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Transcript of Tobacco Cessation
Box 36-2, p.628
Aspects of nicotine addiction can be categorized as:
Physical: Reinforcing effects, tolerance, physical dependence *Table 36-4*
Psychologic: Coping, comfort, security, passive entertainment to decrease boredom, diversion
Behavioral: Learned anticipatory responses
Sensory: Oral gratification
Sociocultural: Peer pressure, influence of family members and significant others who use tobacco, social network that supports tobacco use
carcinogens occurs through the lungs, skin, oral/nasal mucosa; occurs very quickly:
It is the liver's job to metabolize nicotine.
Effects on periodontal tissues:
The degree of inflammatory response to dental biofilm accumulation is reduced compared to that of nonsmokers
Increased rate and severity of perio destruction
Increased bone loss, attachment loss, pocket depths
Gingival blood flow and gingival crevicular flow are diminished
Increased tooth loss from perio causes
NO EFFECT ON THE RATE OF BIOFILM ACCUMULATION
LOWERED HOST IMMUNE RESPONSE-impaired neutrophils=decreased chemotaxis,phagocytosis, adherence
Delayed healing after NSPT and surgical procedures
*Wilkins, 9th Ed. Chapter 11
Helping Clients Become Tobacco Free
The Five A's Approach- Darby Table 36-6, Gehrig 11-1
The Brief Intervention
The Motivational Interview
Ask, Advise, Refer- Darby p. 637, Nield p. 313, Procedure 11-1
Darby p. 632-637, NIeld p. 342-379
Purpose: to provide some blood concentration of nicotine to reduce or eliminate withdrawal symptoms and/or target brain receptors similarly to nicotine
Darby: p.643-645, Table 36-8, 36-9, Nield p.311-312, Table 10-3
Food and Drug Administration:
Some warnings and limitations specified in the directions for use of these products are no longer necessary.
Although any nicotine-containing product is potentially addictive, research and use have shown that OTC NRT products do not appear to have significant potential for abuse or dependence.
Changes being recommended by FDA include a removal of the warning that consumers should not use an NRT product if they are still smoking, chewing tobacco, using snuff or any other product that contains nicotine—including another NRT.
Identify tobacco and tobacco use.
Discuss prevalence and morbidity in US population.
Describe systemic and oral effects of tobacco use.
Discuss the hazards of secondhand smoke.
Delineate process of nicotine addiction.
List evidence based approaches to tobacco cessation including pharmacotherapies
Explain why tobacco cessation counseling is a valuable part of dental hygiene services.
Tobacco is a leafy plant grown around the world
Tobacco use, chiefly in the form of a cigarette, is the leading cause of preventable illness and death in the United States
Contain the chemical
Within 10 seconds nicotine causes the brain to release adrenaline, creating a buzz of pleasure and energy
Tobacco companies also use
additives and chemicals to make them more addictive...
Darby, Walsh. Dental Hygiene Theory and Practice, 4th Ed.
Wilkins. Clinical Practice of the Dental Hygienist, 11th Edition.
Beyond the Basics:
Smoking Cessation Leadership Center. Pharmacotherapy for Smoking Cessation, https://smokingcessationleadership.ucsf.edu/webinars/archive/year/2016
Rabinoff M, Caskey N, Rissling A, Park C. Pharmacological and Chemical Effects of Cigarette Additives. American Journal of Public Health. 2007;97(11):1981-1991. doi:10.2105/AJPH.2005.078014.
Why should RDHs provide tobacco cessation counseling?
Tobacco dependence is a chronic disease that requires repeated interventions and multiple attempts to quit
Health care providers must collaborate and provide education/options
Tobacco cessation programs are effective
Even brief dependence treatment is effective
lungs, trachea,and bronchus
kidney and ureter
colon and rectum
acute myeloid leukemia
Cancer of the:
cardiovascular disease (heart disease)
cerebrovascular disease (stroke)
coronary artery disease
abdominal aortic aneurysm
fetal heart defects
Major cause of:
Battery-powered devices that provide nicotine and other additives in an aerosol form
Currently unregulated by the FDA
No rules as to the amounts and types of components and potentially harmful constituents
In other words, we have no way to tell what is actually in there!
Early studies show e-cigarettes contain hazardous chemicals (including some found in antifreeze).
Many countries have banned the sale of e-cigarettes.
Use of these products in the United States and worldwide is increasing.
Many believe they are safer than traditional cigarettes.
Many current smokers have used them to try to quit (only to still be addicted to vaping a year later).
What does the NIH say about eCigs?