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E-Cigarettes: Tobacco Cessation

Lillie C. Jones

Department of Allied Health, Missouri Southern State University

DH 295: Seminar in Dental Hygiene

Mrs. Merritt

November 11, 2023

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E-Cigarettes: Tobacco Cessation

Mark Twain once said, “Quitting smoking is easy. I’ve done it a thousand times.” This

quote proves just how hard it is to truly quit an addictive habit. History has taught us that

nicotine and tobacco are very addictive products and how much damage they can cause to our

overall and oral health if we use them long-term. We also know that quitting smoking can reduce

the likelihood of negative and deadly side effects from occurring, which is why tobacco cessation

counseling exists. For these reasons, I sought to educate all my patients who currently smoke

about the adverse health effects that it could cause, primarily adverse oral effects. Out of the

many patients I have seen, only one of them currently smokes. Thus, my tobacco cessation

counseling of my patient began.

Patient Identification and Demographics

As I mentioned above, only one of my patients currently smokes. This patient is a 55-

year-old, Caucasian/white female who was given the patient ID of 4408 when she was added to

our database. Before beginning tobacco cessation counseling on her, I did obtain informed

consent to do so. She was hesitant at first, but her curiosity about what information she may learn

from the counseling convinced her to follow through with it. Even though she was nervous about

beginning counseling, she really enjoyed our sessions and was thankful for the information I

provided her with. Patient 4408 was nothing but kind during our sessions and was always eager

to discuss more educational information about smoking.

Dates of Counseling

Correspondingly, after informed consent was obtained, I began tobacco cessation

counseling. The first of two sessions began on October 31st, 2023. This session consisted of
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filling out a tobacco assessment form with my patient to gather data about her tobacco use

history, performing a VelScope screening on my patient, reviewing the VelScope anatomy

checklist to see if there are any abnormalities within my patient’s oral cavity, educating my

patient about tobacco’s side effects, and discussing tobacco cessation strategies. The second

session took place on November 9th, 2023. This consisted of following up on my patient’s current

tobacco cessation outcomes, providing further education about her tobacco product, and

encouraging her to continue her cessation tactics. Patient 4408 fared well during each of these

sessions and was very receptive to all the information I gave her.

Patients Health Status (ASA)

Besides my patient’s smoking habit, her overall health wasn’t bad at all. She is classified

as an ASA II due to her having carpal tunnel syndrome since 2017 and her use of multiple

medications. Patient 4408 takes prescribed and over-the-counter medications. Her current

prescribed drugs are tramadol, gabapentin, and estradiol. Tramadol is taken to treat the pain in

her neck and shoulder caused by the two neck surgeries she had in 2016 and 2017 to correct her

herniated disks and to treat the pain caused by her right-side rotator cuff repair in 2018,

respectively. Gabapentin is taken as a pain reliever for her carpal tunnel syndrome. Estradiol is

taken to counteract any hormonal changes she may be undergoing due to menopause. The over-

the-counter medications my patient is taking are a multivitamin for hair, skin, and nails and

vitamin B-12. She takes the multivitamin to improve her overall health, while the vitamin B-12

is taken to boost her energy and treat acne. Besides the surgeries I already mentioned, my patient

also underwent left calf surgery in 2017 to remove a spider vein after it ruptured, left breast

deduction and biopsy in 2018 to remove calcification buildup and a leaky duct, and left

foot/ankle surgery in 2017 to repair a blown tendon and remove a bone spur on her big toe. Since
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her last surgery in 2018, she has had no further complications with her health other than the

occasional joint pain from her surgeries.

Patient’s Periodontal/Gingival Statement

Furthermore, on my assessment of her oral cavity, I found that she has generalized

moderate, marginal inflammation with no current bleeding on probing or suppuration. My

periodontal assessment findings classified her as having periodontitis one in two quadrants in her

mouth and periodontitis two in her other two quadrants. Her oral hygiene habits were good since

she brushed twice a day and flossed one to two times a day. Patient 4408 is very meticulous

about her oral health, especially since she suffered from mild periodontal disease before. She has

also lost five teeth due to abscesses and caries, so she tries to keep her oral and gingival health as

good as possible. As we moved forward with our visits, her oral and gingival health did seem to

improve, especially after our initial tobacco cessation counseling session.

Tobacco Habit and Indications for Tobacco Counseling

On another note, Patient 4408 and I had a very good discussion about her tobacco use

history. She told me that she started smoking Camel Special Lights and Misty cigarettes in 1989

because of the stress caused by her first divorce. She was only 21 years old at the time, but the

stress was too much to take on alone, so she began smoking to cope. From 1989 until 2018 she

smoked two packs of cigarettes a day. By 2018, she decided to switch from regular cigarettes to

Good Ol’ Custard e-cigarettes. She smokes five to seven e-cigarettes a day with each consisting

of six milligrams of nicotine. This is already a drastic change from her previous cigarette use, but

she has never entertained the idea of quitting entirely. In addition to her long history of smoking,

the Good Ol’ Custard e-cigarettes she uses are also vanilla and maple-flavored. This pleasant
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taste makes the bad habit more enjoyable for her and even harder to quit. It should also be noted

that when I asked her about how confident she would feel if she were to quit the habit

completely, she said she wasn’t at all confident. This long history of tobacco use, her current

periodontal and gingival findings, and her lack in confidence are what led me to performing

tobacco cessation counseling on her. Patient 4408’s health isn’t too bad right now, but if she

doesn’t cease or decrease the bad habit, then she is in for a world of hurt. She will not only

increase the side effects of her mild periodontitis, but she will also increase her caries risk,

decrease her overall health, and increase the chance of developing oral cancer. These are things I

wish not to pass, so performing tobacco cessation counseling seemed like the right thing to do.

