#22 – Helps clients stop smoking

In 1965, 40% of Americans smoked. By 1987 only 29% of Americans smoked. This means that 750,000 lives were saved from smoke related deaths. Every year the percent shrinks a little more. Someday ash trays will be as hard to find as spittoons are today.

That’s good news, but why should hygienists and dentists get involved with helping people stop smoking? Remember one third of Americans still smoke and our job is to help them improve their health not just teeth. FOR EVERY SIX SMOKERS THAT QUIT, ONE LIFE IS SAVED.

1. We see people on a regular basis. We can follow up on their progress.

2. We see them over many years. We can help reinforce the abstinence.
3. Clients are used to getting health suggestions from us.

4. Since we try to develop adult relationships with people, we can be effective in this complex problem.

Look for stages of readiness for change
a. No ways – Don’t want to think or talk about it. Try to plant ideas discuss benefits
b. Maybe – Interested, but haven’t tried to stop. Offer them your help.
c. Trying – In the process of stopping. Encourage them, offer help if they need it.
d. No Luck – Tried to quit, but started again. Help build their self esteem and confidence that they could stop if they tried again. Post failure(s) only helped prepare them for what they need to do this time to be successful. Offer help.

Point out these smoking related symptoms
1. Bad breath
2. Hairy tongue
3. Calculus increased
4. Gum disease
5. Acute Necretizing Ulcerative Gingivitis someone who smokes 10 cigarettes a day has 10 times the chance of contracting ANUG
6. Tooth discoloration
7. Gum irritation
8. Leukeplakia
9. Oral cancer

We recommend Nicorette, Habitrol, or Nicoderm patches and gum to help our clients. It was first available in the U.S. in 1984.

Smokeless tobacco
1. The use of smokeless tobacco is increasing
2. Smokeless tobacco is not less harmful than smoking
a. Cancer
b. Gum recession with bone loss

Stop smoking clinics have a success rate of 20 35%. Also, 20 35% of people who stop, start again within 6 months. Be sure to ask how your client is doing at the next check up.

Some resources for you if you want to read more are: Nicotine: An Old Fashioned Addiction and The Smoker’s Book of Health, and http://www.smokescreen.org/ses.

What Can a Hygienist do?

Please read and learn our stop smoking brochures. Remember,
a. Every year 6 out of every 10 smokers try to quit.
b. Nicotine is eliminate from the body 24 hours after quitting
c. Carbon Monoxide is eliminated in 48 hours

Here’s a way to approach your clients

a. Ask if they use tobacco
b. Advise clients to stop
1. Stress the benefits not the damages.
2. Personalize the message for each client. Show them the damage in their own mouths.
3. Don’t badger the clients if they don’t want to stop and document the smoking in the chart.
4. Let clients who aren’t ready to quit yet know you are here when they are ready.

c. Assist the client in stopping
1. Set a quit date
2. Give them our handouts
3. Let them know about Good Samaritan smoke cessation programs, also 1-800-QUIT NOW

d. Follow up
1. Call or send a letter in 1 2 weeks to see how they are doing

e. For women only
1. Why women smoke
i. Maintain or reduce weight
ii. Reduce stress, depression, and anger
iii. Peers, friends, or parents smoke
iv. They want to be perceived as mature, sexy, and sophisticated

2. Helping women to stop
i. They need more group support. Ask them to get friends to help or sign up for a stop smoking clinic
ii. Learn new stress coping mechanisms
iii. Reinforce teens they can be different from the crowd
iv. Ugly! Yellow teeth/fingernails, bad breath, wrinkled skin around mouth, discolored hairy tongue
v. Reproductive age damage baby, 10x risk of heart attack if on birth control pills
vi. 8 of 10 smokers begin before the age of 18

vii. 6 stages of smoke cessation
a. Not intending to stop
b. Thinking about it occasionally
c. Seriously planning to quit soon
d. Actually quit and trying to prevent relapse (average person quits 5 times before being successful)
e. Off for awhile, but still fighting the smoking urge (70% relapse in 3 months)
f. Free of urge to smoke

Encourage your clients to become Active Copers, not Passive Sufferers!

