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| Year : 2021 | Volume
: 32
| Issue : 1 | Page : 23-26 |
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| Effects of smoking on oral health: Awareness among dental patients and their attitude towards its cessation |
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Archana B More1, Anisha Rodrigues1, Bhakti J Sadhu2
1 Department of Prosthodontics, A.J Institute of Dental Sciences, Mangalore, Karnataka, India
2 Department of Public Health Dentistry, Coorg Institute of Dental Sciences, Karnataka, India
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| Date of Submission | 13-Nov-2018 |
| Date of Decision | 27-Jun-2019 |
| Date of Acceptance | 28-Oct-2020 |
| Date of Web Publication | 13-Jul-2021 |
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 Abstract | | |
Context: Tobacco smoking is the leading cause of preventable premature mortality in the world. Smoking is also detrimental to oral health, causing unaesthetic tooth staining, bad breath, periodontal diseases, impaired healing of wounds, increased risk of dental implant failure, precancerous conditions and oral cancer. Aims: To assess the awareness of the effects of smoking on oral health among smokers in Mangalore city and to assess the smoker's willingness to quit smoking. Settings and Design: Cross-sectional study. Material and Methods: Data was collected from 140 participants. A cross sectional study was conducted using a self-administered questionnaire to determine the sociodemographic characteristics, awareness about the effects of smoking on oral health and their willingness to participate in smoking cessation programs and to quit smoking. Results: There was statistically significant difference found in the level of awareness of the smoking effects on oral cancer, on tooth staining and dental implants. However, it was observed that the upper socioeconomic class showed a comparatively higher level of awareness than the other classes. No significant differences were found in the level of awareness of the smoking effects on gum disease and on wound healing. One hundred and thirteen individual out of 140 expressed their willingness to quit smoking and also 78 respondents showed a positive attitude toward participation in cessation programs.Conclusion: Participants in this sample had some knowledge about the effects of smoking, but were not much aware of its effect on dental implants, requiring further education.
Keywords: Awareness, oral-cancer, smoking, socioeconomic status
How to cite this article:
More AB, Rodrigues A, Sadhu BJ. Effects of smoking on oral health: Awareness among dental patients and their attitude towards its cessation. Indian J Dent Res 2021;32:23-6 |
How to cite this URL:
More AB, Rodrigues A, Sadhu BJ. Effects of smoking on oral health: Awareness among dental patients and their attitude towards its cessation. Indian J Dent Res [serial online] 2021 [cited 2023 Oct 1];32:23-6. Available from: https://www.ijdr.in/text.asp?2021/32/1/23/321382 |
| Background | |  |
Tobacco use is one of the most important causes of preventable deaths globally. It has been estimated that by the 21st century, one billion people will die due to its ill effects.[1] India has over 100 million adult smokers, making it home to 12% of the world's smokers. About one million die every year in India due to smoking.[2]
The ill effects of smoking include cancer, heart disease, stroke, lung diseases, diabetes and chronic obstructive pulmonary disease (COPD). The mortality rates of people who quit smoking before the age of 35 years is similar to those who have never smoked.[3]
Smoking is also detrimental to oral health, causing unaesthetic tooth staining, bad breath, and also weakens immunity leading to periodontal diseases,[4],[5] impaired healing of wounds, increased risk of dental implant failure,[6] precancerous conditions and oral cancer. The effects of smoking on oral health are reversible if detected at an early stage. Therefore, it is important to assess the awareness among the smokers regarding the ill effects of smoking and to focus on the need to incorporate prevention and cessation programs in dental practice.
| Aims | | |
1. To assess the awareness of the effects of smoking on oral health among smokers in Mangalore city. 2. To assess the smoker's willingness to quit smoking.
| Material and Methods | | |
Ethical committee clearance certificate reference number: DCGI Reg. No. ECR/348/Inst/KA/2013
A cross sectional survey was undertaken to assess the awareness of the effects of smoking on oral health and the willingness to quit smoking among the patients visiting at the outpatient department at A.J. Institute of Dental Sciences, Mangalore, Karnataka. Data were collected from 140 adult dental patients who were smokers. Convenience sampling method was used. The sample included dental patients above the age of 16 years. Individuals who have quit smoking and those who have been diagnosed with any smoking related diseases were excluded from the study. The objectives of the study were communicated to them, and those who volunteered were asked to complete a self-administered closed-ended questionnaire. The questionnaire was divided into three sections:
- Demographic details of the participants. The modified Kuppuswamy's socioeconomic classification,[7] was used to classify the socioeconomic status of the subjects, which includes education level, occupation, and monthly income.
- Awareness about the effects of smoking on oral conditions concerning oral cancer, gum disease, tooth staining, delayed wound healing, and dental implants. The respondents were given three options- Yes/No/Don't Know and were asked to tick against one appropriate answer.
- Willingness to participate in smoking cessation programs and to quit smoking.
Data collected from the study were analysed using the Statistical Package for Social Sciences (SPSS) version 12.0 (Chicago, IL, 2003) statistical software.
| Results | | |
All the 140 respondents were males with mean age and standard deviation of 43.04 and 13.681, respectively. [Table 1] represents the socio demographic status and their association with the awareness of smoking on oral health derived using modified Kuppuswamy's scale of socioeconomic status. Amongst 140 study subjects the 80 (57.14%) belonged to the upper socioeconomic status and 60 (42.85%) belonged to the lower socioeconomic status.
