December 4, 2014
Tobacco smoking has many risks to a person’s health and wellbeing, and it also has an effect on the oral cavity and dental health. The damage to lungs is not easily seen, but has been well illustrated in Quit campaigns and on cigarette packets. In the mouth, apart from the visible staining of teeth, tobacco has been associated with gum disease, diminished sense of smell and taste, and bad breath. But the most severe risk is oral cancer, where combining smoking with alcohol puts you at an even greater risk. This is significant because many patients tell us that they are just ‘social smokers’ and don’t smoke during the day or at work. Such occasional social smokers often believe that they are not at risk like heavier smokers. However, since they usually light up socially when they drink alcohol, they might even be at a greater risk.
Smokers can also be poorer candidates for dental implants as the risks for failure, infection and bone loss are higher than in non-smokers.
Ten to Fifteen years ago ago we would decline to place dental implants in smokers. But our views have changed somewhat over the last decade. Due to our strict criteria in the past, some patients would lie to us about their smoking habit in order to get the treatment, and what we found over the years was that regardless of their smoking, implants can still work. This is not in any way an endorsement of smoking, because although they can still work when we look at failures these are certainly more prevalent among smokers.
Relaxing our criteria somewhat meant that our patients can be more honest with us about their smoking habits, and this allows us to talk to them more effective about the risks. On its own, the increased risk for smokers contemplating dental implants are similar to risks posed individually by diabetes, poor oral hygiene, heavy grinding, etc. In other words, if a smoker has no other risk factors and keeps his teeth very clean with regular home brushing, flossing and sees the dentist or hygienist regularly, then he is far better off than a person with poor hygiene, who has uncontrolled diabetes, grinds their teeth at night and on top of all that, smokes. So its the combination of factors, which makes someone a poor candidate for dental implants.
Nevertheless, whilst the long term risks are still not well documented in this area, it is well established that smoking can reduce the healing potential of wounds. For this reason, we require all our patients to stay off the smokes for the initial 3 months of healing after implant surgery.
In our pre-surgical protocol we require patients to quit the day before surgery not weeks in advance for two reasons:
1. Patients who quit a couple of weeks before the surgery may be more susceptible to coughing fits during the anaesthetic and their recovery from the anaesthetic may be more complicated;
2. Quitting for good, whilst ideal, may not be a realistic expectation. By quitting on the day of the procedure there is less chance of picking up again early on, during the most critical healing period.
Whilst we acknowledge that some of our patients who received dental implants smoke, we have seen great success in quitting for many, especially in those who required more involved treatments such as All-On-4 and bone grafting, and who want to protect their investment in themselves because otherwise they would end up with no teeth wearing loose uncomfortable dentures.
For those who want to quit, contact Quitline on 13 78 48 or via their website www.quitnow.gov.au
There are a number of ways to quit smoking, and patients must explore their options with a qualified medical practitioner. From our experience, the most successful way, second to a mental preparedness to quit, involves the use of prescribed medication as follows:
SUGGESTED PRE-SURGICAL PROTOCOL FOR SMOKERS
NOTE: Before embarking on what is outlined below you must speak to your medical doctor.
2 Weeks Prior to Surgery:
- Commence Zyban SR 150mg once a day. You continue to smoke.
- After 7 days, increase frequency of administration to 150mg twice per day (every 12 hours). Continue smoking and STOP the day before surgery.
Day Before surgery:
- STOP SMOKING
- Continue Zyban SR 150mg twice per day (every 12 hours)
- Commence Nicotine patches suitable to your nicotine dosage requirements
- You must CONTINUE with the Zyban and patches as above and avoid smoking until AT LEAST 6 WEEKS after your surgery
To quit smoking altogether (highly recommended):
- Continue with the Zyban SR 150mg twice per day (every 12 hours) and the patches for at least 4-6 months after quitting.
- During this period, gradually reduce the nicotine dose of the patches until you can do without them.
- Continue with Zyban SR 150mg twice per day for 2 weeks after discontinuing the patches, then reducing the frequency to 150mg once a day for at least 2 more weeks.