Chapter 13

Smoking cessation and substance misuse

SMOKING AND TOBACCO USE

Tobacco use remains a significant public health problem in the United Kingdom. Although rates of smoking have declined steadily since the 1970s, figures indicate that 24% of the adult population smoke – approximately 12.5 million people [1]. Smoking rates vary across the United Kingdom population, and are highest amongst socially disadvantaged groups, men and young people. The use of smokeless tobacco and/or areca nut (commonly known as betel nut) is also common amongst certain ethnic minority groups and can have similar effects to tobacco smoking [2] (see Chapter 25).

Reasons why people smoke

Many people who smoke want to stop. They have the knowledge about why they should give up, but not the willpower to do so and require a change in attitude.

Attitudes are formed from personal experiences throughout life and encompass influences from family and friends, values and beliefs. Patients must have a strong desire to change their behaviour before they will do so. In order to influence them to stop smoking, the OHE needs to have some knowledge of the main reasons why people smoke:

• It makes them feel grown up amongst their peers (pre-teens/younger teenagers).
• They began smoking before the dangers were recognised, enjoy it and see no reason to stop (older people).
• To relieve stress (even though nicotine is actually a stimulant). This is the most common reason the OHE will be given, and the usual reason for a relapse.
• To keep weight down. A particularly important reason given by women.
• Social reasons. They may have the odd cigarette on an evening out – but are not addicted.
• They are addicted. Many people in this group want to change their behaviour, yet cannot break the habit.

Effects of tobacco smoking on general health

The OHE also needs to know the potential effects of tobacco smoking on general health, in order to help change patients’ attitudes. Conditions and consequences include:

• Chronic bronchitis and emphysema (lung diseases).
• Cardiovascular disease (CVD) – the biggest single killer in the United Kingdom, including coronary heart disease (angina and heart attacks) and strokes.
• Infertility.
• Certain cancers – particularly of the lung, mouth, larynx, oesophagus and bladder. The combined effects of smoking and moderate–high alcohol consumption (particularly spirits) increase the likelihood of cancer (see Chapter 8).
• Miscarriage, premature birth, ectopic pregnancy, small head circumference and low birth weight. Research [3] has also shown that children of mothers who smoke during pregnancy have a higher caries rate.
• Passive smoking is especially dangerous in children and can increase the risk of:
  • Childhood cancers and leukaemia.
  • Sudden infant death syndrome (‘cot death’).
  • Middle ear infection (‘glue ear’).
  • Poor lung function.
  • Respiratory infections, such as asthma, bronchitis and pneumonia.

Effects of tobacco smoking on oral health

Smoking increases the risk of the following oral diseases and conditions:

• Stickier plaque – greater risk of gingivitis/periodontitis (see Chapters 3 and 4).
• Stained teeth (see Chapter 2).
• Halitosis.
• Xerostomia (see Chapter 7).
• Hairy tongue (see Chapter 8).
• Loss of taste (and smell).
• Destruction of the periodontium (see Chapter 4).
• Increased risk of oral cancer (see Chapter 8).

Helping patients change their smoking habits

OHEs are in a prime position to offer a ‘brief intervention’ with regard to patients wishing to change their smoking (or tobacco chewing) habit and have a duty of care to do so. Stop smoking guidelines recommend that all health professionals, including dental team members, should check the smoking status of their patients at least once a year, and should advise all smokers to stop smoking [4].

Patients may ask the OHE for help and you can help motivate them towards change. However, more detailed advice and support should only be provided by dental staff that have completed a recognised cessation training programme and in dental practices that have the resources available, e.g. carbon monoxide monitors. If not, the OHE can signpost the patient to NHS Stop Smoking Services [2].

The OHE is unlikely to change the behaviour of someone who has not made a decision to stop smoking. Patients will only change their behaviour if they have the knowledge to do so and their attitude is geared towards a behavioural change.

Guidelines for a brief intervention

The following guidelines could be used when delivering brief interventions in a dental practice setting [2]:

• Ensure that the patient is ready to stop smoking for good.
• Highlight the benefits of/>
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