No more butts, now's the time to quit


It's No Smoking Day on 11 March, so we caught up with dental therapist Debbie McGovern to hear why your dental practice is well placed to help you quit

As a smoker looking to quit this No Smoking Day, have you ever thought to seek a helping hand from your local dental practice? It's not an obvious choice but many practices run smoking cessation programmes to help patients give up the habit. Smoking influences oral health in several ways - such as the occurrence of periodontitis, teeth discolouration and oral cancer - therefore, smoking behaviour should be addressed within dental health care. Dental therapist Debbie McGovern is an ex smoker. She explains: 'I began smoking while I was a student. In those days, every one of my friends seemed to smoke and I thought it was part of social interaction. Then I watched my best friend's granddad die of lung cancer and saw how it affected her. From that moment, I made a conscious effort not to smoke again.

'Most dental professionals are able to give advice and encouragement on where to go for help about stopping smoking. The dental team tends to see patients much more regularly than a GP or a GP practice nurse, so we are ideally placed to engage our patients in the "how to quit" discussion - and that can be the first step to them giving up the habit.'

Smoke signals

Debbie says: 'I can smell smoke on a patient, no matter how much they brush or chew gum or use breath freshener. The soft tissues of the mouth can have a paler to white appearance. Smokers often brush hard to try to get rid of the tobacco stains so they tend to have gum recession and loss of tooth enamel because of this excessive scrubbing; this can also make the teeth very sensitive. There is usually very heavy staining behind the teeth and in hard-to-reach cleaning areas. Most importantly, there is evidence of advanced periodontal disease that is crucial to diagnose and treat early.'

She adds: 'There are many well-documented, harmful health effects of cigarette smoking. But, aside from the overall health implications smoking has, it also causes oral health to deteriorate, leading to stained teeth and gums. Smoking can give rise to various health problems of the gums and teeth, such as swollen gums, loose teeth and bad breath. Smoking causes an acidic taste in the mouth and can increase the risk of developing mouth ulcers.'

Warning signs

She warns: 'Smoking may also mask the signs of early gum disease you normally get if you didn't smoke. As a non-smoker, if I intentionally missed an area of cleaning in my mouth, for a few days my body would send blood cells to the area to try to fight the plaque bacteria, and you see the redness and swelling. This is an inflammatory response. However, as a smoker, your blood is full of carbon dioxide and other chemicals from the cigarettes so your inflammatory response will not be as effective as the warning signs of bleeding and swelling won't be apparent so the disease progresses without anyone's knowledge. This, over a period of time, leads to the destruction of collagen in your gums and bone loss around the tooth. Before you know it, the tooth becomes loose and may fall out or require extraction. Smoking also commonly causes vocal changes, especially hoarseness and a raspy deep tone to the voice. These symptoms are often accompanied by a sore throat and frequent throat clearing. The frequent exposure to smoke is known as the cause of chronic laryngitis, or irritation of the area of the throat that houses the vocal cords. Chronic irritation of your larynx (or voice box) can deepen and weaken your voice.'

Debbie explains: 'Smokers are also at greatly increased risk for cancer of the lips, tongue, mouth, throat and larynx. All forms of tobacco use increase the risk for developing these cancers. Although five-year survival rates for cancer of the mouth and throat have improved since 1975, the rate for laryngeal cancer has remained largely unchanged. Early detection remains a critical factor in long-term survival with cancers of the mouth, throat and larynx.'

First step

A patient will usually take the lead to talk about smoking so Debbie sees that as her opportunity to encourage them to take the next step. She says: 'Sometimes, when we have a new patient who smokes and they are diagnosed with gum disease related to their smoking they face the devastating reality of losing some or - in extreme cases - all their teeth.

'The prospect of dentures to most people is terrifying. I work in a dental implant-based clinic but no dentist will consider dental implants while the patient is still smoking so if they want an implant solution rather than dentures they are encouraged to give up and most agree at that stage. The reasons patients wish to quit vary so much…'

Reasons to quit

  • Divorce
  • Financial reasons
  • Children or grandchildren making comments about stained teeth and how they smell
  • Wanting more years with their family and friends
  • They want to be around to share birthdays with their kids
  • Fewer sick days and lost wages
  • They want more energy
  • Improved quality of life
  • Enjoy the smell and taste of food
  • Since the ban on smoking in a public area, many smokers are tired of standing outside in the cold
  • 'I want to live to enjoy retirement' - probably the most common one!

Screening

'At our practice, everyone is screened for oral cancer, no matter what age or their social history. If they are a smoker, I ask about their alcohol intake and what type of alcohol they drink - alcohol (especially dark spirits) and heavy smoking combined are the greatest risk to oral health. The alcohol makes the lining of the skin more permeable and the dangerous chemicals of the cigarettes are absorbed at a higher rate. We have an emergency two-week referral system within our local hospital so we will refer anything we judge suspicious,' she says.

Look into your mouth

'It's important for patients to look in their mouths whether they are smokers or non-smokers and seek advice from their dental team if they notice any changes as soon as possible. I incentivise and motivate my patients to give up with the following:

  • If they quit for three months, I give them a free Aquaclean on their next visit. It jet washes the tooth surface and removes all tobacco stain; it's a great incentive
  • I take 'before and after' photos to show them the difference and this consolidates visually their great efforts
  • I also have a list of all the chemicals in cigarettes and a list of improvements and a timescale they will see general improvements in their health. It's a great motivator!

Countdown to success

  1. Set a date to stop and stick to it - No Smoking Day is ideal!
  2. Tell your family and friends you are trying to quit - ask them to stop with you or support you
  3. Make some new friends who don't smoke (new gym buddies)
  4. Join a gym, focus on eating healthy and being more active
  5. Identify when you crave cigarettes. A craving can last five minutes so, before you give up, make a list of five-minute strategies. For example, if you are out at a party you could leave the party for a minute, dance or go to the bar. And think about this: the combination of smoking and drinking raises your risk of mouth cancer by 38 times
  6. Talk to your doctor. Consider nicotine replacement therapy or medication
  7. Find a support programme. Social support helps when trying to quit
  8. Don't get discouraged. Quitting often takes several tries before you succeed

Debbie McGovern is a dental therapist and chair of the British Association of Dental Therapists. She says: 'I love doing a job that still makes me smile.'