Chapter 36-Tobacco Cessation

Q. A 22-year-old man has used snuff daily for 4 years. He is in good health and takes no medications. Which of the following statements is true? A. There is no risk for developing a carcinoma within 10 years. B. The primary carcinogen in smokeless tobacco consists of nitrosamines. C. There are no sugars in smokeless tobacco and therefore no risk for caries. D. There is so little nicotine in smokeless tobacco that habituation and/or addiction are unimportant factors.

The primary carcinogen in smokeless tobacco consists of nitrosamines. Feedback Nitrosamines are the major cancer-causing ingredient in spit tobacco.

Q. Ms. H, a 38-year-old woman who is a long-time client of yours, comes to you and says she is finally ready to quit smoking. She smokes approximately 1 1/2 packs daily and has her first cigarette about 2 hours after she wakes up in the morning. She has never tried to quit smoking before. She wants to use a pharmacologic therapy that is available over the counter. Which of the following smoking-cessation medications is available over the counter? A. Bupropion- works by increasing NE & Dopamine B. Nicotine nasal spray C. Nicotine oral inhaler D. Nicotine lozenge

Nicotine lozenge Feedback Of the above choices, only nicotine lozenges are available over the counter. All of the other alternatives are prescription products.

Q. Ms. H, a 38-year-old woman who is a long-time client of yours, comes to you and says she is finally ready to quit smoking. She smokes approximately 1 1/2 packs daily and has her first cigarette about 2 hours after she wakes up in the morning. She has never tried to quit smoking before. She wants to use a pharmacologic therapy that is available over the counter. Which of the following nicotine delivery systems provides the fastest onset of action (i.e., is absorbed the fastest)? A. Nicotine gum B. Nicotine lozenge C. Nicotine nasal spray D. Nicotine inhaler E. Nicotine patch

Nicotine nasal spray Feedback The nicotine nasal spray has the fastest absorption rate of all the alternatives listed. Therefore it delivers nicotine most quickly to the brain. The nicotine passes through the nose's capillaries to cross the blood-brain barrier.

Q. Ms. Choy You have completed your examination of Ms. Choy, a 35-year-old woman who has indicated on her health history form that she smokes cigarettes. During the course of the intraoral examination you note 6- to 8-mm probing depths around maxillary and mandibular molars and bleeding on probing throughout the mouth. When you ask Ms. Choy if she would like to try to quit in the next month, she responds that she does not smoke very much and she really does not think it is that big of a problem. She states she will brush and floss more to improve her periodontal health. In which stage of readiness to quit is Ms. Choy? A. Not thought of quitting in the next 6 months B. Thinking about quitting in the next 6 months C. Willing to set a date to quit D. Already engaged in strategies to quit

Not thought of quitting in the next 6 months Feedback Ms. Choy is experiencing no thought of stopping tobacco use. This is the stage of change that needs education on why quitting is best for Ms. Choy's health.

Q. Ms. H, a 38-year-old woman who is a long-time client of yours, comes to you and says she is finally ready to quit smoking. She smokes approximately 1 1/2 packs daily and has her first cigarette about 2 hours after she wakes up in the morning. She has never tried to quit smoking before. She wants to use a pharmacologic therapy that is available over the counter. She decides to use the nicotine patch. Which dose is appropriate for Ms. H to begin with? A. 21-mg patch B. 14-mg patch C. 7-mg patch D. All of the above

21-mg patch Feedback Because the client smokes more than one pack a day, starting with the 21-mg patch is recommended to help weaken or eliminate nicotine withdrawal symptoms to allow the client to focus on changing her behavior and her thinking about tobacco use. Patch works via dosing down principle. Gradually discontinue over the course of 12 weeks (week 1-8 @ 21mg, week 8-10 @ 14 mg, and week 10-2 @ 7mg)

Q. Ms. H, a 38-year-old woman who is a long-time client of yours, comes to you and says she is finally ready to quit smoking. She smokes approximately 1 1/2 packs daily and has her first cigarette about 2 hours after she wakes up in the morning. She has never tried to quit smoking before. She wants to use a pharmacologic therapy that is available over the counter. Which of the following is not a nicotine withdrawal symptom? A. Alertness B. Insomnia C. Increased appetite D. Restlessness E. Anger

Alertness Feedback Nicotine enhances alertness; nicotine withdrawal makes it difficult to concentrate. Other signs of nicotine withdrawal are insomnia, increased appetite, restlessness, and irritability.

Q. Hallmarks for nicotine addiction include which of the following? A. Compulsive use B. Use despite harmful effects C. Recurrent drug cravings D. All of the above

All of the above Feedback Hallmarks of nicotine addiction include compulsive use despite knowledge of harm, use despite harmful effects, and recurrent drug cravings. Therefore all of the above is the correct answer.

