Preventative Dentistry

1. Tobacco
Cessation

2. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Introduction
 A dental hygienist should identify
tobacco use, provide the appropriate
tobacco intervention based on clinical
and supportive findings, and maintain a
patient-centered relationship.
 The clinician has the opportunity to
encourage a tobacco-free life.

3. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Tobacco Use: Morbidity,
Mortality, and U.S. Population
Trends
 Tobacco is the primary cause of
preventable death and disease.
 Approximately 443,000 premature
deaths occur each year.
 41% were attributed to cancer.
 33% to cardiovascular disease.
 26% to respiratory disease.

4. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Tobacco Use: Morbidity,
Mortality, and U.S. Population
Trends
 Lung cancer, chronic obstructive
pulmonary disease (COPD), and
ischemic heart disease are the top three
causes of death due to smoking and are
also the causes for various cancers.

5. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Tobacco Use:
Second-Hand Smoke
 Second-hand smoke is responsible for
premature death and disease for
nonsmokers who are exposed to it.
 It causes an increased risk of acute
respiratory infection, ear infections, and
more severe asthma in children, as well
as coronary heart disease and lung
cancer.

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Primary Preventive Dentistry, Eighth Edition
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Tobacco-Related Oral
Diseases and Lesions
 The physical consequences of using
smoked and/or smokeless (spit) tobacco
on the oral cavity are numerous and
potentially life-threatening.
 Tobacco that is smoked is a causative
factor in the development of
periodontitis, whereas smokeless
tobacco is not.

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Primary Preventive Dentistry, Eighth Edition
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Oral Cancer/Precancerous
Lesions
 Smokeless tobacco poses a lower risk of
oral cancer than smoked tobacco.
 The level of risk depends on:
 How much is used
 How long it is used
 The type of smokeless tobacco consumed
 Dental health care providers are
ethically bound to screen for oral cancer
on every adult patient on a regular
basis.

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Primary Preventive Dentistry, Eighth Edition
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Periodontal Diseases
 A majority of adults in the United States
suffer from some level of periodontitis.
 For patients who continue to smoke, it
is estimated that 75% of their
periodontitis is attributed to smoked
tobacco.

9. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Periodontal Diseases
 The number of cigarettes plus the
number of years smoked is called a
dose response.
 Often times it will be an indicator for the
level of periodontal destruction.
 Smokers have greater probing depths,
gingival recession, loss of attachment,
and bone loss than non-smokers.

10. Copyright © 2014 by Pearson Education, Inc.
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Periodontal Diseases
 Smoking alters the body's ability to
mount a host response at both the local
and systemic levels by change in
vasculature.
 Patients who smoke not only are more
likely to present with moderate or
advanced periodontitis, but will often
respond poorly to nonsurgical
periodontal therapy.

11. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
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Smokeless Tobacco and
Periodontal Diseases
 Use of smokeless tobacco directly
affects the oral tissue where the snuff
or chew tobacco directly touches the
mouth.
 A recent study found that the
smokeless-tobacco users were twice as
likely as non-tobacco users to have
evidence of severe active periodontal
disease.

12. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
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Smokeless Tobacco and
Periodontal Diseases
 The American Academy of
Periodontology strongly recommends
inclusion of tobacco cessation in
periodontal therapy.

13. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
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Tobacco Use: A Behavioral
and Social Addiction
 With approximately 10 puffs taken per
cigarette, a one-pack-per-day smoker
will repeat the administration of nicotine
200 times each day to maintain
relatively stable levels of the drug to
satisfy cravings or avoid withdrawal
symptoms.
 Helping patients overcome this multi-
factorial addiction by necessity involves
behavioral and pharmacologic
assistance.

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Pharmacotherapy for
Treatment of Nicotine
Dependence
 Dental and medical professionals can
have a significant impact on tobacco
quit rates and should be actively
involved in helping patients quit.
 Tobacco cessation medications are safe
and effective, and have been shown to
double the chance of a successful quit
attempt.

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First-Line Medications
 The US Federal Drug Administration
(FDA) has approved several medications
for over-the-counter (OTC) or
prescription use in the treatment of
nicotine dependence.

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First-Line Medications
 Nicotine replacement therapies (NRT)
can provide 30%-80% of the nicotine
normally obtained from tobacco, giving
the user control over the amount of
nicotine needed for cessation.
 Pregnant and lactating women should
be encouraged to quit without using
cessation methods.

17. Copyright © 2014 by Pearson Education, Inc.
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Components of an Effective
Tobacco Dependence
Intervention
 Dental health care providers assess risk
through a variety of exams and health
histories.
 The inclusion of tobacco assessment
and cessation is not only appropriate
but an ethical obligation.

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Primary Preventive Dentistry, Eighth Edition
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Components of an Effective
Tobacco Dependence
Intervention
 Evidence shows that a brief tobacco
cessation intervention (TCI) provided by
a health care provider can help the
patient successfully quit.
 There are barriers such as lack of time,
training, and reimbursement for the
health care professional.

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Components of an Effective Tobacco
Dependence Intervention: The PHS
Guidelines' 5 A's
 Ask
 If patient uses tobacco
 Advise
 Encourage patient to quit. How question
is posed could cause a negative reaction
or possibly a positive one.

20. Copyright © 2014 by Pearson Education, Inc.
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Components of an Effective Tobacco
Dependence Intervention: The PHS
Guidelines' 5 A's
 Assess
 Taking into account behavioral factors,
emotional factors, level of addiction, past
quit attempts, and willingness to quit.
 Assist
 Includes pharmacotherapy discussion,
recommendation, OTC nicotine
replacement, referral, pamphlets, or a
personalized quit plan

21. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
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Components of an Effective Tobacco
Dependence Intervention: The PHS
Guidelines' 5 A's
 Arrange
 Providing follow-ups for patient with a
letter, post card, or a call have been
effective

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Tobacco-Use Prevention
 Provide magazines that do not have
tobacco advertisements within them.
 Have information on the benefits of
quitting in the wait room.
 Ask youth if they have tried tobacco
products, followed by support for their
decision to not use them.

23. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Tobacco Use Prevention:
The CDC's Strategy
 Provide effective educational tobacco
prevention strategies for youth.
 Provide tobacco cessation assistance
adapted to the needs of youth.
 Restrict youth to the access of tobacco
products.

24. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Tobacco Use Prevention:
The CDC's Strategy
 Raise taxes on tobacco products.
 This requires collaboration among
private, governmental, public health,
and business entities.

25. Copyright © 2014 by Pearson Education, Inc.
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Primary Preventive Dentistry, Eighth Edition
Harris | Garcia-Godoy | Nathe
Summary
 Every dental patient who uses tobacco
is at an increased risk for general and
oral diseases including cardiovascular
disease, oral cancer, and periodontitis.
 Tobacco interventions need to be
provided over an extended period of
time with relapse and remission.