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  • Passive Smoking and Dental Caries in Children Davies JAMA. 2003; 289: 2940 Tobacco use is the root of many oral health problems, including tooth-loss, jawbone loss and periodontal diseases. Half the cases of adult periodontitis are attributable to smoking. 1 Moreover, tobacco use impedes the effectiveness of periodontal therapy, dental implants, and wound healing. 1 Worst of all, smoking a pack of cigarettes a day or using smokeless tobacco quadruples the risk of developing oral cavity or oropharyngeal cancer, which kills 49% of its victims within 5 years of diagnosis. 2,3 The most significant risk factor in the development and progression of periodontal disease. Major risk factor for oral and pharyngeal cancer.
  • Treating Tobacco Use and Dependence p 63 Kattyapong, et al 2002
  • Leukoplakia is a precancerous lesion that develops on the tongue or the inside of the cheek as a response to chronic irritation. Leukoplakia is primarily a disorder of the mucous membranes of the mouth, caused by irritation. Lesions usually develop on the tongue, but they may also appear on the insides of the cheek. Irritation may result from smoking or other tobacco use (smoker's keratosis). Pipe smoking involves a high risk for development of leukoplakia, as does holding chewing tobacco or snuff in the mouth for a prolonged period of time. Like other mouth ulcers , leukoplakia may become a cancerous lesion. The longer plaque and tartar are on teeth, the more harmful they become. The bacteria cause inflammation of the gums that is called "gingivitis."  In gingivitis, the gums become red, swollen and can bleed easily.  Gingivitis is a mild form of gum disease that can usually be reversed with daily brushing and flossing, and regular cleaning by a dentist or dental hygienist. This form of gum disease does not include any loss of bone and tissue that hold teeth in place. When gingivitis is not treated, it can advance to "periodontitis" (which means "inflammation around the tooth.")  In periodontitis, gums pull away from the teeth and form "pockets" that are infected. The body's immune system fights the bacteria as the plaque spreads and grows below the gum line. Bacterial toxins and the body's enzymes fighting the infection actually start to break down the bone and connective tissue that hold teeth in place. If not treated, the bones, gums, and connective tissue that support the teeth are destroyed.  The teeth may eventually become loose and have to be removed.    Black hairy tongue: An overgrowth of bacteria normally present in the mouth may cause discoloration of the tongue. These bacteria can accumulate on the hairlike projections (papillae) of the tongue. Some types of bacteria and yeast make red blood cell pigments (porphyrins), which give the tongue a black color. Also, the papillae may sometimes grow profusely, causing the tongue to look as though hair covers it. Smoker’s Palate Inflamed, highlighted ducts of Salivary Gland s Palatal submucosa rich in minor Salivary Gland s Diffuse white mucosal thickening on Hard Palate Pinpoint reddish Papule s on this white background Benign lesions, but predicts other Oral Tumor s
  • This figure helps to represent the target of this initiative and shows that without this new tool there is an expected decline in the number of dental hygienists who screen patients regarding tobacco use.
  • hafdentalclinictraining.ppt

    1. 1. Helping Patients to Quit Using Tobacco Hill Air Force Base Dental Clinic August 11, 2005 Isa Kaluhikaua, CHES Davis County Health Department Bureau of Health Promotion 451-3398 [email_address]
    2. 2. Why are we here? <ul><li>Train dental clinicians in a proven effective 3-minute intervention to help their tobacco using patients to quit. </li></ul><ul><li>Provide consistent tobacco cessation information to all tobacco using patients. </li></ul><ul><li>Introduce The TRUTH Network materials. </li></ul><ul><li>Address ADHA and UDHA goals. </li></ul>
