COVID-19 and the ‘smoking’ pandemic

Patient smokingWith COVID-19 shutting down many NHS services, Brasanyaa Raveendran explores how this will impact smoking habits amongst patients.

Across the NHS, new stringent measures have been introduced in the last few months in response to COVID-19.

With the ease of lockdown from the pandemic and opening of dental practices from the 8 June 2020, the provision of all routine, non-urgent dental care will continue to be affected into the near future.

Nationally, phone triaging has become the ‘new normal’. It is an integral part of practice and hospital dentistry.

This article will discuss the benefits of implementing smoking cessation into telephone triage services. This could reduce the long-term disease in the population related to smoking.

Tackling smoking

Smoking is a silent killer we’re tackling regularly on a global scale.

In the UK, over the decades there has been a lot of changes from by the government and organisations such as Public Health England (PHE). National strategies range from a smoking in public ban to changing the outer packaging of cigarettes.

However, amidst these changes, the association between smoking and a recent increase in mental health during the COVID-19 pandemic is unknown.

Smoking is a major problem for dentists. They encounter a lot of oral health disease related to it, varying from bleeding gums to oral cancer.

Smoking cessation is important at all levels but more so during this pandemic; where the nation is facing the frontline of COVID-19 related stress and mental health problems. It highlights the increased uptake of smoking.

Pausing dentistry

In primary care, dentists are in the fortunate position to see patients for regular check-ups on a routine basis, in comparison to medical colleagues.

Dental practitioners are able to see patients of all ages and in varying stages of health.

With professional guidance, as shown by Public Health England, there is a four times higher chance of patients quitting smoking.

In recent years, dental schools have introduced a more pragmatic approach to educate students of the importance of smoking cessation. But working in the busy world of dentistry, there are often time constraints.

Prior to the COVID-19 pandemic, data from the Adult Dental Health Survey found that only 9% of adult patients who went to the dentist remember enquiries about their smoking status.

When speaking to dental health professionals they explain the barriers they face on a regular basis. This may be due to inadequate training, ease of referral, time pressures in practice and awkwardness of the discussion with the patient.

The outbreak of COVID-19 created a major limiting factor – the pausing of routine dentistry (Khalaf, Curtin and Reilly Trace, 2020).

Side effects of smoking

From mid-March 2020, the COVID-19 pandemic has been a game changer impacting the nation in a somewhat unique way.

It came with a drastic increase in stress and mental health problems. These were a result of the measures to curb the spread of COVID; with restrictions on going out; being in isolation; losing loved ones suddenly and working from home becoming the new norm.

In response to this whirlwind of issues, we might expect a sudden increase in the uptake of smoking.

Dental care professionals need to implement changes in the way they work. This will help inform and educate patients of the risks associated with smoking. Then offering guidance related to mental health issues.

Day in and day out, a lot of conditions are seen directly or indirectly related to the side effects of smoking.

As shown by studies, smoking is a major contributory factor for developing respiratory infections like COVID-19. This increases the need for smoking cessation.

Studies conducted during the COVID-19 outbreak indicate that a vast majority of patients who died as a result of COVID-19 were smokers. As a result, they required ICU treatment and experienced severe symptoms in comparison to a non-smoker (Jimnez-Ruiz et al, 2020).

Don’t forget smoking cessation

During this pandemic, there has been multiple changes to the way the profession is functioning in dental care. Both in general dental practices and in hospital care.

With new PPE, and the ‘new normal’ and time efficiency in clinics being promoted more than ever, practices and hospitals are keen to get patients in and out of the surgery as soon as possible.

In the midst of this efficiency to fight COVID-19, health professionals should not forget the importance of smoking cessation.

With telephone triaging becoming more prominent in the world of dentistry and reduced time, patients may have reduced possibility to discuss their smoking status.

Therefore, it’s vital we do not forget this service and offer it to all patients; incorporating social history into telephone triaging or even the COVID-19 risk assessment.

Appropriate protocol for referring patients for smoking cessation will still give opportunity for patients to reduce or stop smoking.

Physical and mental wellbeing

It is vital to not only discuss the importance of smoking cessation with patients, but also with fellow medical and dental colleagues.

Healthcare colleagues across the NHS have been very busy as a result of the pandemic. They have performed beyond their job specifications to meet the needs of the NHS.

Studies show that psychological impairments due to the stress of COVID-19, increase in workload, the ‘new normal’ and the stress of being redeployed into departments they have not worked with previously, has led to further stress (Holliday et al, 2019).

It is key that the NHS considers offering counselling or hospital-based psychological services. In addition to smoking cessation referral.

This will ensure the physical and mental wellbeing of everyone around us (Zaka et al, 2020).


This article discusses the importance to link smoking and how to provide help to patients during this pandemic.

Continued provision of smoking cessation services – and ensuring patients receive appropriate counselling and help during this time where elective treatment has come to a standstill – is essential. 


Holliday R, Preshaw PM, Ryan V, Sniehotta FF, McDonald S, Bauld L and McColl E (2019) A feasibility study with embedded pilot randomised controlled trial and process evaluation of electronic cigarettes for smoking cessation in patients with periodontitis. Pilot Feasibility Stud 5: 74

Jimnez-Ruiz CA, Lopez-Padilla D, Alonso-Arroyo A, Aleixandre-Benavent R, Solano-Reina S and de Granda-Orive JI (2020) COVID-19 and Smoking: A Systematic Review and Meta-Analysis of the Evidence. Arch Bronconeumol 18(20)

Khalaf ME, Curtin S and Reilly Trace A (2020) Perception and Attitudes of Dental Students towards Their Role in the Delivery of a Brief Smoking Cessation Intervention. Med Princ Pract 29(1): 69-74

Zaka A, Shamloo SE, Fiorente P and Tafuri A (2020) COVID-19 pandemic as a watershed moment: A call for systematic psychological health care for frontline medical staff. J Health Psychol 25(7): 883-7

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