Smoking Cessation

Tobacco Facts

* #1 public health problem in U.S. * Causes more deaths each year than alcohol, motor vehicle accidents, suicide, AIDS, homicide, illicit drugs, & fires combined. * Proven risk factor heart disease, malignant neoplasms, & stroke. * One-third of all tobacco users will die prematurely.

Five A's of Intervention

* Ask * Advise * Assess * Assist * Arrange

Smoking Increases The Risk of:

* Impaired kidney function in smokers with type II diabetes. They are two times more likely than nonsmokers. * Serious cardiovascular side effects for those who take oral contraceptives. Risk increases with age and the # of cigarettes smoked. * Birth defects.

Arrange

Arrange follow-up contact (in person/by phone), preferably during the first week. Second follow-up within the first month. Assess pharmacotherapy use; consider more intensive treatment. If relapsed,review circumstances and elicit re-commitment to total abstinence.

Action

Support the smoker and the actions taken for change. Discuss any relapses and develop plan to deal with relapses as necessary. Ask questions about trigger. Strongly suggest to the smoker to keep on using strategies for at least three months. Refer to group program or support group as needed. As necessary, revise therapies.

Termination

Most smokers say this never really occurs; desire for a cigarette never disappears completely. Maintenance becomes less vigilant over time. Withdrawal is manageable. No longer any serious temptation.

Nicotine Drug Interactions

Nicotine decreases the effects of: * Alcohol * Beta blockers (e.g., metoprolol ) * Opioids * Valium * Insulin * Aspirin's antiplatelet effect

Nicorette

Nicotine gum. Available over the counter. May not be the right choice for those with TMJ issues.

Nicotrol Inhaler

Nicotine inhaler. Prescription. Designed to combine pharmacological and behavioral substitution. Nicotine is absorbed through buccal membrane. Satisfies hand-to-mouth ritual of smoking.

Commit

Nicotine lozenge. OTC. Like hard candy, dissolves in mouth. Should not use tobacco during 12 week program and stop lozenge use after 12 weeks.

Nicotrol NS

Nicotine nasal spray. Rx only. Designed for quick delivery of nicotine. May irritate passages. Absorption decreased with colds or rhinitis. May be most beneficial to highly dependent, heavy smokers.

NicoDerm

Nicotine patch. Available over the counter. Some may experience an allergy to the adhesive.

Oral Cavity Risks/Effects from Tobacco Use

* Significant in the development & progression of periodontal disease. * Increase chances for oral and pharyngeal cancer. *Responsible for ~75 % of all oral cancers (mouth, tongue, lips, throat, nose, & larynx). * Brown, stained, teeth. * Children exposed to second-hand smoke are twice as likely to have cavities (weaken immune system).

Alternative Cessation Therapies

*Acupuncture *Hypnosis *Massage *Laser

Stages of Change

*Precontemplative (not ready to consider quitting) *Contemplative (planning to quit in the next 6 months, no stop date set) *Preparation (planning to quit, stop date set). *Action (has quit). *Maintenance (has not used for more than 6 months). *Termination (no longer any serious temptation).

Primary Routes of Nicotine Absorption

Respiratory tract, buccal mucosa, and skin. 90% absorption across respiratory epithelium. Absorbed in tar, nicotine is less irritating to the throat.

Preparation

Ask smoker to set quit date. Explore the possible behavioral substitutes. Discuss the strategies and available resources. Help smoker to decide on a plan of action. Encourage observation of smoking behavior in order to be aware of pattern/vulnerable times. Motivate smoker as the planning takes place.

Contemplation

Assure that advantages of quitting will be more significant than inconveniences. Offer confidence that the smoker can do it. Identify obstacles in quitting and explore solutions. Encourage smoker to picture life as an ex-smoker. Reinforce the reasons given by the smoker to change.

Nicotine Withdrawal Symptoms (peaks within 24-48hrs. & diminishes over 1-3 mo.)

Constant cigarettes cravings, insomnia, irritability, anxiety, frustration, anger, depression, difficulty concentrating, restlessness, decreased heart rate, increased appetite, and fatigue.

Advise

Deliver clear, strong, personal, and straightforward advice about the importance of quitting.Emphasize the four R's; risks, relevance, rewards, and repetition.

Smokeless Tobacco

Delivers up to 5 times the amount of nicotine found in one cigarette.

Precontemplation

Employ consciousness-raising to help the smoker to think of quitting in the next 6 months. Discuss smoker's feelings about the idea of quitting. Review advantages of quitting/ inconveniences and risks of smoking. Adapt message to suit the beliefs, knowledge, and attitudes of the smoker.

Nicotine Replacement Therapy (NRT)

FDA approved therapies reliably increase long-term smoking abstinence rates. Goal is to replace nicotine from cigarettes in order to reduce or eliminate physical withdrawal symptoms. All help with symptoms of withdrawal.

Why Should Dental Hygienist be Involved in Tobacco Cessation?

Have interviewing skills, educating skills, motivating skills. and counseling skills. Dental hygiene is the most frequently provided service. There is no other clinical practice that has more impact on reducing illness, preventing death, and increasing quality of life.Follow-up procedures have always been an important part of the dental hygiene practice.

Assist

Help patient formulate a quit plan. Set a quit date within 2 weeks. Tell friends and family for support. Anticipate challenges

Maintenance

Help to recognize and use strategies to prevent relapses. Reevaluate the strategies based on smokers knowledge and behavior and modify as needed. Reinforce reasons for quitting their decision to quit. Reinforce self confidence in quitting. Encourage rewards.

Ask

Identify if client uses tobacco.

Biology of addiction

Inhaling produces a rapid distribution of nicotine to the brain. Drug levels peak within 10 seconds in the brain. Addictive drugs stimulate the release of dopamine. Acute effects dissipate within minutes, causing the smoker to continue frequent dosing throughout the day. Average smoker takes 200-300 boluses to the brain per day. Tolerance to the drug develops.

The Most Common Cause of Preventable Disease & Death in the U.S.

Tobacco use.

Chantix

Varenicline tartrate. Partial nicotine agonist; Smoking aid. Rx only. Monitor patient behavior and mood changes (suicidal thoughts, etc.). Safety of combining with any other agents has not been established.

Bupropion

Wellbutrin; Zyban. Antidepressant, dopamine-reuptake inhibitor; Smoking cessation aid. Available by Rx only. Can be used in combination with NRT.

Assess

Willingness to make a quit attempt. If patient is willing to quit, provide assistance. Offer intensive treatment or refer patient. If patient is unwilling to quit, provide motivational intervention.