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BDS3 PMHP > