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How many people die each year because of tobacco related deaths, tobacco is related to what percent of lung cancer and on average how much life expectancy is lost
- 450,000
- 87%
- 50% of smokers lose 20-25% of life expectancy
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What is Healthy people
- Healthy People is a nationwide health promotion and disease prevention plan initiated by the United States Department of Health and Human Services
- One objective of Healthy People 2020 is to “Increase tobacco cessation counseling in health care settings” and more specifically to “Increase tobacco cessation counseling in dental care settings”
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While _______ is the most addictive substance in tobacco, other chemicals are just as, if not more, harmful than nicotine such as
- nicotine
- Pesticides, aldehydes (such as formaldehyde), ketones (similar to solvents used in paint), and amines
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The lungs are lined with millions of ______ , which are _______. Once in the bloodstream, nicotine is delivered to the brain in
- alveoli
- tiny air sacs where gas exchange occurs
- less than 20 seconds
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About 80% of nicotine is broken down to _____ by ______. It is excreted via the _______
- cotinine
- enzymes in the liver
- kidneys in urine
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Oral snuff and chewing tobacco, are also called _______. Snuff is ________ . Users place _______. Chewing tobacco is ________ and users place _________
- spit or smokeless tobacco
- a finely ground tobacco leaf, packaged either loose or in a tea bag–like sachet
- a small amount of snuff between the cheek and gum
- a more coarsely shredded tobacco leaf
- a “chaw” of loose leaf tobacco, or a “plug” of compressed tobacco, in the cheek
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Free nicotine is _______. The higher the PH the ________
- ionized nicotine that passes rapidly through the oral mucosa into the bloodstream and the brain
- more available free nicotine
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Manufacturers control the amount of free nicotine available by adding __________. Usually new users start with products with low amounts of free nicotine to avoid the unpleasant side effects of nicotine toxicity such as ________.
- alkaline buffering agents
- nausea and vomiting
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What are the kinds of dissolvable tobacco products
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ENDS devices are ________. One ENDS refill cartridge is roughly equivalent to _________
- battery-powered vaporizers designed to deliver nicotine, flavor and other chemicals without the adverse effects of tobacco
- one pack of traditional tobacco cigarettes
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A hookah is a _________. Tobacco is heated by _______, passed through _______
- glass waterpipe used to smoke flavored tobacco
- charcoal
- water and drawn through a hose to a mouthpiece
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45 min. – 1 hr. of smoking is equivalent to inhaling ______ the volume of smoke from one cigarette. Second-hand some poses a threat because of the ________
- 100-200 times
- toxic chemicals in tobacco but also from the charcoal used as a heat source
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All forms of tobacco (smoking or smokeless) are associated with __________ cancer.
oral, pharyngeal, and esophageal
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____% of oral and pharyngeal cancers are attributed to tobacco and/or heavy alcohol use
Seventy-five percent
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What are the numerous oral conditions that are attributed to tobacco use
- Nicotine stomatitis (smoking)
- Melanin pigmentation of the gums (smoking)
- Hairy or coated tongue
- Delayed would healing
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Smokers are _____ times more likely than nonsmokers to develop periodontal disease
3-6 times
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Almost half of spit tobacco users have
gingival recession and hyperkeratosis of the vestibular mucosa associated with use
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Patients have a _________ associated with smokeless tobacco placement called _________
- The corrugated white lesion
- snuff keratosis, snuff patch, or tobacco pouch keratosis
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Secondhand smoke, also known as ________is a general term for any smoke that non-smokers are exposed to including ________
- environmental tobacco smoke (ETS)
- Mainstream smoke refers specifically to the smoke that a smoker inhales and then exhales
- Side-stream smoke refers to the smoke that comes off the end of a lit cigarette, cigar, or pipe
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What is Pyrolysis
the chemical decomposition of a condensed substance by heating
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Results of epidemiologic studies provide strong evidence that exposure of infants and children to environmental tobacco smoke is associated with increased rates of
- sudden infant death syndrome (SIDS)
- lower respiratory illness
- asthma
- middle ear infections
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What is tolerance?
