COVID-19, Smoking, and Vaping

Looking at some of the statistics can help to demonstrate what we are dealing with. In 2018, there were an estimated 52 million adults in the United States who were aged 65 or older.¹ It has also been estimated that there are presently 10 million people in the United States who can be considered immunocompromised.² Clearly, one of the best ways to protect these vulnerable groups is to minimize their exposure to the virus. We have attempted to accomplish this by isolating them to the greatest extent possible from both people who are potentially carrying the virus and any objects that may have been contaminated by it.

On the ADA Center for Professional Success's COVID-19 frequently asked questions webpage, the association affirms that "while providing emergency care to patients of record may be necessary, nonessential treatment should be deferred until state and local public health authorities deem it appropriate to proceed."³ This position will certainly help to minimize the number of people who are infected or killed by COVID-19.

In addition to protecting the elderly and the immunocompromised, there is another potentially vulnerable group that should be addressed. Presently, there are an estimated 34.2 million adults in the United States who still smoke cigarettes⁴ and 10.8 million adults who are using e-cigarettes.⁵ Some are even dual users. It has also been estimated by the latest National Youth Tobacco Survey that 5 million young people are using e-cigarettes and that almost 1 million are using them daily.⁶

It is a known fact that people who use combustible tobacco products are more likely to be immunocompromised due to their potential to develop chronic obstructive pulmonary disease and other respiratory ailments, diabetes, cancer, and a host of other maladies, including significantly compromised oral health. In addition, the recent outbreaks of e-cigarette or vaping product use-associated lung injury (EVALI) and associated research about vaping and its effects on the lungs suggests that using these products could aggravate users' COVID-19 symptoms. Further research may be needed to corroborate the relationship between the use of these products and mortality related to COVID-19, but do we need to wait until then to act?

Given that dentists are no longer seeing patients for elective procedures in their offices, I have a suggestion that may help in a modest but meaningful way. If dental practices are sending out online newsletters to their patients, they might want to consider including a list of some programs that their nicotine-addicted patients can consider to help them quit during this difficult time. Because 95% of smokers who do not use a smoking cessation program fail to quit, making patients aware of how to avail themselves of these programs while hunkering down at home may be of great help. Smoking cessation programs offer a variety of recommendations to combat addiction, including the use of nicotine replacement therapeutics, such as patches, gum, lozenges, or sprays, which can be combined in their usage, and behavioral support via telephone, internet, or text messaging services.

Counseling, which can be performed individually or in a group setting, using the telephone or tools such as Zoom, Google Hangouts, or another web-based format, may be helpful to comfort those who are feeling socially isolated. Oftentimes, tobacco cessation specialists can help users cope with their stresses just by listening to their concerns and offering some suggestions related to their use of these products. Even if patients fail to quit, these counselors can still provide a helpful resource during these trying times. The US Centers for Disease Control and Prevention's How to Quit Smoking webpage⁷ offers telephone numbers for free support services and numerous links to websites, smartphone applications, and other resources that can be included in a dental practice's newsletter.

I am proud to be part of a profession that is prepared to help patients with dental emergencies while being under the threat of exposure to COVID-19. And if we can help in any other capacity, such as continuing to support our patients in smoking cessation, let's do what we can. Stay safe, and be well.

Nevin Zablotsky, DMD, a past president of the Vermont Periodontal Society, has lectured throughout the United States and internationally as well as for the American Dental Association.