    3. 3. Why is this my job? <ul><li>More than half of adult smokers see a dentist each year. </li></ul><ul><li>Effects of tobacco use are visible in the mouth even in relatively early stages of use. </li></ul><ul><li>Tobacco is the root of many oral health problems. </li></ul><ul><li>Dental patients request treatments that counter the effects of tobacco use on their appearance. </li></ul><ul><li>Most dental patients want and expect dental professionals to provide cessation advice. </li></ul><ul><li>Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment. </li></ul>
    4. 4. Tobacco Use Trends in Utah <ul><li>Average age of initiation - 12.5 </li></ul><ul><li>60% by age 14 </li></ul><ul><li>90% by age 19 </li></ul><ul><li>Tobacco use rate in Davis County 9.8% </li></ul><ul><li>Tobacco use rate at HAFB 28%. </li></ul><ul><li>There are more than 190,000 smokers in Utah. </li></ul><ul><li>81.5% of Utah smokers report that they would like to quit. </li></ul>
    5. 5. Oral Health Problems caused by Tobacco <ul><li>Tooth-loss, jawbone loss and periodontal diseases. </li></ul><ul><li>Impeded effectiveness of periodontal therapy, dental implants, and wound healing. </li></ul><ul><li>Tooth decay for the tobacco-user’s children, results from exposure to secondhand smoke </li></ul><ul><li>4x the risk of developing oral cavity or oropharyngeal cancer, which kills 49% of its victims within 5 years of diagnosis . </li></ul>
    6. 6. Success Rates of Tobacco Dependence Treatments <ul><li>No help = 7-8% </li></ul><ul><li>Health care provider advice (<5 minutes) = 10-12%, 15% for pregnant women </li></ul><ul><li>Counseling (91-300 minutes) = 10-20% </li></ul><ul><li>NRT = 15-30% </li></ul><ul><li>NRT + Counseling (91-300 minutes) = 25-35% </li></ul><ul><li>Zyban = 25-35% </li></ul>
    7. 7. How do I help tobacco users quit? <ul><li>Even a minimal intervention, lasting less than 3 minutes, can significantly increase overall tobacco abstinence rates. </li></ul><ul><li>The “5 A’s” </li></ul><ul><li>ASK the patient if he or she uses tobacco </li></ul><ul><li>ADVISE him or her to quit </li></ul><ul><li>ASSESS willingness to make a quit attempt </li></ul><ul><li>ASSIST him or her in making a quit attempt </li></ul><ul><li>ARRANGE for follow-up </li></ul>
    8. 8. How do I help tobacco users quit? cont. <ul><li>Use The TRUTH Network materials to help </li></ul><ul><li>you with your 5A’s intervention. </li></ul><ul><ul><ul><li>Treating Nicotine Dependence, Utah’s Healthcare Provider Guide </li></ul></ul></ul><ul><ul><ul><li>Brochures (Welcome Guide & Think About It) </li></ul></ul></ul><ul><ul><ul><li>Utah Quit Line & Utah QuitNet </li></ul></ul></ul><ul><ul><ul><li>Fax Referral Form </li></ul></ul></ul><ul><ul><ul><li>Pharmacotherapy Guide </li></ul></ul></ul>
    9. 9. 1. ASK <ul><li>Ask EVERY patient about tobacco use status at </li></ul><ul><li>EVERY visit. </li></ul><ul><li>Current </li></ul><ul><li>Former </li></ul><ul><li>Never </li></ul><ul><li>This occurs most consistently when there are systems in place, such as question on intake form, chart stickers, or electronic prompts on electronic medical records. Chart stickers are available. </li></ul>
    10. 10. 2. ADVISE <ul><li>Clinicians should urge all tobacco users to quit. </li></ul><ul><li>Even brief advice to quit by a clinician results in greater </li></ul><ul><li>quit rates. Smokers cite a clinician's advice to quit as an </li></ul><ul><li>important motivator for attempting to stop smoking. </li></ul><ul><li>Advice should be: </li></ul><ul><li>clear </li></ul><ul><li>strong </li></ul><ul><li>personalized </li></ul><ul><li>Specific to the individual 's own situation (e.g. oral health </li></ul><ul><li>condition, family status, costs of tobacco). </li></ul>
    11. 11. ADVISE cont. “ I can’t see what tobacco is doing to your heart, lungs, brain and other organs, but I would like to show you some changes in your mouth .” Gingival recession Gingivitis Leukoplakia Oral Cancer Periodontitis, Stained teeth Nicotine Stomatitis “Smoker’s Palate” Black, hairy tongue
    12. 12. 3. ASSESS <ul><li>&quot;Are you willing to try to quit at this time?&quot; </li></ul>
