In March, we celebrate No Smoking Day. It’s an important reminder for the almost 12% of UK adults who admit to smoking cigarettes regularly,[i] that cessation is beneficial and possible. For the dental team, it also provides an opportunity to talk to patients about the impact their lifestyle choice can have on their systemic, oral and mental health.
A physical problem
It’s no secret that smoking cessation is essential for improved health. The habit is associated with an array of negative health effects and is cited in the literature[ii] as a significant risk factor for various chronic illnesses. Respiratory conditions are high on the risk list for smokers, with many of these illnesses made worse by a smoking habit. The cardiovascular and reproductive systems are also adversely affected, with some effects possible even from passive or second-hand smoke where exposure is high enough. In addition, smoking cigarettes has been shown to hinder the body’s immune system, enhancing the inflammatory response and increasing the risk of conditions like multiple sclerosis.[iii] Smoking tobacco also the largest avoidable risk factor for cancer, responsible for 15% of all cancer cases and up to 28% of all cancer deaths in the UK.[iv]
When it comes to oral health, cigarette smoking is no better. There is an extensive body of evidence to show an increased risk of dental caries,[v] periodontal pocketing, tooth mobility, oral lesions,[vi] and tooth loss.[vii] What’s more, the lifestyle choice can impact a patient’s suitability of dental treatment because outcomes may be compromised. For example, research shows that dental implants placed in smokers have an up to 140% higher risk of failure than implants placed in non-smokers.[viii] There is also evidence to suggest that smoking can delay healing of apical periodontitis after endodontic treatment.[ix]
Not just in the body
However, smoking does not only have physical impacts on the body. It can also negatively affect mental health. A systematic review[x] from 2014 found psychological quality of life to significantly increase in those who quit smoking, with improved positive mood and reduced stress also described.
A study[xi] published in 2023 supported this sentiment, reporting that smoking cessation for at least 15 weeks was associated with enhanced mental health outcomes. This was true for participants both with and without existing psychiatric disorders, in particular, leading to lower depression and anxiety scores six months after stopping.
Boosting success of cessation
There are various smoking cessation interventions available to people today. These consist of pharmacological therapy (including nicotine replacement therapy), behavioural therapy and a combination of the all the above. Smokers will often find different solutions useful, depending on their personal preferences and experiences. Not surprisingly, research[xii] has suggested that combination therapy may offer the best option, with pharmacological and behavioural support leading to a success rate of approximately 24% after 12 months.
Of course, for any of these to work, it is crucial that individuals are sufficiently educated and motivated to remain dedicated to the cause. To this end, governments around the globe have invested substantially in educating their populations about the dangers of smoking and encouraging them to quit in recent years. Research[xiii] into what has worked best shows that people are more likely to consider cessation after seeing these campaigns and general related health warnings. Tax increases have also been linked with a higher likelihood of individuals trying to kick the habit.
I was also interested to come across research about gradual versus immediate quitting. Although we hear that cutting down the cigarettes is better than doing nothing at all, the research actually suggests that going cold turkey is far more successful for most people in the long-term.[xiv] Smokers, therefore, must be sufficiently prepared if they are to really quit.
Making a difference
The dental team also have an important role to play in helping patients to kick the habit for good. We likely see them more often than their GP and we are well-versed in discussing such topics with different people in a positive and non-judgemental manner. It is also common practice for dental practitioners to ask about smoking habits as part of our continuously updated patient histories, so we always know (as far as they tell us) what each patient’s smoking status is.
From here, the Very Brief Advice on Smoking (VBA) from the National Centre for Smoking Cessation and Training (NCSCT)[xv] can be helpful for all team members. This provides simple yet useful information to be used opportunistically in under 30 seconds when speaking to a current smoker. It offers a two-step pathway to establish whether a smoker is open to cessation and if it is an advantageous moment to signpost them towards support.
Aside from the initial motivation to quit, the dental team can also help individuals during their cessation journey. Social support has been proven to help people stay away from the cigarettes,[xvi] and a little extra encouragement from the dental team certainly can’t hurt!
At the end of the day, smoking remains a harmful practise for anyone of any age or gender to partake in. For those ready to quit, they are embarking on a journey to a healthier version of themselves and that must always be commended.
For further information about the endodontic referral services available from EndoCare, please call 020 7224 0999 or visit www.endocare.co.uk
[i] Office for National Statistics. Adult smoking habits in the UK: 2023. October 2024. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandlifeexpectancies/bulletins/adultsmokinghabitsingreatbritain/2023#:~:text=The%20estimated%20proportion%20of%20people,smokers%2C%20according%20to%20APS%20data. [Accessed December 2024]
[ii] Varghese J, Muntode Gharde P. A Comprehensive Review on the Impacts of Smoking on the Health of an Individual. Cureus. 2023 Oct 5;15(10):e46532. doi: 10.7759/cureus.46532. PMID: 37927763; PMCID: PMC10625450.
