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Oral Hygiene Therapy Assists in Behavioural Intervention for Smoking Cessation: A Pilot Approach for Oral Health Care Providers

Published online by Cambridge University Press:  28 November 2017

Danielle Furgeson and
Chin-Wei (Jeff) WangOpen the ORCID record for Chin-Wei (Jeff) Wang[Opens in a new window]
Danielle Furgeson
Affiliation:
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
Chin-Wei (Jeff) Wang*
Affiliation:
Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan
*
Address for correspondence: Chin-Wei (Jeff) Wang, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, 1011 N. University Ave, Ann Arbor, MI 48109-1078. Email: jeffwa@umich.edu
Rights & Permissions [Opens in a new window]

Abstract

Introduction: Behavioural dependency, such as oral and hand fixation, can hinder cessation efforts when nicotine replacement therapy is used as a stand-alone intervention. We here present a case report of one of several patients who has successfully achieved smoking cessation utilizing oral hygiene therapy (OHT).

Case description: The patient is a 52-year-old male with a 25-year smoking habit of two packs daily. Previous attempts at smoking cessation were unsuccessful with various nicotine replacement therapies (NRTs). After introducing interdental cleaning device and modifying tooth-brushing techniques during oral hygiene therapy, the patient reported frequent use of toothpaste and using the device to satisfy his oral-hand fixation to successfully quit smoking.

Conclusion: Oral hygiene therapy may enhance smoking cessation in select patients who are more behavioural dependent than nicotine dependent. Future studies are needed to develop evidence-based individualized intervention to include OHT as part of the interdisciplinary approach for smoking cessation.

Information

Type
Protocol
Information
Journal of Smoking Cessation , Volume 13 , Issue 3 , September 2018, pp. 176 - 178
Copyright
Copyright © The Author(s) 2017 

Introduction

Smoking cessation intervention has evolved, yet it still poses a great challenge for both health care professionals and patients. The development of pharmacologic agents, such as nicotine replacement therapy (NRT), has given both providers and smokers more options in the quest for successful smoking cessation. However beneficial these agents are, they are still limited in their success as stand-alone interventions. For example, NRT has been found to be relatively unsuccessful with only about 20% of smokers successfully achieving cessation with NRT as the sole intervention (Schnoll et al., Reference Schnoll, Martinez, Tatum, Glass, Bernath and Ferris2011). Providers must therefore identify concomitant interventions to help patients achieve and sustain cessation.

Smoking addiction comprises several components, which include nicotine and behavioural dependence (Figure 1). Behavioural interventions have been noted as an imperative mechanism for successful and sustainable smoking cessation (Schnoll et al., Reference Schnoll, Martinez, Tatum, Glass, Bernath and Ferris2011). As such, oral hygiene therapy (OHT) delivered by the oral health professional has the potential to become an integral component of behavioural intervention. Oral health care professionals are well versed in using motivational interviewing (MI) to affect behaviour change, and also have the advantage of seeing patients two to four times a year for preventive visits. In tandem with MI strategies (Sachs, Reference Sachs1990), OHT is utilized as a behavioural modification intervention to improve patients’ daily routine oral hygiene practice. This combination of MI and OHT, together with multiple preventive visits, may be of significant aid in selected patients with oral or hand fixations. The aim of this pilot case report is to demonstrate how OHT can assist in managing behavioural dependency for patients who are not purely nicotine dependent. This practical approach can constitute part of the multidisciplinary co-management strategy to enhance the overall success of smoking cessation.

Figure 1

Smoking addiction constitutes both behavioural and nicotine dependence, and oral hygiene therapy can assist in behavioural intervention.

Case Description

The patient is a 52-year-old male who has smoked two packs a day for the past 25 years. The patient has several previous unsuccessful attempts at smoking cessation with NRT. The patient presented to our clinic with generalized moderate, and localized severe chronic periodontitis. During the initial therapy of periodontal debridement, OHT was given to the patient, in addition to smoking cessation counselling in regards to his periodontal condition. The adjunctive interdental cleaning device (Stimudent) was introduced to the patient for interdental cleaning and management of the localized residual deep periodontal pockets. The patient was also advised to keep the mouth fresh to aid his smoking cessation efforts through increased brushing with toothpaste.

