According to the Research Trisha E. O’Hehir, RDH, BS
Editorial Director, Hygienetown Magazine

A new message is being conveyed by healthcare workers to smoking addicts: Kick the smoking habit without giving up the nicotine. Smoke, with its hundreds of harmful chemicals, is the injurious factor here – not the nicotine.

In fact, taking the smoke out of the nicotine equation eliminates 99% of the health risks. Nicotine isn’t really all that bad, in fact it’s considered about as bad as caffeine, so nicotine replacement therapy (NRT) is encouraged as a healthy alternative to smoking.

Motivation efforts focused on a substitute nicotine source are reaching dental hygiene audiences. Carol Southard, RN, MSN, who presented “Patient Motivation for Smoking Cessation” at the California Dental Hygienists’ Association continuing education event November 5, 2005 near San Francisco, encouraged hygienists to talk with their patients about smoking cessation, specifically recommending NRT as part of a comprehensive program. Carol emphasized this point by stating: “I’d rather have people use NRT for life than smoke another cigarette.”

Which product should you recommend?

Several products are available over the counter that deliver nicotine without the harmful effects of smoking. Some, like patches, release the nicotine slowly and some, like nicotine gum, more rapidly. What you recommend will be dependent on the needs of the smoking addict. Recommend one, or a combination of products, to achieve the necessary nicotine levels to help your patients stop smoking.

Patches are good for people who smoke steadily throughout the day. With the patch they will receive a continual, low dose of nicotine all day. For stressful moments, a boost of nicotine is needed. This is where the gum comes in. Recommended use suggests chewing the gum a couple of times and then holding it in mouth until the next craving. Constant chewing releases a constant, higher dose of nicotine than may not be needed. The idea is to chew it to overcome a craving and then wait until the next craving.

For those with TMD problems who shouldn’t be encouraged to chew gum, recommend nasal sprays, tablets or lozenges. The nasal spray offers the quickest uptake of nicotine, while tablets and lozenges are placed under the tongue for rapid uptake through the mucosa.

Inhalers are a good choice for people who need to keep their hands busy while at the same time, satisfying the craving. The nicotine inhaler actually looks like a cigarette, but isn’t “smoked.” Instead, nicotine cartridges inserted in the inhaler deliver a measured puff of nicotine vapor that reaches the back of the throat, but doesn’t go into the lungs. Puffing seems to be more difficult in cold weather and easier in warm weather.

NRT is safe and effective and the above products can be used indefinitely with no apparent harm. NRT is simply a way to swap high doses of nicotine derived from cigarettes for lower doses delivered more slowly. It helps reduce the cravings and withdrawal symptoms.

According to the research, NRT can double the chances of successfully beating the smoking habit and all the NRT products are equally successful. Some people are able to quit “cold turkey;” however, research shows that the combination of NRT and some kind of group support increases success. “Ask. Advise. Refer.” is ADHA’s national program to promote cessation intervention by dental hygienists. Find out the referral sources in your area such as “quitlines” (smoking cessation telephone hot lines), Web-based cessation programs and local cessation support groups.

Make NRT a part of your smoking cessation program.

More Information on Smoking Cessation

American Dental Hygienists’ Association
www.askadviserefer.org

American Cancer Society (The Great American Smoke Out)
www.cancer.org

American Lung Association
www.lungusa.org

The Foundation for a Smoke Free America
www.tobaccofree.org