Patient Attitude/Acceptance Toward Counseling

As I mentioned before, Patient 4408 was hesitant to participate in tobacco cessation

counseling. She was also not very confident that she would be able to cut back on her e-cigarette

use or cease it entirely. Even with these doubts, she still accepted my offer to perform tobacco

cessation counseling with her. When we engaged in conversations about tobacco and nicotine’s

adverse oral and systemic health effects, she was very receptive. I could tell from her body

language that she was engaged in our conversations and would often ask questions about the

topic. She even thanked me many times for teaching her new information that she had not known

about smoking. After the completion of our first session, she stated that while she hadn’t thought

about quitting until now, she would like to lessen her use since she now knows the true harm it

can cause. This was great news to me, but what really surprised me was how much progress she

made by the time of our second session. She told me that she took to heart what I explained to

her and had become more self-aware of her bad habit. Patient 4408 had decreased her e-cigarette

use to 4 times a day and even began performing daily oral cancer self-examinations to make sure
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there weren’t any unusual developments. She even implemented the coping strategies I suggested

to her, such as going outside for walks, distracting herself with chores, or starting new projects to

sidetrack herself when she feels the need to smoke. So far, these tactics have been working for

her and she plans to continue them until he cuts her e-cigarette use in half.

Summary Narrative

Now, you may be wondering what we discussed to produce such changes. First, I

had to determine what hierarchy of needs my patient would be most receptive to. Based on her

attitude toward the counseling, I could tell that she would benefit from information garnered to

promote her self-actualization. Even with her hesitance, I could see that she wanted to improve

her oral health to improve her overall health. She knew the habit was bad and wanted to alter it in

some way that would allow her to be the best version of herself. Knowing this, I discussed facts

that would feed into her self-actualization desire and promote tobacco cessation. The first item I

addressed with her was how smoking can worsen her current periodontal disease and cause a

variety of other oral health issues. These issues include bad breath, hairy tongue, leukoplakia,

gingival recession, oral cancer, tooth staining, and delayed wound healing (American Dental

Association, 2022). From there, I showed her what oral cancer and tobacco-related lesions look

like so that she could be aware of what to look out for. I also talked about how periodontitis, if

not treated, would be promoted by her smoking and could cause further dental destruction such

as tooth loss, spontaneous bleeding of the gums, tissue sloughing, tooth decay, caries formation,

and necrotizing gingiva. From there, I showed her an infographic of what oral cancer looks like

and how to properly perform an oral cancer self-examination. I also performed the oral cancer

screening on her to show her how she should perform it when she does it at home. The next thing

I discussed was the benefits she would obtain from quitting smoking. Apart from the
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improvement of her oral and overall health, it has been proven that tobacco cessation can cause

quick changes in health. For example, after twenty minutes of not smoking, one’s blood pressure

drops. Within 24 hours of ceasing tobacco use, one’s risk of having a heart attack decreases.

These positive changes in health continue to build and the individual’s quality of life in the long

run improves (Nicorette, 2022). The final thing I discussed with Patient 4408 was the strategies

for quitting smoking. I mentioned a few of them in the above paragraphs, but the ones I didn’t

mention were different kinds of nicotine replacement therapy, or NRT, and using a quitline when

she felt she was failing to stop the temptations. The quitline I provided her with was the National

Cancer Institute Quitline at 1-877-44U-QUIT. This is a common line used and they allow their

patients to call or text experts when needed (Smokefree.gov, 2023a). The NRT I offered my

patient was to use nicotine patches, gum, or lozenges that had lower doses than her e-cigarettes. I

also clarified that these should only be used to help wean her off of her e-cigarette use until she

felt she could quit entirely (Smokefree.gov, 2023b).

All things considered, I count this tobacco cessation counseling as a win. To be honest, I

was afraid that Patient 4408 would tell me that her habit had worsened after our discussions.

Thankfully, this is not the case. She is making great progress in decreasing her e-cigarette use

and becoming more conscientious about any changes in her oral health. I know that it isn’t a

complete cease of tobacco use, but any improvement is some improvement.

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References

AAMOS. (2019, November 13). How to do an Oral Cancer Self-Exam: AAOMS. AAOMS Oral

and Maxillofacial Surgeons. https://myoms.org/what-we-do/oral-head-and-neck-

pathology/oral_cancer_self_exam/

ADA. (2022, November 1). Tobacco Use and Cessation. American Dental Association.

https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/

tobacco-use-and-cessation

CDC. (2023, October 25). Adult Smoking Cessation—The Use of E-Cigarettes. Centers for

Disease Control and Prevention. https://www.cdc.gov/tobacco/sgr/2020-smoking-

cessation/fact-sheets/adult-smoking-cessation-e-cigarettes-use/index.html?

CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Ftobacco%2Fdata_statistics

%2Fsgr%2F2020-smoking-cessation%2Ffact-sheets%2Fadult-smoking-cessation-e-

cigarettes-use%2Findex.html

Cherry, K., & Susman, D. (2022, August 14). Maslow’s Hierarchy of Needs. Verywell Mind.

https://www.verywellmind.com/what-is-maslows-hierarchy-of-needs-4136760

Nicorette. (2022). Smoking and Blood Pressure. Stop Smoking Aids to Help You Quit.

https://www.nicorette.com/why-quit-smoking/reasons-to-quit/smoking-and-blood-

pressure/

Smokefree.gov. (2023a). How to Manage Cravings. smokefree gov.

https://smokefree.gov/challenges-when-quitting/cravings-triggers/how-manage-cravings
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Smokefree.gov. (2023b). Using Nicotine Replacement Therapy. https://smokefree.gov/tools-

tips/how-to-quit/using-nicotine-replacement-therapy