Q. Motivational interviewing is which of the following? A. A patient-centered philosophy to address behavior change B. Designed to facilitate resolution of ambiguity that inhibits positive behavior change C. An approach to actively engage the patient in the communication process D. All of the above

All of the above Feedback Motivational interviewing actively engages the hygienist to elicit information from the client about the pros and cons of quitting. Once clients resolve ambiguity about quitting, they are more likely to make a decision to quit.

Q. Nicotine addiction is a: A. Chronic relapsing brain disorder B. Disorder that has physiologic, psychologic, sensory, and behavioral aspects that must be addressed for cessation C. Challenge that makes it difficult to stop using tobacco D. All of the above

All of the above Feedback Nicotine addiction is a chronic relapsing brain disorder. Individuals go in and out of abstinence and relapse. Understanding how nicotine works on the neurotransmitters in the brain is important to create an effective quit plan with an individual. For example, neurochemical effects on the brain include such rewards as decreasing one's appetite, increasing feelings of pleasure, and relaxation, all of which reinforce the use of tobacco. Other reinforcing aspects of nicotine addiction are behavioral as well as sensory. It is the nicotine addiction that makes it difficult to stop using tobacco.

Q. Key skills of motivational interviewing include which of the following? A. Use of open-ended questions to allow patients to express themselves B. Affirming "change talk" C. Reflective responding (i.e., acknowledging "Here is what I heard you say") D. Summarizing results of the dialogue E. All of the above

All of the above Feedback Open-ended questions elicit responses from clients; affirming "change talk" reinforces reasons for change that clients articulate; reflecting back to clients what they have said indicates the counselor has heard them and provides opportunity for further client elaboration. Summarizing the counseling visit provides closure for the appointment and is the basis for recommending continued client actions and future directions.

Q. Pharmacotherapy for tobacco-use cessation involves which of the following? A. Use of Zyban B. Nicotine replacement C. Some help from adjunctive counseling D. All of the above

All of the above Feedback Zyban (a mild antidepressant) and nicotine replacement products are evidence-based strategies to promote smoking cessation. Pharmacotherapy combined with counseling improves success rates for tobacco cessation, and it is recommended that pharmacotherapy be used in conjunction with cognitive-behavioral counseling.

Q. With regard to the federal clinical guidelines for Tobacco Cessation Treatment, the Five A's approach stands for: A. Ask, Alert, Assess, Assist, and Arrange B. Ask, Advise, Accentuate, Assist, and Arrange C. Ask, Advise, Assess, Assist, and Arrange

Ask, Advise, Assess, Assist, and Arrange Feedback Asking about tobacco use, advising users to quit, assessing readiness to quit, assisting with the quitting process based on readiness to quit, and arranging follow-up are the Five A's. The Five A's were developed as a guideline for clinical practitioners to address all the steps necessary to provide effective intervention with a tobacco-using client.

Q. The spirit of motivational interviewing is: A. Collaborating B. Imparting information C. Persuading D. All of the above

Collaborating Feedback The spirit of motivational interviewing is one of collaboration in which both parties are working together toward a common goal. A collaborative approach to communication emphasizes partnering with clients to problem solve with regard to their tobacco use. It engages clients to help resolve ambivalence so they can make a decision to quit. It explores both sides of the ambivalence. Raising only one side of the argument causes an ambivalent person to defend the opposite point of view.

Q. Increased absorption of tobacco nicotine and aromatic hydrocarbons is related to which of the following? A. Low pH B. High pH C. Neutral pH (7) D. Acidity and alkalinity make little difference.

High pH Feedback The higher the pH, the easier the absorption of nicotine across the blood barrier.

Q. Which of the following smoking-cessation techniques or methods has no validity? A. Transdermal nicotine patches to increase nicotine blood levels to help break tobacco smoking habituation and addiction B. Group psychology sessions to help break the smoking habit C. Hyperbaric oxygen treatments to reduce tobacco-related carbon monoxide blood levels D. Use of a chewing gum containing nicotine to reduce the urge to smoke

Hyperbaric oxygen treatments to reduce tobacco-related carbon monoxide blood levels Feedback A, B, and D have scientific evidence to support the claim that they enhance the success rate of tobacco cessation.

Q. Ms. Choy You have completed your examination of Ms. Choy, a 35-year-old woman who has indicated on her health history form that she smokes cigarettes. During the course of the intraoral examination you note 6- to 8-mm probing depths around maxillary and mandibular molars and bleeding on probing throughout the mouth. When Ms. Choy verbally informs you that she smokes, what is the very next thing you would do? A. Try to persuade her to stop. B. Inform her about how smoking affects her periodontal health and advise her to quit. C. Assess her willingness to quit. D. Arrange follow-up.