the user needs more and more to achieve the same desired feeling of well-being
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Nicotine dependence is
nicotine tolerance combined with withdrawal symptoms if nicotine is removed
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Addiction is characterized by
compulsive use of a substance
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Withdrawal peaks within _______ and lasts ______
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Nicotine Withdrawal Symptoms
- Constant craving of cigarettes
- Insomnia
- Irritability
- Anxiety
- Frustration
- Anger
- Depression
- Difficulty concentrating
- Restlessness
- Decreased heart rate
- Increased appetite
- Fatigue
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What is the Tobacco Master Settlement Agreement (MSA)
- It was between the four largest US tobacco companies and the attorney generals of 46 states
- The tobacco companies agreed to curtail or cease certain tobacco marketing practices, as well as to pay various annual payments to the states to compensate them for some of the medical costs of caring for persons with smoking-related illnesses
- This money also funds anti-smoking groups
- The settlement agreed to pay a minimum of $206 billion over twenty-five years
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Typical reasons to quit include
- –General health awareness
- –Specific health problem directly or indirectly related to tobacco use
- –Effect on family: Need to act as a role model Awareness of effects of ETS
- –Cost
- –Social pressure and restrictions on smoking
- –Personal recognition of the dangers of nicotine addiction and the desire to regain control of one’s life
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Overall, self-quitters have a success rate of
4 to 6%
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Tobacco cessation methods or treatment for nicotine addiction fall into two categories
- –Self-help
- –Assisted strategies
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What are some Self-Help Intervention Methods
- Go cold turkey
- Reduce the number of daily tobacco exposures and/or purchase a brand with lower nicotine content
- Select over-the-counter nicotine replacement patches, gum, or lozenges
- Join a family member or friend in the tobacco cessation effort
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The four primary ways in which stop-smoking counseling can be delivered are
- –Phone-based
- –Face to face
- –Group
- –Internet-based
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What are some Over the Counter (OTC) treatment
- –Nicotine gum
- –Nicotine patch
- –Nicotine lozenge
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What are some prescription treatment
- –Nicotine inhaler
- –Nicotine nasal spray
- –Oral
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What is the mechanism of action of Nicotine Gum and what are the side effects
- The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth
- –Mouth soreness, hiccups, indigestion, and jaw ache
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What doses is the Nicotine gum available in and who it is recommended for
- 2mg and 4mg doses
- –2-mg gum is recommended for patients smoking less than 25 cigarettes per day
- –4-mg gum is recommended for patients smoking 25 or more cigarettes per day
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What is the prescribing information for the Nicotine gum
–Smokers should use at least one piece every 1 to 2 hours for the first 6 weeks with no more than 24 pieces to be used per day
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What is the Chewing technique of the Nicotine gum
- –Gum should be chewed slowly until a “peppery” or “flavored” taste emerges, then “parked” between cheek and gum to facilitate nicotine absorption
- –Gum should be slowly and intermittently “chewed and parked” for about 30 minutes or until the taste dissipates
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_______ interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for ________ and the average cost is about
- Acidic beverages (e.g., coffee, juices, soft drinks)
- 15 minutes before or during chewing
- $5/day during the first six weeks
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What is the mechanism of action for the nicotine patch and what are the side effects
- A nicotine patch is a transdermal patch that releases nicotine into the body through the skin
- –Skin reactions: Up to 50% of patients experience a local skin reactionReactions are usually mild
- –Insomnia and/or vivid dreams
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What is the average regimen for the Nicotine patch and the average cost
- 1.4 weeks 21mg/24hrs
- 2.2 weeks 14mg/24hrs
- 3.2 weeks 7mg/24 hrs
- $4/day
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What is the mechanism of action for Nicotine Lozenge and what are the side effects
- A nicotine lozenge is a tablet (usually flavored) that contains a dose of nicotine which dissolves slowly in the mouth to release the nicotine
- The nicotine is absorbed through the lining of the mouth and enters the blood vessels
- –The most common side effects are nausea, hiccups, and heartburn
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What is the dosage of the Nicotine lozenges
- –Available in 2-mg and 4-mg (per piece) doses
- –2 mg for patients who smoke their 1st cigarette more than 30 minutes after waking
- –4 mg for patients who smoke their 1st cigarette within 30 minutes of waking
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How many lozenges should be used daily
- –Generally, smokers should use at least nine lozenges per day but no more than 20 lozenges per day in the first 6 weeks
- The lozenge should be used for up to 12 weeks
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What is the nicotine inhaler
- It looks like a small cigarette holder and contains a chamber into which a nicotine-containing cartridge is placed
- The cartridge is punctured when placed in the holder, making the nicotine available
- The nicotine becomes an aerosol when the individual inhales strongly on the holder
- The nicotine is then deposited on the oropharyngeal membranes and is transferred into the bloodstream, similar to the gum
- –It is not a true pulmonary inhaler
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What are the side effects of the Nicotine inhaler
- –Local irritation in the mouth and throat
- –Coughing and rhinitis (irritation and inflammation of the mucous membrane inside the nose)
- –Severity is generally mild, and the frequency of symptoms usually declines with continued use
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What is the dosage of the nicotine inhaler
- –Each cartridge delivers 4 mg of nicotine over 80 inhalations
- –Recommended dosage is 6–16 cartridges/day
- –Recommended duration of therapy is up to 6 months
- –Instruct the patient to taper dosage during the final 3 months of treatment
- –Best effects are achieved by frequent puffing of the inhaler and using at least six cartridges/day
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–The delivery of nicotine from the inhaler declines significantly at temperatures below _____ and just like the lozenge and gum eating and drinking anything except water should be avoided for
- 40°F
- 15 minutes before or during use
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Which treatment delivers nicotine to the brain faster than any other NRT
Nicotine Nasal Spray
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What are the side effects of the nicotine nasal spray
- –Moderate to severe nasal irritation especially in the first few days of use
- –Nasal congestion and transient changes in the sense of smell and taste
- –Nicotine nasal spray should not be used in persons with severe reactive airway disease
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What is the dosage of treatment for the nicotine nasal spray
- –A dose consists of one 0.5-mg dose delivered to each nostril (1 mg total)
- –Initial dosing should be 1–2 doses per hour, increasing as needed for symptom relief–Minimum recommended treatment is 8 doses/day, with a maximum limit of 40 doses/day.
