Where there’s smoke

No-one spends more time peering into people’s mouths than dentists. So it makes sense for them to try and convince their patients who smoke—and are therefore at a greater risk of developing oral cancer—to kick the habit. By Susan Chenery

Dentists cannot be too proactive when it comes to encouraging patients to quite smoking.

Professor Michael McCullough, spokesman for the Australian Dental Association (ADA), says there is no such thing as being intrusive or invading privacy when patients are putting their health at risk. “I don’t think dentists having frank conversations about the relationship between smoking and oral cancer and periodontal disease is intrusive,” he says. “We as dentists should be joining the rest of the health professions in saying smoking is bad for you. Dentists should be telling patients frankly that they need to get their mouths checked to make sure that they don’t have changes that could be the beginning of a cancer. And they should be doing it every six months.”

ADA president Dr Hugo Sachs said as much in a recent statement: “There is no room for complacency. Smoking is strongly associated with oral cancer, a highly aggressive disease which often goes undetected until it is at an advanced stage.”

The director of Quit Victoria, Sarah White, agrees that dentists should be on the front line in the battle against tobacco. “It absolutely should not be considered a no-go zone,” she says. “It is an addiction that is the leading cause of preventable death and disease in Australia. So dentists absolutely should be raising it as a legitimate issue. It affects their domain.

“[Smoking] is an addiction that is the leading cause of preventable death and disease in Australia. So dentists absolutely should be raising it as a legitimate issue. It affects their domain.”—Sarah White, director, Quit Victoria

“People expect health professionals to ask them about smoking,” she continues. “But they are often surprised when their dentist does because they don’t think it affects their teeth so much. It is a really great wake-up message to them if their dentist says ‘I can see you smoke because of the condition of your teeth and these are the risks that you face if you keep smoking.’”

In fact, around 70 per cent of oral cancers are recognised by dentists rather than doctors. “And we should be doing that more” insists McCullough, “because we’re the ones trained to recognise oral mucosa disease, abnormalities in the mouth. Some doctors are very good at it but we should be better at it. We’ve got the big light and the mirror.”

The link between alcohol, smoking and oral cancer is well established. But the public is often unaware of how devastating combining these addictions can be. The stats bear this out. There is a fourfold increase in the likelihood of getting oral cancer if you’re a long-term alcohol consumer, says McCullough.But that shoots up to a 15-fold increase if you’re also a heavy smoker. “We know that if we recognise early changes—before [the cancer] has spread into the lymph nodes—there is a much better treatment and success rate. I have seen patients who’ve got little white patches on their mouth who have stopped smoking and the white patches have disappeared because the insult is not there any more.”

Quit Victoria has been working with Dental Health Services Victoria and the ADA Victorian branch to try and increase the intervention rate of oral health professionals. “We are providing training and evidence about why they should care about smoking and what they should do to help their patients quit,” says Sarah White. “I believe that there are efforts in other states to run similar programs. So we are going to hopefully do a statewide rollout of this approach for dentists this year. We will hopefully be taking some of the lessons learned to other states.”

“I have seen patients who’ve got little white patches on their mouth who have stopped smoking and the white patches have disappeared because the insult is not here any more.”—Prof Michael McCullough, ADA

Dentists can broach the subject in a non-judgemental way. “It is all in the approach,” says White. “We say you can really make a difference and play to your strengths in a dental chair by doing what we call the brief intervention. Suggest the patient goes to their GP to get help or calls the Quitline. That takes 30 seconds but it will help people quit.”

Dentists can also remind their patients that stopping smoking reverses many of the habit’s negative effects. McCullough says the risk of cancer, “never really goes away”, but is reduced by 80 to 90 per cent five to 10 years after a person has stopped smoking.

He adds that dentists should be talking to and collaborating with patients, for example, recommending not just a teeth clean but one that “gets them all really nice and cleaned and polished as they are giving up smoking”. McCullough also suggests dentists direct their patients to Quitline where many of the trained advisers are ex-smokers and can empathise. “I don’t think any dentist has a magic wand but being part of the conversation is very important. If they’re not telling their patient smoking is deleterious for their health then they’re not doing the right thing by that patient.”

www.Quit.com.au provides training for oral health professionals

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