    13. 13. What if they are not willing? <ul><li>Provide patient with “Think About It” brochure from The TRUTH Network. </li></ul>
    14. 14. 4. ASSIST <ul><li>Provide patient with “Welcome Guide” brochure from The TRUTH Network. </li></ul><ul><li>Discuss the quitting process. </li></ul><ul><ul><li>Set a quit date. </li></ul></ul><ul><ul><li>Tell family and friends. </li></ul></ul><ul><ul><li>Review past quit attempt experiences. </li></ul></ul><ul><ul><li>Anticipate challenges. </li></ul></ul><ul><ul><li>Remove tobacco products. </li></ul></ul><ul><ul><li>Avoid alcohol. </li></ul></ul><ul><ul><li>Recommend pharmacotherapy. </li></ul></ul>
    15. 15. Pharmacotherapy <ul><li>Use the Pharmacotherapy Guide from The TRUTH </li></ul><ul><li>Network. </li></ul><ul><li>Many medications have been approved by the FDA for smoking cessation and have been shown to significantly improve abstinence rates. </li></ul><ul><li>They work to reduce cravings and other withdrawal symptoms. </li></ul>
    16. 16. ASSIST cont. <ul><li>“Would you like the Utah Tobacco Quit Line to help you quit?” </li></ul>
    17. 17. ASSIST cont. <ul><li>YES </li></ul><ul><li>Have patient fill out the Utah Tobacco Quit Line Fax Referral Form. </li></ul><ul><li>1. Clinician writes name on item 1 of the form. </li></ul><ul><li>2. Patient fills out items 2-12. </li></ul><ul><li>3. The client must sign the form. </li></ul>
    18. 18. ASSIST cont. NO If the patient does not want to fill out the form, give the patient the Quit Line's toll free telephone number (1-888-567-TRUTH) or offer a Utah Tobacco Quit Line card so that the patient can contact the Quit Line when they are ready.
    19. 19. UTAH TOBACCO QUIT LINE 1-888-567-TRUTH (8788) <ul><li>The Quit Line triple or quadruples quitting rates of Utah tobacco users. </li></ul><ul><li>Free Cessation Services: </li></ul><ul><ul><ul><li>Telephone Counseling </li></ul></ul></ul><ul><ul><ul><li>Quit Kits </li></ul></ul></ul><ul><ul><ul><li>Referrals </li></ul></ul></ul><ul><ul><ul><li>Nicotine Replacement Therapy (NRT) if eligible and appropriate </li></ul></ul></ul>
    20. 20. UTAH QUITNET http://utahquitnet.com <ul><li>All Utah QuitNet services are available to all </li></ul><ul><li>Utahns free of charge. </li></ul><ul><li>Personalized quitting plans </li></ul><ul><li>Quitting information </li></ul><ul><li>Peer support </li></ul><ul><li>Expert advice </li></ul><ul><li>Pharmaceutical product support </li></ul>
    21. 21. 5. ARRANGE FOLLOW-UP <ul><li>Fax the form to the Utah Tobacco Quit Line's toll </li></ul><ul><li>free fax number: </li></ul><ul><li>1-800-483-3114 </li></ul><ul><li>The Utah Tobacco Quit Line faxes your clinic so </li></ul><ul><li>that you know what type of services your patients </li></ul><ul><li>received. </li></ul>
    22. 22. Review <ul><li>Ask </li></ul><ul><li>Advise </li></ul><ul><li>Assess </li></ul><ul><li>Assist </li></ul><ul><ul><li>Provide “Welcome Guide” brochure & Fax Referral Form </li></ul></ul><ul><ul><li>Brief discussion of quitting process </li></ul></ul><ul><ul><li>Pharmacotherapy </li></ul></ul><ul><li>Arrange follow-up </li></ul><ul><ul><li>Fax referral form to Utah Tobacco Quit Line </li></ul></ul>
    23. 23. American Dental Hygienists’ Association’s Smoking Cessation Initiative <ul><li>Goal: 50% of dental hygienists screen their clients regarding tobacco use by 2006 </li></ul><ul><li>www.askadviserefer.org </li></ul>
    24. 24. The Current Trend
    25. 25. Utah Dental Hygientists’ Association Gold Card Program Goal: One referral to Utah Tobacco Quit Line for each hygienist.
    26. 26. Tobacco Cessation Websites for Health Care Providers <ul><li>1. Tobacco Cessation Guideline Publications:   </li></ul><ul><li>http://www.surgeongeneral.gov/tobacco/default.htm </li></ul><ul><li>Dr. Fiore's course in the 5 A's: http://www.cme.wisc.edu/online/ctri/index.htm </li></ul><ul><li>Utah Department of Health, Tobacco Prevention & Control Program </li></ul><ul><li>http://www.tobaccofreeutah.org/healthcare.html </li></ul>