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single most preventable cause of disease and premature death
tobacco
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most addictive substance in tobacco
nicotine (not most harmful)
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Metabolism of nicotine in smoking
- nicotine absorbed through lungs
- remains in body 8-12 hrs (one puff)
- concentration declines over 20-30 min
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metabolism of smokless tobacco
- absorbed throuh oral cavity and intestines
- 2-3 times more nictine absorbed than a cigarette
- concentration declines over 2 hrs
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systemic effects of tobacco affect which organ systems
All
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desease consequences of tobacco use are in 3 categories
- Cardiovascular (atherolsclerosis)
- pulmonary (COPD)
- Cancer (oral cavity 75% and lungs87%)
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COPD
chronic obstructive pulmonary disease
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Respiratory diseases casued by tobacco use
- COPD
- Emphysema
- Bronchitis
- Asthma
- Bacterial pneumonia
- tuberculosis
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cardiovascular diseases caused by tobacco
- atherosclerosis
- coronary artery disease
- hypertension
- aortic aneurysm
- arterial thrombosis
- stroke
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ETS
Environmental Tobacco Smoke
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The principal contributor to ETS is
Sidestream smoke
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other names for ETS
- passive
- secondary
- second-hand
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Toxicity of ETS
- many of the same chemicals are found
- some toxic components are actually in higher concentrations in sidestream smoke than in mainstream
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Primary cause of lung cancer
smoke
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what are the most commoly reported symptoms of nonsmokers
eye and nose irritation
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most deaths that occur annully from exposure to ETS are attributed to
heart disease
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problems of ETS in utero
- risk of miscariage
- placenta previa (placenta implanted in lower segment of uterus)
- low birth weight
- increase in perinatal mortality
- cleft lip/palate
- delayed tooth formation
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problems of ETS in infancy
- chemicals passed through breast milk
- lower respiratory illness
- SIDS
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problems of ETS in young children
- Affects lung development (coughing phlegm, and wheezing)
- higher risk for asthma
- inceased middle ear infection
- possible behavioral and low academics due to missed days of school from other illness
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Major risk factor for periodontal disease
tobacco
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Effects of smoking on Periodontal tissues
- Gingivitis is REDUCED compared to nonsmokers
- Increased rate and severity of periodontal destruction
- increased severity
- bone loss
- attachment loss
- pocket depths,
- recesssion in anterior regions
- tooth loss
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Mechanisms of periodontal destruction
- host response: lowered immune factors
- imparied neutrophils: decreased chemotaxis, phagocytosis, and adhearence
- altered antibody production: decreased serum IgG
- Imperment of revascularization: impact on healing
- negative effect on bone metaboism: influences osteoperosis
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Smoker's response to treatment
- delayed healing
- resistance to conventional therapy
- greater risk for implant failure
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nicotine withdrawal syndrome
- dysphoric (depressed mood)
- insomnia
- irritability, frustration, and anger
- anxiety
- difficulty concentrating
- restlessness
- decreased heart rate
- increased appetite or weight gain
- cravings for tobacco
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reasons for quitting
- general health awareness
- specific health problem related to tobacco
- effect on family (rolemodel, or ETS)
- effect of smoking druing pregnancy
- cost
- social pressure and restrictions
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self-help strategies
- go cold turkey
- reduce number of dialy exposures
- OTC nicotine replacement
- Join family or friend
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assisted strategies
- counsling
- pharmacotherapies
- combination
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NRT
Nicotine replacement therapy
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5 NRTs
- gum (transmucosal)
- patch (transdermal)
- inhailer (transmucosal)
- Nasl spray (nasal mucous membrane)
- Lozenge (transmucosal)
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Nicotine free therapy
- Bupropion SR (Zyban)
- Varenicline tartrate (chantix)
- Other therpies are not approved for tobacco dependence therapy
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What is included in the dental hygiene assessment of a tobacco patient
- Patient history
- viatal signs
- extraoral examination
- intraoral examination
- consulatation
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Extraoral exam
- Halitosis
- fingers(yellow brown)
- skin (wrinkles)
- lips (at risk for lesions)
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Intral oral exam
- detection of intraoral lesion/problem: show, explain, record
- Refer: (if lesion persists for more than 2 weeks, biopsy indicated)
- oral self-exam: (teach patient how to do self-exam)
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First prioraty in clinical procedures
dental biofilm control
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Clincal treatment and procedures
- dental biofilm removal
- scaling and root planning
- Patient instruction
- tobacco cessation program
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What are the 5A's
- Ask
- Advise
- Assess
- Assist
- Arrange
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Explain Ask
- Health history: ask patient about tobacco use
- Present questions carefull
- Obtain patient's confidence
- children affected by habit
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Explain Advise
- Never Users/former Users
- Stop-look-listen approach (avise about stopping now, show patients how to look in their mouths, listen to patients reasons for now quitting)
- brief advice to patients
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Explain Assess
- Ask patient "are you ready to quit"
- If yes, proceed to assist
- If no, go to 5 R's
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Explain Assist
- Establish a quit plan
- provide practical counceling
- pharmacotherapy
- provide education material
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Explain arrange
- contact the patient before the quit date
- follow up contact (phone or email)
- actions during follow up contact (congradulate, encourage, restore confidence)
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what are the 5 R's
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition
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Factors to teach patient
- Perform self-exam
- risks of tobacco use in pregnancy
- risks of addiction
- effects of ETS
- advocacy for patients and community
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