Can dentists provide smoking cessation programs for patients?

Originally published in the February/March 2013 issue of Dispatch

Yes, tobacco use has been implicated in oral cancer and other conditions of the oral-facial complex such as periodontal disease. The provision of smoking cessation, including the prescription and/or recommendation for use of nicotine replacement products or other pharmaceutical aids, is considered within the scope of practice of dentistry.

What are the recommended educational requirements?

Recommended initial educational requirements for dentists who wish to provide smoking cessation programs for patients are courses that:

• are conducted by persons with recognized formal training and significant experience with smoking cessation programs;
• teach methods and strategies that have been shown to be successful; provide information about:
• the general and oral effects of smoking;
• the physiological mechanisms of tobacco use;
• addiction and the quitting process;
• the physiology of the heart and blood vessels;
• the biochemistry of nicotine including the mechanism(s) of action;
• effective methods to help patients cease smoking;
• advanced counselling strategies and methods;
• how to integrate a smoking cessation program in the dental office;
• patient selection criteria; nicotine replacement therapy including:
• prescribing information;
• contraindications and warnings;
• use during pregnancy and while breastfeeding;
• use with adolescents;
• adverse reactions and effects;
• other cautions;
• other health effects such as increased blood glucose levels; and
• other pharmacological methods to assist patients with smoking cessation.

Dentists involved in smoking cessation programs for their patients should maintain and update their knowledge periodically through continuing education and pharmacology reviews.

What about patient evaluation and selection?

Proper patient evaluation is important for all aspects of dental care, including smoking cessation programs using nicotine replacement therapy or other pharmaceutical approaches.

Medical histories must be complete and must be updated regularly and patient records should clearly indicate that informed consent was obtained prior to commencing a smoking cessation program.

Patient records should also contain detailed entries about all medications prescribed and/or recommended, as well as a record of any and all advice that was given to the patient. Follow-up notes should record the progress of the smoking cessation initiatives and indicate any changes made to the program.