Chapter 34- Tobacco

Question 1

True or False: Advice from health professionals has been shown to be a great influence on patients decisions to stop or not begin using tobacco.

Answer 1

TRUE

Question 2

What are the health hazards of tobacco?

Answer 2

• Toxic to humans
• Life expectancy is shortened
• Women at the same risk as men (smokers or ETS, environmental tobacco smoking)

Question 3

What is the single most preventable cause of death in the world?

Answer 3

tobacco

Question 4

What percent of adults use some sort of tobacco?

Answer 4

25%

Question 5

What drug is most addictive in tobacco?

Answer 5

Nicotine

Question 6

Once tobacco is ignited, what does it put into the air?

Answer 6

Carcinogens (ETS)

Question 7

True or False? Tobacco products contain 7,357 chemicals; over 90 of these are hazardous FDA.

Answer 7

True

Question 8

What is the metabolism, of nicotine?

Answer 8

Occurs thru lungs, skin, oral, buccal, nasal mucosa, and GI tract

Question 9

Nicotine enters the lungs quickly and passes into circulation by the blood vessels lining the what?

Answer 9

BRONCHI

Question 10

Smoking: DISTRIBUTION

Answer 10

Nicotine is delivered to the brain by the bloodstream in less than 20 seconds

Question 11

How many carcinogens are in smokeless tobacco?

Answer 11

28

Question 12

Is nicotine directly absorbed through the gingiva and oral mucous membranes?

Answer 12

YES

Question 13

True or False:
Once smokeless tobacco is placed in the mouth, the amount of nicotine absorbed is two to three times the amount delivered by a cigarette

Answer 13

TRUE

Question 14

Do electronic cigarettes contain tobacco?

Answer 14

no, but they deliver vaporized nicotine

Question 15

Has the FDA approved electronic cigarettes safety or effectiveness?

Answer 15

nope

Question 16

Smoking and the development of atherosclerosis, is a major risk factor for what?

Answer 16

heart disease

Question 17

What is the major cause of COPD, including emphysema and chronic bronchitis?

Answer 17

smoking

Question 18

What percent of smoking is responsible for lung cancers in the U.S?

Answer 18

87%

Question 19

Are those who smoke more likely to consume alcohol?

Answer 19

yes

Question 20

Combining tobacco and alcohol can increase the risk for what?

Answer 20

neoplasms and other oral problems

Question 21

true or false: Smoking is the primary cause of lung cancer

Answer 21

true

Question 22

Cardiovascular effects:

Answer 22

• Both ETS and mainstream smoke have similar effects on cardiovascular system
• There is a relationship between second hand smoke and the risk of a stroke

Question 23

What crosses the placenta and has higher levels than in the mother?

Answer 23

nicotine and carbon monoxide

Question 24

low placenta usually need c-section, pregnancy risk of ETS

Answer 24

Placenta Previa ( in utero )

Question 25

ETS Pregnancy risk factors:

Answer 25

- low birth rate, pre-term delivery, and spontaneous abortion - cleft lip/palate, and delayed tooth formation

Question 26

ETS risk factors for infants:

Answer 26

- chemical passed thru breast milk - Increase upper respiratory problems - Increases incidence of lower respiratory tract illness - Can increase chances of SIDS

Question 27

ETS risk factors for children:

Answer 27

- affects lung development with symptoms of coughing, phlegm, and wheezing - higher risk for asthma - increased incidence of middle ear infections

Question 28

Tobacco use is a major risk for development and progression of __________ disease.

Answer 28

periodontal

Question 29

What are the effects of tobacco on periodontal tissues?

