13 September 2023

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Therapeutic alliance, lifestyles and tobacco use

Gianna Maria Nardi

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Oral health and systemic health are strongly linked to lifestyles which, if not correct, can increase the risk of periodontal and systemic diseases.

An interesting review of the literature on gender differences in lifestyles underscored that men are less motivated to follow-up with the dentist for oral hygiene. They are also less motivated to maintain home hygiene and develop more periodontal diseases than women. 

When we study different surveys produced on oral hygiene, toothbrushes remain the most used tool and are recognized as fundamental for oral hygiene. But a small percentage of people do not use toothpaste, and few people understand the importance of keeping bacterial biofilm under control in the interproximal spaces. 

For professionals, the need arises to remind patients how necessary it is to mechanically control the bacterial biofilm in the oral cavity with the use of toothbrushes, interdental brushes, dental floss and tongue cleaners and chemical control with toothpastes, gels and mouthwashes.

Home oral hygiene must be emphasized as a therapeutic plan, where a patient is responsible for the result.

In terms of dietary lifestyles, although the data from the questionnaires highlight a knowledge of foods and drink that are dangerous for the health of the oral cavity, behaviors tend to ignore this knowledge, which is confirmed by the epidemiological data of the caries process.

Alcohol and smoking are linked to the health of the oral cavity. From the critical analysis of the data presented at the World No-Tobacco Day 2023 in May, cigarette smokers in Italy represent 20.5% of the population or 10.5 million people. 

This is a decrease of nearly four percentage points and almost two million people compared to the previous year's survey and the numbers reported for the 2021-22 period. The percentage of smokers in the 15-24 age group fell to 17.3% in 2023, compared to 21.1% in 2022, a decrease of 3.8 percentage points.

In the U.S., a study unveiled in November 2022 by the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) found that more than three million or 11.3% of U.S. middle and high school students reported current use of any tobacco product in 2022, which includes 2.5 million or 16.5% high school students and 530,000 or 4.5% middle school students.

In addition, CDC data found that nearly one in five adults or an estimated 47 million reported current tobacco product use in 2020, including 30.8 million who smoked cigarettes. The analysis revealed that, in 2020, 19% of U.S. adults used at least one tobacco product, down from almost 21% in 2019. 

Cigarette replacement is also being promoted with new combustion-free products, rather than initiation into smoking, as found in a recent analysis from the Global Youth Tobacco Survey. One young person in four is a smoker, and health professionals and educators must continue their work to educate young people about the dangers of smoking tobacco.

The available evidence means that health professionals and educators must dedicate greater attention to the motivational approach. The need arises to implement the training of dental hygienists with courses of knowledge of the management of patients on a psychological level to increase skills to obtain greater adherence to the correct lifestyles.

The agreement on what the assisted person is willing to follow is fundamental to building a true therapeutic alliance for an oral health project that must last a lifetime.