Smoking and Oral Health
As succinctly summarized by C. Everett Koop, MD, a former US Surgeon General, “Tobacco use is the chief, single, avoidable cause of death in our society and the most important public health issue of our time.” While Dr. Koop held the office of the Surgeon General from 1982 to 1989, his sentiment remains true even to this day. Tobacco is responsible for over 480,000 deaths annually and has a health related economic cost of over $132.5 billion annually1. In the last decade, California has seen immense progress in decreasing the use of cigarettes in both adults and adolescents, as shown in Figures 1 and 22 below, but still counts 3.6 million people who smoke.
Tobacco can cause a myriad of adverse health outcomes and is known to harm every organ of the body. Given its usual method of consumption, harm generally starts with the oral cavity. Oral health plays a major role in an individual patient's overall wellness because it can affect the entire body across the life cycle. According to the World Dental Federation, “[Oral health] is multifaceted and includes, but is not limited to, the ability to speak, smile, smell, taste, touch, chew, swallow and convey a range of emotions through facial expressions with confidence and free from pain or discomfort, and disease of the craniofacial complex.”
Though oral health affects an extensive range of patient’s everyday lives, more people somehow suffer from untreated oral conditions than are afflicted with heart disease, cancer, diabetes, asthma or upper respiratory infections combined. A major aggravator and contributor to this phenomenon is tobacco. Tobacco is not only the primary cause of major oral ailments, including oral cancer and gum disease, it also disrupts nearly every facet of oral health: from taste perception, salivary flow, to the success of dental treatment. About 35,000 new cases are diagnosed in the US annually and anywhere from 7,000 to 8,000 result in death. Even if caught early, treatment will generally involve surgery. Smoking increases the risk of bone loss, deep pockets, gingival diseases, heavy plaque/calculus, tooth loss and impairs any response to treatment. For these reasons and more, it is important to stress the connection between smoking cessation and better oral health.
Family physicians and other non-dental professionals are well positioned to deliver effective tobacco cessation support and preliminary oral healthcare to their patients. The Institute of Medicine (IOM) even lays out clear roles for family physicians in its report on advancing oral health care. Not only does the IOM report suggest that adequate training would increase the amount of dental referrals, but training could also lead to increased access to preventive services and decreased dental disease. Family medicine has already taken a number of steps to incorporate oral health into residency curriculum. The Society of Teachers of Family Medicine Group on Oral Health, for example, published an oral health curriculum for family medicine in 2005, and the residency review committee for family medicine residencies added oral health as a requirement in 2006 (ACGME, 2007; Society of Teachers of Family Medicine Group on Oral Health, 2011). Though requirements now exist, much work is still needed to actually enforce these changes. According to the same IOM report mentioned, only three-fourths of the residency directors knew of the oral health requirement, and only about two-thirds of the programs were actually including oral health content, with the most common training time being two hours per year (Douglass et al., 2009).
As family physicians continue to care for the subpopulation of patients who smoke, CAFP encourages family physicians to also advocate cessation as a gateway to better oral health. To access free, evidence based information and/or resources, visit the training and technical assistance arm of the California Smoker’ Helpline, the Center for Tobacco Cessation:
- Online training, some available for CE credits
- In-person training
- Download or order patient materials at www.nobutts-catalog.org/
Family physicians can also look to the Family Medicine for America’s Health campaign, Health is Primary. Health is Primary is a collaboration between eight leading family medicine organizations with a mission to demonstrate the value of true primary care. Each month, the campaign will develop materials around one topic. This month focuses on smoking cessation. To access their toolkits, visit the Health is Primary website or directly download their November toolkit.
AAFP also has a number of resources available on their website, including office-based tools, community engagement, advocacy action and education.
1. [USDHHS Surgeon General Report (2014) The Health Consequences of Smoking - 50 Years of Progress]↩