Here are some of the benefits when smoking stops

Within 20 minutes of last cigarette:
blood pressure drops to normal
pulse rate drops to normal rate
body temperature of hands and feet increases to normal

After eight hours:
carbon monoxide level in blood drops to normal
oxygen level in blood increases to normal

After 24 hours:
chances of heart attack decreases

After 48 hours:
nerve endings start to regrow
ability to taste and smell improves

After 72 hours:
bronchial tubes relax, making breathing easier
lung capacity increases

Two weeks to three months:
circulation improves
walking becomes easier
lung function increases up to 30%

One to nine months:
coughing, sinus congestion, fatigue, shortness of breath decrease
cilia regrow in lungs, increasing ability to handle mucus, clean the lungs and reduce infection
body’s overall energy level increases

Five years:
lung cancer death rate for average smoker decreases from 137 per 100,000 people to 72 per 1,000,000 people

Ten years:
pre cancerous cells are replaced with normal cells
risks of other cancers, such as those of the mouth, voice box, esophagus, bladder, kidney, and pancreas decrease.

Smoking involve 3 factors
1. Physiological
2. Psychological
3. Habitual

The 2 primary signs of addiction are:
1. Smoke within ½ hour of waking
2. Withdrawal symptoms if the person doesn’t get to smoke
a. Craving of nicotine
b. Irritability
c. Anxiety
d. Fatigue
e. Restlessness
f. Difficulty concentrating

1. Chantix (approved in 2006)
a. Significantly reduce pleasure of smoking
2. Nicotine patch plus nicotine gum or nasal spray
3. Zyban
a. Doubles quit rates
b. Can be used with nicotine nasal spray

Be sure to give your clients a copy of our Quit Smoking brochure.



Research shows that in 1989, 15-20% off all adolescent men use smokeless tobacco. About one half of them have pre-cancerous lesions in their mouth. The chances of a smokeless tobacco user getting oral cancer, is 400% greater than non- users.

What is tobacco snuff?

1. An organic carcinogen nitrosonornicotine (NNN) which produces malignant tumors in the trachea, esophagus, liver and mouth.
2. Some contain high amounts of sugar that increase blood sugar levels and TOOTH DECAY.
3. Some contain salts for flavoring which contribute to increase risks of high blood pressure and
kidney disease.

Additional Risks

Nicotine addiction
Heart Problems (HBP, blood clotting problems, poor circulation and increased heart rate)
Cancer (oral, palate, tongue)
Teeth and gum problems

In our office we recommend the product “Mint Snuff” to clients who want to stop using smokeless tobacco. It does not contain nicotine or any dangerous chemicals so it does not help with the physical addiction, but it does help with the habit of using smokeless tobacco and the psychological dependency.

The information is kept in the third drawer from the bottom in the middle row of drawers behind room. There are brochures on the risk and samples of “Mint Snuff”.

Our job is to provide this information and support to our clients who are interested in quitting and to perform an oral cancer screening on all our patients. If we notice any keratinized tissue or pre-cancerous lesions we need to take intraoral pictures and document our findings in the patients chart. Possible biopsy.


Cigarettes aren’t the only problem. Spit tobacco has as many damaging side effects as cigarettes. Chew tobacco is chewed, while snuff is held between the cheek and gums.

When helping clients to stop they have two choices
1. Cold turkey – hard for most people
2. Taper down- cut back by ½ your usual amount per day

a. Leave the tin at home, then throw it away
b. Use substitutes (sugar free candies, sunflower seeds, or mint leaf snuff)
c. When is the need greatest and when is the habit (after meals, etc) the worse.
d. Avoid being around friends/workers who use, when they are using
e. Switch to a lower nicotine brand. This makes your nicotine withdrawal easier when you quit
f. Don’t start smoking as a substitute.
g. Let friends/co-workers know you are quitting and you may be edgy for a couple of weeks.
h. Exercise 30 minutes/day, keep busy
i. Withdrawal symptoms get better after two weeks
j. If you slip, go right back on your plan

Extra help

1. Nicotine replacement
a. One pinch = 4 cigarettes
b. Nicotine patch (see handout)
c. Nasal spray – not as good as the patch
d. Zyban – non-nicotine tablet to be used for 7-12 weeks
e. Support group – increases chance of success

2. When the urge hits – delay – it last only a few minutes