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MyView: Becoming experts at helping our patients quit

February 04, 2013

By Todd Beck, D.M.D.

I quit smoking about 12 years ago. In fact, it's almost 12 years to the day. That was a big deal. I had smoked about a pack a day for just over 10 years. Cigarettes had become a large part of my coping mechanism for life. For the first few months, I didn't feel better; in fact, I was emotionally and physically worse. But I kept at it and over time I started to get and feel better. I could exercise without being winded and I could remain calm without an infusion of nicotine. Life was getting better.

Over the years I have not been afraid to talk to my patients about their smoking. After all, I was a smoker once, so we share a sort of unhealthy kinship. I know what they are going through and I know what it is doing to their oral and general health. I have walked the walk by quitting and not starting back up again; and that gives me some credibility ... with smokers anyway.

So, fast forward to about a year ago. I am sitting in a faculty meeting at the dental school and the head of grad perio comes up to me and asks if I would mind speaking to his residents on tobacco cessation for patients. I had been interviewed by our alumni newspaper on how I quit smoking and how I use that experience to help my patients quit smoking. Well, Dr. Carter had read that article and decided I was the expert at the dental school on tobacco cessation. Wow! It doesn't take much to be an expert these days.

In any event, I found myself helping put together a full-day seminar on tobacco cessation for the entire student body and faculty of the dental school at Oregon Health and Science University. One of the senior instructors asked us why we would waste a perfectly good golfing day on something that is such a waste of time. He said we can't even get out patients to brush and floss, let alone quit something as addictive as smoking. And he is probably right.

So, why then should we educate ourselves on how to help our patients quit using tobacco products? Why should we bother with something that most, if not all, will not appreciate? The answer is simple: because we are health care providers. Because we have a responsibility to offer our patients the absolute best health care we can provide. We should do it for the same reasons we keep talking to deaf ears about better home care and prevention. We should do it because we have a professional responsibility to help the whole person and not just their dentition.

We all know the effects tobacco has on health. Our patients know it, too. Why then, would someone elect to continue a habit that is killing themselves and endangering the health of those around them? Because it's an addiction! And unless you have smoked, you really have no idea what that means and how difficult it is to stop. Are we, as dentists, going to be the sole reason a patient will stop using tobacco? Probably not, but we can be one reason that may help them quit. We have many tools at our disposal to aid in helping our patients. First of all, we see them twice a year and talk to them about their oral health. That is a perfect opportunity to bring up smoking or chewing as it relates to oral health and remind them of the benefits of cessation. We can prescribe medications that will aid in kicking the habit and we can recommend support groups, quitlines and over-the-counter nicotine replacement products.

I have a longtime patient in my practice. I'll call him Jim (yes, he is real). Jim has been coming to me for 12 years. He has a near 40-pack-a-year history of smoking, and over the past decade I have seen his periodontal and general health decline. Every appointment, I or my hygienist would ask him if he was ready to quit. Finally after 10 years, he said yes. He actually did it on his own with nicotine patches and a support group. When I asked him what finally made him decide to quit, he said he didn't want to lose his teeth. Of all the reasons this man had to quit, it was the threat of losing his teeth that motivated him into action. He actually thanked me for not giving up on him. That was over two years ago and he still doesn't smoke and has all this teeth.

Talking to patients about tobacco isn't comfortable. It's much easier to leave it to their physicians or some other health care professional. But who said practicing dentistry was easy? I think we have a professional responsibility to do everything in our skill set to improve the health and lives of our patients.

Dr. Beck is the president of the Multnomah Dental Society in Oregon. His comments, reprinted here with permission, originally appeared in the October 2012 issue of the MDS Hotline newsletter.

Editor's note: According to the ADA Council on Access, Prevention and Interprofessional Relations, studies have shown that dentists can be effective in assessing and advising tobacco users (including smokeless/spit tobacco users) to quit. Given the large number of tobacco users who visit a dental office each year, the potential impact of advising patients to quit is substantial. The U.S. Department of Health and Human Resources' website (www.ahrq.gov/path/tobacco.htm#Clinic) offers Treating Tobacco Use and Dependence: Clinical Practice Guidelines, which include evidence-based recommendations for dentists as well as professional and patient resources. Patients can also be referred to www.smokefree.gov and 1-800-QUIT NOW—the national access number to state-based quitline services.

The University of Montana is holding the 7th National Smokeless and Spit Tobacco Summit for health professionals and researchers in August.