In the dental office, tobacco cessation can be offered as a natural extension of the other routinely delivered preventive and oral treatment procedures. If a patient has a desire to stop using tobacco, dentists may want to consider prescribing nicotine transdermal patches. Addicted patients may include those who smoke more than 25 cigarettes per day (or a can of snuff every 2 days); those who use tobacco within the first one-half hour of arising; those who find it difficult to refrain from smoking in nonsmoking areas; and those who have had withdrawal symptoms in previous attempts to quit.

Nicotine patches were developed to help reduce or eliminate withdrawal symptoms for heavy tobacco users. These patches may help patients stop by allowing them to cope with the social and psychological aspects of not using tobacco without also going through nicotine withdrawal.

It is important to note that patients seldom are successful in stopping tobacco use when using nicotine patches in the absence of appropriate advice, guidance, and follow-up. Dentists should have office tobacco cessation plans that include these services.

Clinical trials assessing the nicotine patch have not turned up any severe adverse reactions. Transdermal nicotine is well tolerated systemically and topically. The most commonly reported side effects are temporary itching, burning, and/or erythema at the application site.

Some symptoms (e.g., headaches, insomnia, dizziness) are found to occur as a result of nicotine withdrawal and not as a reaction to the medication. The dose-related adverse effects of transdermal nicotine therapy are mild-to moderate sleep disturbances (e.g., insomnia and abnormal, vivid dreams), dyspepsia, various myalgias and body aches, and increases cough. The incidence of almost all side effects decreases after a few days of treatment. Fewer than five percent of tobacco users stop patches due to side effects.

The patch only provides nicotine at about half to two-thirds the level a person obtains by smoking, and without the more than 4,000 chemicals and gases found in cigarette smoke.

• Stop using tobacco before use of patch.
• Patch is applied once every 24 hours to non-hairy, clean, dry site on the upper body or arm. Skin site should not be reused for a least one week.
• Different brands vary in nicotine dose and recommended length of use.
• All brands recommend a higher dose (21-22 mg) for the first 4-6 weeks. Some then use lower dose patches.
• Lower initial dose may be used for patients with cardiovascular disease or those weighing less than 100 lbs.

• Under age 18
• Women who are pregnant or nursing
• Immediate post-myocardial infarction period
• Patients with severe arrhythmia
• Patients with severe or worsening angina pectoris
• Use with CAUTION:
  • hyperthyroidism
  • pheochromocytoma
  • insulin-dependent diabetes
  • active peptic ulcers
  • very high blood pressure
  • severe skin conditions
  • and kidney or liver disease