- –Each bottle contains approximately 100 doses
- –Recommended duration of therapy is 3–6 months
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What are some prescribing instructions that come with the nasal spray
- –Patients should not sniff, swallow, or inhale through the nose while administering doses, as this increases irritating effects
- –The spray is best delivered with the head tilted slightly back
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Bupropion hydrochloride (Zyban)
- It is a non-nicotine pill which reduces craving for nicotine
- The drug is also sold as an antidepressant under the name Wellbutrin
- Common side effects include insomnia and dry mouth
- Treatment with Zyban begins while the user is still smoking, one week prior to the quit date
- Treatment is then continued for 7 to 8 weeks
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Verenicline (Chantix)
- Binds to nicotine receptors to block the neurochemical effects
- Common side effects include nausea, vomiting, and constipation
- Treatment begins one week before the quit date
- –This allows Chantix build up in the body
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What is the dosage guide for Chantix and how should you take it
- Chantix is taken after eating and with a full glass (8 ounces) of water
- Treatment is up to twelve weeks
- –Days 1 – 3 one white tablet (0.5 mg) each day
- –Days 4 -7 one white tablet (0.5 mg) twice a day- one in the morning and one in the evening
- –Days 8 - the end of the treatment one blue tablet (1mg) twice a day- one in the morning and one in the evening
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________ has been shown to be the most effective in helping patients to quit using tobacco
Counseling combined with pharmacotherapy
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What are some alternative therapies
- –Acupuncture
- –Hypnosis
- –Laser
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What changes are seen within 20 minutes of the last cigarette
blood pressure drops and the temperature of hands and feet increase to normal
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What changes are seen 8 hours after of the last cigarette
the level of carbon monoxide in the blood drops to normal
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What changes are seen between 2 weeks and 3 months of quitting
circulation improves and lung function increases up to 30%
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What changes are seen within 1 to 9 months of quitting
coughing, sinus congestion, fatigue and shortness of breath decrease
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What benefits are there after
1 year after quitting __________
5 years after quitting _________
After 10 years _________
After 15 years ________
- coronary heart disease is half that of a smoker’s
- stroke risk is reduced to that of a non-smoker
- the lung cancer death rate decreases by almost half
- the risk of coronary heart disease is that of a non-smoker
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What are the “5 A's” that provide the basis for a brief, simple, but effective tobacco dependence intervention
- –Ask
- –Advise
- –Assess
- –Assist
- –Arrange
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If the patient is not ready to quit, what are the “5 R’s
- –Relevance: Pt identifies personal importance of quitting
- –Risks: Pt identifies negative consequences of continued use
- –Rewards: Pt identifies personal benefits of quitting
- –Roadblocks: Pt identifies barriers to quitting (clinician helps address barriers)
- –Repetition: Reinforce the motivational message at every visit
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Contact the patient once within the _____ after the quit date when the patient's physical withdrawal symptoms are most intense, and again at the end of the ______ months
- 1st week
- 1st, 2nd, and 3rd
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American Dental Hygienists Association Simplifies tobacco cessation to a 3-step process
- Ask about tobacco use at every visit
- Advise tobacco users to quit
- Refer tobacco users to a state or national tobacco quitline
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