Inform her about how smoking affects her periodontal health and advise her to quit. Feedback Cultivating an understanding with the patient during the teachable moment enhances communication regarding the patient's disease state and how smoking can aggravate the effects of periodontal disease.

Q. Which statement about the use of smokeless tobacco is correct? A. It is a safe alternative to smoking. B. It delivers a rapidly absorbed dose of nicotine. C. It is not addicting. D. Long-term use is not associated with an increased risk of oral cancer.

It delivers a rapidly absorbed dose of nicotine. Feedback Spit tobacco has a high pH level, which allows for quick absorption into the body. Nicotine diffuses through the oral mucosa into the bloodstream.

Q. In using motivational interviewing to help individuals quit their tobacco use, it is important to have the client voice the arguments for change known as "change talk." Examples of change talk include which of the following? A. Reasons for concern about their tobacco use B. Reasons for continued use C. The good things to be gained from quitting D. All of the above E. a and c

a and c Feedback Helping a tobacco user explore reasons for use and reasons for quitting helps the client resolve ambiguity about quitting, which facilitates making a decision to quit. The goal of motivational interviewing is to have the patient voice the arguments for change (change talk), such as reasons for concern, and/or advantages of change, such as the good things to be gained.

Q. Ms. H, a 38-year-old woman who is a long-time client of yours, comes to you and says she is finally ready to quit smoking. She smokes approximately 1 1/2 packs daily and has her first cigarette about 2 hours after she wakes up in the morning. She has never tried to quit smoking before. She wants to use a pharmacologic therapy that is available over the counter. Which of the following statements is or are true regarding nicotine withdrawal symptoms? A. Symptoms peak within 12 to 24 hours. B. Symptoms peak within 24 to 48 hours. C. Symptoms last approximately 4 weeks. D. Symptoms last approximately 2 to 3 months. E. a and c F. a and d G. b and c H. b and d

a and c Feedback Nicotine withdrawal symptoms are the strongest the first 2 days after stopping tobacco use and diminish over approximately 4 weeks.

Q. In using motivational interviewing to assist individuals who are not ready to quit their tobacco use, which of the following technique or techniques apply? A. Explore benefits of smoking as well as benefits of quitting. B. Explore only the benefits of quitting. C. Emphasize your authority as an expert. D. Explore concerns about quitting. E. Emphasize patient's autonomy. F. a, d, and e G. All of the above

a, d, and e Feedback Exploring the benefits of smoking and the benefits of quitting helps clients to resolve ambivalence about quitting. Emphasizing clients' autonomy reinforces that they are responsible for their behavior and provides a psychologic aspect for them to make decisions about their behavior in a supportive environment.

Q. Ms. Choy You have completed your examination of Ms. Choy, a 35-year-old woman who has indicated on her health history form that she smokes cigarettes. During the course of the intraoral examination you note 6- to 8-mm probing depths around maxillary and mandibular molars and bleeding on probing throughout the mouth. Given Ms. Choy's stage of change, what is the recommended clinician response to her statement that she is not ready to quit? A. Try to persuade her one more time to stop her tobacco use. B. Tell her you understand she is not ready to quit now. C. Try to set a quit date. D. Provide her with some information on the benefits of quitting. E. Inform her that when she is ready you are here to help. F. Ask permission to ask again at her next visit about where she is in her decision-making process regarding her tobacco use. G. Make a note of her response in the chart. H. b, d, e, f, and g

b, d, e, f, and g Feedback When clients say they are not ready to quit, it is important for the dental hygienist to convey that the client has been heard and to promote the benefits of quitting in order to enhance motivation to quit. Providing nonjudgmental support for future decisions to quit promotes a positive ongoing relationship; asking permission to ask again about where clients are in the quitting process shows respect for the client; and making a note in the chart documents the conversation for the record and provides for continuity of care.

Q. Tools for eliciting "change talk" include which of the following? A. Persuasion B. Emphasizing your authority and expertise C. Open-ended questions D. Affirming "change talk" E. Reflective responding F. Summarizing G. All of the above H. c, d, e, and f

c, d, e, and f Feedback Open-ended questions engage the tobacco user by eliciting "change talk" from the user and allow the tobacco user to do most of the talking; affirming change talk reinforces reasons for quitting; reflective responding communicates to the client that the counselor has been listening; summarizing the client's change talk helps guide the tobacco user in a positive direction to resolve his or her ambiguity.