Tobacco Use

Board takeaway

• Screen: Ask about the child’s use and household exposure, examine for tobacco-related oral changes, and support prevention and cessation.
• Include and refer: Include smokeless products and coordinate with medical or addiction services when needed.
• Exposure: Environmental tobacco smoke is carcinogenic, with no demonstrated safe exposure level.

Prevention and youth risk

• Tobacco dependence commonly begins in adolescence; preventing initiation can reduce later adult smoking.
• Drivers include marketing, parental smoking, peers, perceived benefits or normalcy, access and price, socioeconomic disadvantage, low academic achievement/self-image, and limited refusal skills.
• Tobacco use accompanies higher likelihood of alcohol/drug use and high-risk sexual behavior; provide substance-use counseling and referral when indicated.
• The policy describes substantial mortality, health care costs, and productivity losses. Its youth prevalence and economic figures are historical, not current surveillance estimates.

Systemic and developmental consequences

• Smoking increases cardiovascular, pulmonary, and cancer risks; reproductive harms include infertility and ectopic pregnancy.
• Youth smoking is linked with poorer cognitive performance, psychotic-like experiences, and anxiety-related behaviors.
• Maternal smoking/exposure during pregnancy may increase low birth weight, cleft lip/palate, and lower offspring IQ; paternal smoking may increase certain childhood cancer risks.

Secondhand and thirdhand exposure

• Secondhand smoke: associated pediatric harms include SIDS, respiratory and middle ear infections, bronchitis, pneumonia, asthma, allergies, and reduced cardiorespiratory fitness.
• Primary-tooth caries, especially early childhood caries, is associated with secondhand exposure.
• Prenatal maternal smoking–caries findings differ between systematic reviews: one equivocal, another significant. Do not present this relationship as settled causation.
• Childhood exposure may relate to enamel hypoplasia; prenatal secondhand exposure is associated with cognitive/learning deficits.
• Thirdhand smoke: residual toxins remain on household surfaces and release compounds into air for months. Young children have greater contact with contaminated low surfaces and greater dust ingestion; the policy reports associated cognitive deficits.

Examine for tobacco-related oral findings

• Cancer, leukoplakia, periodontitis, caries, altered saliva, impaired wound healing, and implant failure.
• Reduced smell/taste; smoker’s palate, melanosis, coated tongue, and staining of teeth/restorations.
• Smokeless tobacco also carries oral cancer, leukoplakia/erythroplakia, periodontal-support loss, and staining risks.

Screen, counsel, and refer

• Record patient tobacco use and caregiver smoking status; educate families about use and household ETS exposure.
• Give anticipatory guidance and cessation/substance-use counseling during dental care.
• Refer to primary care or behavioral health/addiction specialists if indicated.
• Continue routine oral examination for tobacco-associated changes.
• Use the US Public Health Service tobacco-dependence guideline and AAP tobacco/nicotine guidance for detailed cessation treatment. Also review Electronic nicotine delivery systems when counseling about vaping.

Practice and community responsibilities

• Maintain tobacco-free facilities and grounds; clinicians model abstinence and encourage staff cessation.
• Support tobacco-free schools, vehicles, property, and events; protect children in daycare and adolescents’ workplaces.
• Support merchant education, enforcement against sales to minors, elimination of cigarette vending sales, higher excise taxes, and restrictions on advertising, promotion, and sponsorship.
• Develop community prevention/cessation services and professional education; advocate payer coverage for cessation counseling and pharmacotherapy.

Common board traps

Answer aloud

A teen uses smokeless tobacco. What do you do?

Document use, examine for oral changes, and counsel cessation with referral when indicated.

• Explain addiction, oral cancer, leukoplakia/erythroplakia, and periodontal-support risks.
• Assess associated substance use and need for primary-care or behavioral/addiction support.
• Avoiding smoke does not make smokeless tobacco safe.

A caregiver smokes but the child does not. Is tobacco screening complete?

No. Assess household exposure and support caregiver cessation and tobacco-free environments.

• Secondhand: inhaled environmental smoke; associated with respiratory and oral-health harms.
• Thirdhand: residual contamination on surfaces and in dust, with disproportionate young-child contact.
• No safe environmental-tobacco-smoke exposure level is established.