LETTERS: There is significant evidence indicating tobacco use as the leading cause of preventable disease and premature mortality globally. The World Health Organisation in May reported death from this habit amounted to more than eight million every year.
This number undoubtedly points to the enormous health and economic burden of tobacco use and treatment of the related diseases faced by the different nations, including Malaysia. The scenario thus calls for an urgent increase in the effort to promote tobacco cessation.
The National Health and Morbidity Survey 2019 reported the prevalence of Malaysians aged 15 and above who were using any form of smoked tobacco product was at 21.3 per cent, and only 48.9 per cent of them made any effort to quit smoking in the past one year despite the compelling evidence to support substantial health benefits from the cessation of smoking.
Kicking the habit can be difficult for many smokers due to the wide array of cravings and symptoms of withdrawal. Smokers smoke because of the addictive effects of nicotine and generally, the severity of the symptoms correlates with the level of nicotine dependency of the individual.
Dental visits offer a strategic platform for the dental team to be involved in smoking cessation efforts. The repeated nature of dental visits for many patients provides a unique opportunity to build a rapport and discuss their quitting process regularly.
Unfortunately, not all dental practitioners routinely ask about tobacco use or advise smokers to quit. Dentists have the potential to recognise patients who are smokers by identifying the signs of tobacco use in the mouth, such as nicotine stains on the teeth, severe gum recession, smoker's palate and so on. It is vital to document the patient's tobacco use as part of the medical and dental history records.
Oral health professionals have a duty to inform patients of these tobacco-induced signs and enquire whether they wish to stop and the options available to them. Patients may be more receptive to cessation advice if their health concerns can be related to their use of tobacco.
Not all smokers considered quitting. According to the National E-Cigarette Survey 2016, two-thirds of smokers had no intention to quit within the next six months. For this group, it is imperative to help them begin to think seriously about stopping by educating them about the effects of smoking and increasing the motivation to quit.
All oral health providers should at least be able to deliver brief intervention using the 5As approach:
ASK about patient's smoking status;
ADVISE current smokers to quit;
ASSESS their willingness to quit;
ASSIST with quitting by giving a brief three- to five-minute advice; and,
ARRANGE to follow up as necessary.
This simple intervention can be implemented without the need to disrupt the practice routine. However, oral health care professionals who are not comfortable to counsel the patient may assist patients who wish to quit by arranging referrals to tobacco cessation services convenient to the patient.
The Dental Centre of AIMST University in Kedah provides counselling and support to smokers who wish to quit smoking, run by the Dental Public Health Unit of the Dentistry Faculty, and is open to the public. The clinic aims to increase awareness of the adverse effects of smoking and to equip smokers with the skills to help them stop smoking.
Associate Professor Dr Hasnah Hashim
Dental Public Health Department, Dentistry Faculty, AIMST University
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times