Pharmacology · patient case question
Which of the following is the LEAST effective smoking cessation aid?
Patient case: Two conversations about habits
Patient: Two patients
Chief Complaint: A: “My teeth are getting thinner and they are sensitive to everything.” B: “I want to stop smoking this year.”
Background: A, 26-year-old female: eats five to seven whole lemons a day and has done for two years. Also grinds at night. No reflux symptoms, no history of disordered eating on direct questioning. Brushes immediately after eating. B, 45-year-old male: 25-year smoking history, roughly a pack a day. Two previous unaided quit attempts.
Findings: A: generalised loss of enamel with cupped occlusal surfaces, shortened incisors and a glassy appearance; the palatal surfaces of the maxillary anteriors are relatively spared.
Show answer and explanation
Correct answer: D. A nicotine lozenge used alone
- A. Bupropion performs roughly comparably to single-form nicotine replacement. It is generally a second-line choice because of its neuropsychiatric warnings and its lowering of the seizure threshold.
- B. COMBINATION nicotine replacement — a patch providing steady baseline levels plus a gum, lozenge, inhaler or spray for breakthrough cravings — performs comparably to varenicline and is clearly superior to any single form. This is the combination to recommend when a patient prefers nicotine replacement.
- C. VARENICLINE is the MOST effective single agent of those listed, roughly doubling to tripling quit rates and outperforming single-form nicotine replacement and bupropion in head-to-head trials. It is a partial agonist at the alpha-4 beta-2 nicotinic receptor, which both relieves craving and blunts the reward of smoking if the patient does smoke.
- D. CORRECT. A single SHORT-ACTING nicotine replacement product used ALONE is the least effective of these options. Short-acting forms used on their own increase quit rates by roughly one and a half times over placebo, and their success depends heavily on the patient dosing frequently enough through the day — which most patients do not do.
Note: If that was the intended key, the recall is wrong. Note also that the FDA REMOVED varenicline's boxed neuropsychiatric warning in 2016 after the EAGLES trial. The dentist's role is the 5 A's, and ASK is the first step at every single visit — brief advice from a clinician measurably increases quit rates on its own.