Overall, there was no statistically significant difference regarding the awareness of the ill effects of smoking among the various socioeconomic classes. However, it was observed that the upper class showed a comparatively higher level of awareness than the other classes.
The majority of patients reported that smoking and oral health are related. Oral cancer was recognized by 126 (90%) patients as an oral health effect of smoking. Effects on tooth staining was recognized by 96 (68.8%) subjects, effects on gum disease and implants by 49 (35%) each, and effects of smoking on wound healing was recognized by only 26 (19.3%) study subjects.
Among the individuals belonging to various socio-economic classes, significant differences were found in their level of awareness of the effects of smoking on oral cancer (P < 0.05), on tooth staining (P < 0.01), effects on dental implants (P < 0.001). No significant differences were found in the level of awareness of the smoking effects on gum disease (P > 0.05) and on wound healing (P > 0.05) [Table 1].
To evaluate whether an awareness of these effects on oral health would encourage smokers to seek smoking cessation help, smokers were asked whether they would quit smoking if an association between smoking and oral health is proven to them.
One hundred and thirteen individuals out of 140 (80.7%) expressed their willingness to quit smoking and also 78 (55.7%) respondents showed a positive attitude toward participation in cessation programs [Table 2]. | Table 2: Respondents attitude towards smoking cessation programs and their willingness to quit
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| Discussion | | |
The effects of smoking on oral health range from life threatening conditions like oral cancer to tooth staining with potential jeopardies to oral health morbidity and tooth mortality. Smokers have a 3 times higher risk of developing oral cancer as compared to non-smokers. Smoke contains several precarcinogens that produce free radicals that affect the defence mechanism and also cause cell mutations.[8] Dental patients in this study seem to be well aware of the risks of oral cancer allied with smoking (90%). Graphic warnings on the cigarette packages may have contributed to a substantial increase in the awareness among the general public.
Various studies have shown smoking as a risk factor leading to an increase in the incidence and progression of periodontitis, contributing to tooth loss and edentulism as compared to non-smokers.[5],[9],[10] There is a decline in pro-inflammatory cytokines causing an immunosuppressive effect in smokers, leading to periodontitis.[11] It also leads to fibrinolytic activity which reduces blood supply, causing delayed wound healing especially post dental extractions increasing the risk of a dry socket.[12]
Dental implants are one of the most sought after treatment modalities to replace missing teeth. Smoking is considered a patient-related risk factor for implant success.[13] The implant failure rate was found to be higher in smokers with an association between implant survival and the amount of smoking i.e., number of cigarettes per day, the number of smoking years and also the time elapsed since its cessation.[14] There is evidence to suggest that smoking is a risk factor for perimplantitis and increased marginal bone loss.[15],[16] Nicotine, one of the major components of cigarettes has a high permeability into the gingival epithelium, affecting osteoblastic activity and therefore, bone healing.[17],[18] Lambert et al.[19] have suggested that the increase in implant failures is not due to poor osseointegration but due to the exposure of peri-implant tissues to tobacco smoke after the second-stage surgery. It was witnessed that patients in our study are not much aware about the effect of smoking on dental implants (35%).
There is a contrast with the results of the present study compared to previous studies by Al-Shammari[20] where the participants are more aware about the relationship between smoking and oral cancer (90% vs 52%), but have not much about its effect on periodontal health (35% vs 72%). Our study sample appears to be less knowledgeable about the dangers of smoking on the other aspects of oral health. Dentists should therefore be aware of this deficit and integrate oral health promotion in their clinical practice.
A vast majority of the patients expressed their willingness to quit smoking (80.7%), though 55.7% are willing to take part in cessation programs. Evidence from a systematic review suggests that smoking cessation decreases the risk of periodontitis and leads to better non-surgical treatment outcomes.[21] It also reduces the risk of oral cancer by 50% after 5 years and the same risk as life long non-smokers in 10 years of cessation.[22] Dentists are 'ideally positioned' and therefore should counsel patients on the dangers of smoking. They also need to motivate patients to participate in cessation activities. These interventions can be included as a component of dental treatment procedures. Dentists are 'ideally positioned' and therefore can play a crucial role in counselling their patients against smoking. Also, there is a regular patient-dentist contact which makes it easier for the dentist to motivate patients on a regular basis. Therefore, however, studies have reported certain barriers to these services by the dentist such as insufficient time, lack of training and a fear of an interference in the patient–dentist relationship.[23]
Study limitations
There are some limitations is this study. It was conducted on patients visiting a dental hospital. The sample size was small and all of the respondents were male. Therefore, the results may not replicate the perception of the general population. Also, the results may not be applicable to populations in other geographic locations.
| Conclusion | | |
Participants in this sample have a good overall knowledge about the effects of smoking. They were not much aware of its effect on dental implants, requiring further education. Dentists are in a strategic position and can play a crucial role in creating awareness and provide smoking cessation counselling, effectively. Further studies involving a larger and more varied sample may be warranted.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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Correspondence Address:
Archana B More
C-401, Sainath Shilp Apt, Syndicate, Ramdaswadi, Kalyan (West), District – Thane, Maharashtra - 421 301
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijdr.IJDR_711_18
[Table 1], [Table 2] |
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