Answer 29

- Can affect outcome of plaque-induced gingivitis - Increase rate and severity of perio destruction - Increase bone loss - Increase tooth loss - Gingival blood flow is diminished - Prevalence and severity decrease sensation

Question 30

Mechanisms of periodontal destruction:

Answer 30

- no affect on rate of biofilm accumulation - altered antibody production - lowered immune response - negative effect on bone after menopause

Question 31

Response to treatment:

Answer 31

- People who smoke have a weakened response to therapy - Negative impact on bone regeneration - Implants greater risk for failure - Delayed healing after procedures

Question 32

A chronic progressive, relapsing disease characterized by compulsive use of a substance.

Answer 32

addiction

Question 33

Tobacco cessation methods fall into two categories:

Answer 33

1. self help | 2. assisted strategies

Question 34

Reasons for quitting?:

Answer 34

- effect ETS has on family - specific health problem - cost - effect of smoking while pregnant - social pressures - dangers of nicotine

Question 35

What are example of assisted strategies?

Answer 35

- counseling - pharmacotherapies - social suport - combination

Question 36

True or false: About one-third of adult smokers attempts to quit, but only 2-3 are able to achieve long term results on their own

Answer 36

true

Question 37

Benefits of pharmacotherapies:

Answer 37

- reduce withdrawals - fulfill cravings - provide some effects (mood, cognitive changes) - make it easier to abstain from tobacco by partial replacement of nicotine or by counteracting nicotines action

Question 38

Considerations of pharmacotherapies:

Answer 38

- discourage casual use | - inform pt of sign and symptoms nicotine overdose such as nausea, vomiting, dizziness, weakness, or rapid heart beat

Question 39

CONTRAINDICTIONS OF PHARMACOTHERAPIES: | need to know ya'll

Answer 39

- Self medication without professional advice - pregnancy and breastfeeding - Nicotine patch- pt may be allergic - Nicotine gum/lozenge- hypertension, using meds for asthma, depression, diabetes, ulcers

Question 40

Transmucosal delivery, nicotine released in mouth during chewing. Sweetened by xylitol.

Answer 40

Nicotine gum

Question 41

Transdermal delivery, nicotine released through skin

Answer 41

Nicotine patch

Question 42

Transmucosal delivery, nicotine releasing in mouth during inhalation or puffing

Answer 42

nicotine inhaler

Question 43

Nasal mucous membrane delivery

Answer 43

nicotine nasal spray

Question 44

Transmucosal delivery, nicotine released in mouth as lozenge dissolves. Sweetened with mannitol. DIRECTIONS FOR PATIENT: do not bite or chew lozenge as it dissolves in mouth, this can cause more nicotine to be swallowed quickly may result in heartburn

Answer 44

Nicotine lozenge

Question 45

The first non nicotine medication shown to be effective for tobacco cessation

Answer 45

Bupropion SR

Question 46

Second non nicotine med shown effective for smoking cessation: it reduces cravings for nicotine and reduces the release of dopamine

Answer 46

Varenicline tartrate

Question 47

Majority of tobacco using patients

Answer 47

want to quit, almost 1/2 say they have tried in the past 12 mos

Question 48

Tobacco use status is considered

Answer 48

a Vital Sign, along with temp, pulse, respiratory rate, and blood pressure

Question 49

Extraoral exam for tobacco using pt

Answer 49

Observe breath/body odor fingers-yellowish/brownish tint to fingernails skin more wrinkling lips-looking for lesions

Question 50

Why might pts who use tobacco may require longer and more frequent appointments, than nonusers

Answer 50

due to dental stains, calculus, caries, and perio problems

Question 51

The 5 As

Answer 51

``` Ask Advise Assess Assist Arrange ```

Question 52

Brief advice to pts

Answer 52

significantly increases long term abstinence rates.

Question 53

If the patient is not ready to quit tobacco

Answer 53

Use the 5 Rs

Question 54

The 5 Rs

Answer 54

``` Relevance Risks Rewards Roadblocks Repetition ```

Question 55

What is a preferred quitting date for tobacco users

Answer 55

within 2 weeks

Question 56

First report of a surgeon general that focused on oral health

Answer 56

Surgeons General's Report on Oral Health