental professionals can leverage the structured and efficient Very Brief Advice (VBA),10,11 model, which involves three concise steps:

  1. 1.

    Ask: ‘Do you smoke?' Understanding the patient's smoking status is the first step in initiating a conversation about cessation

  2. 2.

    Advise: ‘Did you know that the best way of stopping smoking is with a combination of specialist support and medication or e-cigarettes… I can refer you to our friendly local stop smoking service that many patients have found useful.' Providing clear guidance that can be practically actioned is critical in encouraging patients to reflect on their smoking habits and consider quitting

  3. 3.

    Act: If interested, refer the patient to a local Stop Smoking Service or other support services (see below). If the patient is not interested, you can say ‘It's your choice of course. Help will always be available. You can always return to see me, contact the smokefree helpline or your GP if you change your mind.'

This approach has been shown to significantly increase quit attempts.12 More comprehensive behavioural counselling, either individually or in groups, can further aid patients in managing withdrawal symptoms and identifying smoking triggers.

Nicotine replacement therapy

Nicotine replacement therapy (NRT) products include patches, gums, lozenges, nasal sprays and inhalators that provide controlled doses of nicotine to mitigate withdrawal symptoms without exposure to harmful combustion products. Combining short-acting (eg gum) and long-acting (eg patches) NRT formulations increases the likelihood of successful cessation compared to monotherapy.11,13

Pharmacotherapy

First line medications include Varenicline (Champix) which is a tablet that reduces cravings and withdrawal symptoms by modulating neurotransmitter activity. These agents are typically prescribed by general medical practitioners.11

E-cigarettes (vaping)

Public Health England's commissioned report states that e-cigarettes are moderately effective as smoking cessation and harm reduction aids, however a significant component of this is the behavioural rather than the nicotine delivery system of the e-cigarettes.14 Although long-term outcomes continue to be evaluated, current evidence supports their efficacy in smoking cessation strategies.15

Combining pharmacotherapy with behavioural support offers the most effective strategy for achieving long-term smoking abstinence.14

NHS smoking cessation resources

The NHS provides comprehensive, freely accessible smoking cessation support services to both patients and healthcare professionals:

Role of the oral healthcare team in smoking cessation

Dental professionals are well-placed to initiate smoking cessation discussions, as approximately 61% of UK adults attend dental check-ups annually. Practical measures include:

  • Implementing VBA for dental patients: Efficiently assessing smoking status, providing succinct cessation advice and facilitating direct referrals to cessation services16

  • Patient education: Utilising clinical evidence (eg periodontal inflammation) to highlight smoking-related oral health risks

  • Referrals: Encouraging patient engagement with NHS resources and cessation services

  • Oral cancer screening: Emphasising routine examinations to detect potentially malignant and malignant oral lesions early.

    A number of resources are available to equip dental professionals with the necessary skills and knowledge for effective smoking cessation interventions.

Additional resources

A number of resources are available to equip dental professionals with the necessary skills and knowledge for effective smoking cessation interventions. These include: