Evaluation of electronic cigarettes for smoking cessation in patients with periodontitis

Abstract

Background Smoking cessation interventions play an important role in dental care, especially for patients with periodontitis. Novel nicotine products, such as electronic cigarettes (e-cigarettes), have recently become popular with smokers and can be used to quit or reduce tobacco smoking. Aims/objectives This research aimed to explore the behavioural and biological changes that occur when smokers with periodontitis are provided with an e-cigarette. Methods This research had three components. Firstly, a systematic review investigated the in vitro effects of nicotine on periodontal cells. Secondly, a 6-month pilot randomised controlled trial (RCT) was conducted of an e-cigarette smoking cessation intervention in smokers with periodontitis. Outcome measures were collected on both smoking status and oral health. The main focus was on feasibility, including recruitment and retention rates. Thirdly, theory-based qualitative interviews investigated patient perceptions about smoking, dental smoking cessation interventions and e-cigarettes. Results The systematic review concluded that nicotine, at physiological concentrations, was not cytotoxic to periodontal cells in vitro. Nicotine may have effects on other cell functions although evidence was contradictory. In the pilot RCT, 80 smokers with periodontitis were recruited in 15 months. Participant retention was 73% at 6 months. The e-cigarette intervention was well received with 90% using an e-cigarette at the quit date. 20% of participants in the control group used an e-cigarette, against instructions. Outcome measures were successfully completed. A weekly smoking questionnaire had poor completion rates. Several factors were perceived to influence smoking behaviour in individuals with periodontitis. These patients perceived dentist-delivered smoking cessation advice positively. General perceptions of e-cigarettes were mixed and influenced by personal experience, other users, addiction concerns, health concerns and social acceptability. Conclusions Providing and studying an e-cigarette intervention within the dental setting was feasible and well accepted by patients. Insights were gained into perceived influences on smoking behaviour and how to best conduct future research.