Tobacco, alcohol and vaping
Assess exposure without judgement, explain oral and general health effects and offer evidence-based cessation support. Document the discussion.
Understand
Smoking increases periodontal and oral cancer risk; alcohol contributes to oral cancer risk, particularly alongside tobacco. Vaping evidence and products vary and should not be treated as risk-free.
Assess
Record type, amount, duration and changes in use sensitively. Ask permission to discuss cessation and identify the patient's readiness and support preferences.
Apply
Give brief evidence-based advice and signpost to a cessation service. Revisit without judgement; do not reduce an oral lesion assessment to a lifestyle explanation.
Key distinctions
Tobacco and alcohol histories support prevention and lesion risk assessment but should be asked without moral judgement. A former smoker's exposure history remains relevant. For vaping, avoid claiming either equivalence to smoking or complete safety; product and evidence vary. Offer effective cessation support while independently investigating suspicious clinical findings.
Think through a case
A smoker with a persistent tongue patch asks whether switching to vaping eliminates concern. Support cessation, but assess the lesion on its clinical features now.
The distinction to remember
Do not imply a risk factor is required for oral cancer or that its removal means a suspicious lesion can wait.
Test your recall
Why record tobacco and alcohol in an oral lesion history?
Show answer
They influence risk assessment and prevention counselling.