Prevention and Anti Guidance II

Question 1

When to transition care

Answer 1

• Have a clear policy and give patients information with enough time to find a general dentist for care
• Consider different time frame for patients with special health care needs

Question 2

Adolescents and confidentiality

Answer 2

• Each state varies relative to what age an adolescent can make their own decisions and when parents can or should be told about behaviors.
• The healthcare professional may screen the adolescent for high-risk behaviors such as alcohol or drug use, sexual behavior, violence, and mental health issues but it is unclear what should be disclosed to parents.

Question 3

The substance most commonly used by teens

Answer 3

Alcohol

Question 4

Dental findings from substance abuse

Answer 4

• Excessive tooth decay
• Malnourished appearance
• Unreliability in keeping appointments
• Excessive tooth wear from grinding/clenching
• Xerostomia
• Hypersensitive teeth

Question 5

Top drugs used by teens

Answer 5

• Marijuana – delta-9-tetrahydrocannabinol
• Prescription opioids - oxycodone, oxycontin
• Prescription sedatives - tranquilizers
• Prescription stimulants - amphetamines
• Alcohol
• Synthetic, psychoactive - Ecstasy
• Inhalants - household items

Question 6

Signs of substance abuse

Answer 6

• Changes in behavior: rebelling, irresponsible, changing friends, problems in school
• Emotional or mental changes: irritable, poor concentration, depression
• Physical changes: fatigue, slurred speech, bloodshot eyes, lack of coordination

Question 7

Substance abuse definition

Answer 7

A maladaptive pattern of substance use manifested by recurrent and significant adverse consequences related to the repeated use of substances.

Question 8

E-cigarette ingredients

Answer 8

• Nicotine
• Ultra fine particles that get inhaled deep into lungs
• Diacetyl – a flagrant linked to serious lung disease
• Volatile organic compounds – formaldehyde, benzene, Isoprene, acetaldehyde, toluene
• Heavy metals – nickel, tin, lead, cadmium

Question 9

Juul device (“pod mod”)

Answer 9

• Charged through USB port; looks like a thumb drive
• Small
• Uses nicotine salts (less harsh)
• Increased use in middle schools – “Juuling”
• 0.7mL nicotine per pod = 1 pack of cigarettes/200 puffs

Question 10

Lethal dose of nicotine

Answer 10

• Children is 10mg

- Adult is 30-60mg

Question 11

E-cigarettes

Answer 11

• 5mL vial contains 100mg of nicotine

- Most e-cigarettes have a battery, a heating element and a place to hold liquid

Question 12

FDA tobacco rule

Answer 12

• Requires health warnings
• Regulates manufacturing, distribution and marketing of tobacco products
• Restricts youth access – requires photo I.D. (can’t be sold in vending machines unless adult-only facility)

Question 13

Smoking cessation medications

Answer 13

• Nicotine replacement therapies: nicotine gum, transdermal patch, nasal spray, inhalers, lozenges
• Bupropion (Xyban) and Varenicline tartrate (Chantix) – non-nicotine medications
  
  • Target nicotine receptors in the brain

Question 14

Cigarettes

Answer 14

• Accounts for 1/3 of all cancers and 90% of lung cancers
• Second hand smoke causes respiratory tract infections in 150,000-300,000 children under 1.5 years every year
• Parental smoking has led to sudden infant death for more than 100,000 over the past 50 years
• Destructive periodontal effects are dose dependent

Question 15

Percentage of smokers started by age 18

Answer 15

90%

Question 16

Five A’s

Answer 16

Ask, advise, assess, assist, arrange to counsel regarding cessation of tobacco products

Question 17

Tobacco products

Answer 17

• Cigarettes, pipes, cigars
• Bidis - hand rolled small thinkcigarettes
• Kreteks - clove cigarettes
• Hookas - water pipes
• Herbal cigarettes
• Smokeless tobacco - dip, snus, lozenges, nicotine water
• E-cigarettes