[iii] Alrouji M, Manouchehrinia A, Gran B, Constantinescu CS. Effects of cigarette smoke on immunity, neuroinflammation and multiple sclerosis. J Neuroimmunol. 2019 Apr 15;329:24-34. doi: 10.1016/j.jneuroim.2018.10.004. Epub 2018 Oct 9. PMID: 30361070.
[iv] Action on Smoking. Smoking and cancer. August 2023. https://ash.org.uk/uploads/Smoking-and-Cancer-Fact-Sheet.pdf?v=1692800564 [Accessed January 2025]
[v] Jiang X, Jiang X, Wang Y, Huang R. Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis. Tob Induc Dis. 2019 Apr 19;17:34. doi: 10.18332/tid/106117. PMID: 31516477; PMCID: PMC6662788.
[vi] Ahmed N, Arshad S, Basheer SN, Karobari MI, Marya A, Marya CM, Taneja P, Messina P, Yean CY, Scardina GA. Smoking a Dangerous Addiction: A Systematic Review on an Underrated Risk Factor for Oral Diseases. Int J Environ Res Public Health. 2021 Oct 20;18(21):11003. doi: 10.3390/ijerph182111003. PMID: 34769523; PMCID: PMC8582668.
[vii] Souto, M.L.S., Rovai, E.S., Villar, C.C. et al. Effect of smoking cessation on tooth loss: a systematic review with meta-analysis. BMC Oral Health 19, 245 (2019). https://doi.org/10.1186/s12903-019-0930-2
[viii] Mustapha AD, Salame Z, Chrcanovic BR. Smoking and Dental Implants: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2021 Dec 27;58(1):39. doi: 10.3390/medicina58010039. PMID: 35056347; PMCID: PMC8780868.
[ix] Paljevic E, Brekalo Prso I, Hrstic JV, Pezelj-Ribaric S, Persic Bukmir R. Impact of Smoking on the Healing of Apical Periodontitis after Nonsurgical Endodontic Treatment. Eur J Dent. 2024 Feb;18(1):124-130. doi: 10.1055/s-0043-1761451. Epub 2023 Mar 28. PMID: 36977477; PMCID: PMC10959606.
[x] Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: systematic review and meta-analysis. BMJ. 2014 Feb 13;348:g1151. doi: 10.1136/bmj.g1151. Erratum in: BMJ. 2014;348:g2216. PMID: 24524926; PMCID: PMC3923980.
[xi] Wu AD, Gao M, Aveyard P, Taylor G. Smoking Cessation and Changes in Anxiety and Depression in Adults With and Without Psychiatric Disorders. JAMA Netw Open. 2023;6(5):e2316111. doi:10.1001/jamanetworkopen.2023.16111
[xii] Onwuzo CN, Olukorode J, Sange W, Orimoloye DA, Udojike C, Omoragbon L, Hassan AE, Falade DM, Omiko R, Odunaike OS, Adams-Momoh PA, Addeh E, Onwuzo S, Joseph-Erameh U. A Review of Smoking Cessation Interventions: Efficacy, Strategies for Implementation, and Future Directions. Cureus. 2024 Jan 11;16(1):e52102. doi: 10.7759/cureus.52102. PMID: 38344627; PMCID: PMC10858725.
[xiii] Akter, S., Rahman, M.M., Rouyard, T. et al. A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nat Hum Behav (2024). https://doi.org/10.1038/s41562-024-02002-7
[xiv] Xie J, Zhong R, Zhu L, Chang X, Chen J, Wang W, Zhang L, Chen O, Yu X, Zou Y, Li Y. Smoking cessation rate and factors affecting the success of quitting in a smoking cessation clinic using telephone follow-up. Tob Induc Dis. 2021 Dec 20;19:99. doi: 10.18332/tid/143375. PMID: 35002594; PMCID: PMC8686120.
[xv] Very Brief Advice on Smoking for Dental Patients. NCSCT. https://www.ncsct.co.uk/library/view/pdf/NCSCT%20dental%20VBA.pdf [Accessed December 2024]
[xvi] Soulakova JN, Tang CY, Leonardo SA, Taliaferro LA. Motivational Benefits of Social Support and Behavioural Interventions for Smoking Cessation. J Smok Cessat. 2018 Dec;13(4):216-226. doi: 10.1017/jsc.2017.26. Epub 2018 Jan 21. PMID: 30984294; PMCID: PMC6459678.