During the next periodontal maintenance visit, the patient declared that he had achieved cessation due to the addition of the OHT he had received. He expressed that brushing with toothpaste more frequently was helpful, but that the most significant impact was from the interdental cleaning device. Keeping the device on hand prevented him for reaching the cigarettes, by satisfying his oral-hand habit. Testimony from the patient: ‘I don't necessarily crave for the nicotine. It's the motion’. ‘If I have this (interdental cleaning device) in my hand, I do this (oral hygiene practice) instead of this (smoking motions)’ (Figure 2 and Supplemental video). In addition, the OHT intervention contributed to a significant improvement in both the patient's overall oral hygiene and his self-reported well-being.

Figure 2

(Left) Patient holding interdental cleaning device in hand for oral hygiene practice. (Right) Patient expressed that ‘It's not the nicotine; it's the motion’. The device helps him to quit smoking as a substitute for oral and hand fixation.

Discussion

Smoking has long been associated with poor oral health and periodontitis. Smokers usually have poor oral hygiene practices, which includes infrequent tooth brushing, flossing, and the irregular use of toothpaste (Albandar, Streckfus, Adesanya, & Winn, Reference Albandar, Streckfus, Adesanya and Winn2000; Ghasemi, Khami, Virtanen, & Vehkalahti, Reference Ghasemi, Khami, Virtanen and Vehkalahti2015). Therefore, most smokers need OHT to improve their home care to enhance oral health outcomes (Chambrone et al., Reference Chambrone, Preshaw, Rosa, Heasman, Romito and Pannuti2013; Nociti, Casati, & Duarte, Reference Nociti, Casati and Duarte2015). This also gives an opportunity to provide smoking cessation intervention utilizing OHT.

Success with smoking cessation has been linked to strategies that integrate alternatives to smoking that enable patients to assert self-control (Heckman, Ditre, & Brandon, Reference Heckman, Ditre and Brandon2011), which supports findings that increased self-efficacy has been shown to predict smoking cessation for a longer period of time (Schnoll et al., Reference Schnoll, Martinez, Tatum, Glass, Bernath and Ferris2011). The use of convenient oral hygiene devices such as portable toothbrushes has been shown to reduce consumption of cigarettes in about 50% of cases (Ishida & Oda, Reference Ishida and Oda1999). Although it may be helpful, repeated use of toothpaste may not be practical for every patient. Interdental cleaning device (Hoenderdos, Slot, Paraskevas, & Van der Weijden, Reference Hoenderdos, Slot, Paraskevas and Van der Weijden2008), such as the one utilized by the patient in this case study, is a small, portable oral hygiene device, making it convenient for use in cessation efforts.

Although motivation is a major factor in success, introducing practical approaches or tools such as interdental cleaning device can enhance behaviour change, and create an itemized self-reinforcing motivational approach for patients with oral and hand fixation. For smoking behavioural intervention to be effective, there needs to be a cue, which in this particular case, would be a cue for oral hygiene care practice. In addition, an individual must believe that the behaviour will work, and that they are empowered to control the situation. Studies have shown that self-efficacy significantly affects the outcome of smoking cessation to the extent that it can make or break the cessation attempt (Hendricks, Delucchi, & Hall, Reference Hendricks, Delucchi and Hall2010). Additionally, new treatment interventions have demonstrated a positive effect on increasing the self-efficacy of those attempting smoking cessation (Hendricks et al., Reference Hendricks, Delucchi and Hall2010). Therefore, providing OHT to improve oral health behaviours and help patients control behavioural-dependent smoking urges could be a novel approach that addresses two concomitant factors.

Conclusion

This case study demonstrates the potential efficacy of OHT and the use of adjunct interdental cleaning device for behaviour modification for successful smoking cessation. Such an approach may suggest the benefit of including oral health professionals in a synergized interdisciplinary smoking cessation strategy. Further controlled clinical trials would be beneficial in optimizing the efficacy of OHT for individualized behavioural modification as part of a smoking cessation intervention.

Acknowledgements

The author (CW.W.) would like to thank the Periodontics-Dental Hygiene Task Force for stimulating innovative collaborative initiatives.

Financial Support

This research received no specific grant from any funding agency, commercial or non-for-profit sectors.

Conflict of Interest

None.

Ethical Standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Supplementary material

To view supplementary material for this article, please visit https://doi.org/10.1017/jsc.2017.22

References

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Figure 0

Figure 1Smoking addiction constitutes both behavioural and nicotine dependence, and oral hygiene therapy can assist in behavioural intervention.

Figure 1

Figure 2(Left) Patient holding interdental cleaning device in hand for oral hygiene practice. (Right) Patient expressed that ‘It's not the nicotine; it's the motion’. The device helps him to quit smoking as a substitute for oral and hand fixation.

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