In addition  to being a risk factor for mouth cancer and periodontal disease, smoking is associated with staining of the teeth.  Nicotine replacement therapy (NRT) is widely used to assist patients quit smoking.  In vitro tests of NRT gum have suggested that they may have stain reduction effects.  A product which not only assists smokers kick the habit and also reduces tooth staining may provide an added incentive.   This study tested the hypothesis that a nicotine replacement gum removes more stain and whitens teeth more during a 6-week smoking cessation programme than a nicotine replacement sub-lingual tablet

What did they do

Healthy smokers motivated to quit smoking and with visible staining of teeth were randomised to use either a nicotine replacement gum( n=102)  or a nicotine replacement sub-lingual tablet ( n=98) . The main outcome measure was mean change in the modified extrinsic tooth stain score (modified Lobene Stain Index) and a secondary outcome measures was the change in tooth shade, measured by the Vita Shade Guide. Evaluations were carried out at baseline and weeks 2, 6 and 12.

What did they find

• At week 6, the gum-group experienced a reduction in mean stain scores whilst the tablet group experienced an increase with mean changes of -0.14 and +0.12 respectively, (p = 0.005,ANCOVA).
• The change in mean tooth shade scores was statistically significantly greater in the gum-group than in the tablet group at 2 (p = 0.015), 6 (p = 0.011) and 12 weeks (p = 0.003)with greater lightening in the gum-group at each examination period.

They concluded

These results support the efficacy of the tested nicotine replacement gum in stain reduction and shade lightening. These findings may help dentists to motivate those wishing to quit smoking using a nicotine replacement gum.

Whelton H, Kingston R, O’Mullane D, Nilsson F. Randomized controlled trial to evaluate tooth stain reduction with nicotine replacement gum during a smoking cessation program. BMC Oral Health 2012, 12:13

Comment

Encouraging patients to quit smoking has significant health benefits and as it also impact on oral health. Consequently dentists should both enquire regularly about their patients smoking habits and encourage and or direct patients to smoking cessation services.  This study suggests that NRT gum can have positive  cosmetic effects on the teeth with may prove to be of  additional benefit and a potential motivational device for dentists to encourage patients to quit.

It is worth noting that there was a 50% drop out rate in this study  and although the study was powered with this level of drop out anticipated this should be borne in mind.    It should also be noted (as acknowledged in the paper) that the study was fully funded by the manufacturer.

While the focus on this study is on the potential stain reducing effects of the NRT gum the study also reports the intent-to-treat abstinence rates  which were :-

•  41.2% (42/102) in the gum group;  36.7% (36/98) in the tablet group at week 6
• 35.3% (36/102) in the gum group:  37.8% (37/98) in the tablet group. at week 12

A Cochrane Review  by Stead et al 2008  found that

All of the commercially available forms of NRT (gum, transdermal patch, nasal spray, inhaler and sublingual tablets/lozenges) can help people who make a quit attempt to increase their chances of successfully stopping smoking. NRTs increase the rate of quitting by 50-70%, regardless of setting.
The effectiveness of NRT appears to be largely independent of the intensity of additional support provided to the individual. Provision of more intense levels of support, although beneficial in facilitating the likelihood of quitting, is not essential to the success of NRT.

Stead LF, Perera R, Bullen C, Mant D, Lancaster T. Nicotine replacement therapy for smoking cessation. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD000146. DOI: 10.1002/14651858.CD000146.pub3.