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The Oral Health Professionals' Guide to Nicotine Addiction and Treatment Approaches (AGD 158)

Presenter: Laura M. Romito, DDS, MS, MBA


In recent years, the stage has been set for all oral healthcare professionals to become actively involved as facilitators and leaders in tobacco dependence education and control efforts. One goal of Healthy People 2020 is to increase the proportion of adults who received information from a dentist or dental hygienist focusing on reducing tobacco use or on smoking cessation.1

In this millennium, we expect an ever-increasing number of dentists, dental hygienists, and dental assistants to participate in clinical and community interventions that focus on both tobacco prevention and cessation strategies. Although upwards of 90% of dental providers have reported that they routinely ask patients about tobacco use, only 50-76% counsel patients, and less than half routinely offer cessation assistance such as self-help materials, referral to cessation counseling or a prescription for pharmacotherapy.2-4 Many lack confidence in providing cessation advice.5-7 The fact is, helping dental patients to quit using tobacco can be practically accomplished in clinical settings by oral healthcare  professionals. More than twenty years of accumulated evidence has shown the efficacy of this approach. Oral healthcare providers are able to offer this service with few interruptions in their daily routine.8-10 Additionally, many patients who are helped respond with gratitude and loyalty.

Oral healthcare professionals and other health care workers, have an ethical obligation to inform patients about the hazards of tobacco use and to encourage tobacco users to stop. Additionally, the oral healthcare team needs to praise and support those patients (especially impressionable young people who have never used tobacco in any form). Currently, 14% of U.S. adults aged 18 and above are smokers11 and 3.4% are smokeless tobacco users.12 About 480,000 tobacco-related premature deaths occur each year in the United States.11 However, nearly 70% of adult smokers desire to quit and U.S. adult smoking rate has decreased substantially from its peak of nearly 45% in the mid-1960s.13 Nonetheless, approximately 34 million adults continue to smoke and oral health professionals can be effective in motivating and assisting these individuals to quit tobacco.11,14

The purpose of this course is to alert professionals to the harmful effects of tobacco, both to oral and systemic health. The course is also designed to teach oral health professionals specific skills that they may utilize to help individuals become free of their nicotine addiction. A significant amount of the course material applies to both smoked and smokeless tobacco; however, a discussion of electronic nicotine delivery systems (ENDS) is also included. Additional information on smokeless tobacco is presented in the ADAA continuing educational course, “Understanding the Dangers and Health Consequences of Spit Tobacco Use.”15 


Laura M. Romito, DDS, MS, MBA:  Associate Professor, Department of Biomedical Sciences and Comprehensive Care. Director, Indiana University Nicotine Dependence Program.

Dr. Romito serves on the faculty of Indiana University Schools of Dentistry and Medicine, Indianapolis, and University of Southern Indiana, Evansville, IN.


Upon completion of this course, the dental professional should be able to:

• Summarize the harmful effects of tobacco on the body and oral health.
• Explain the addictive nature of nicotine.
• Discuss the psychological and sociocultural aspects of tobacco use.
• List the steps which can be initiated to create a smoke-free dental practice.
• Describe the oral health professional’s role in a clinical smoking cessation program.
• Identify the cycle of change and its relationship to smoking behaviors.
• Demonstrate the supportive role that oral healthcare professionals can have in helping patients to become nicotine and tobacco-free.


The ADAA has an obligation to disseminate knowledge in the field of dentistry.  Sponsorship of a continuing education program by the ADAA does not necessarily imply endorsement of a particular philosophy, product or technique.

The ADAA cautions participants taking this course on the hazards of using limited knowledge when integrating new techniques into their practices.

Credits earned upon completion of the course may be used to meet DANB’s Recertification Requirements.


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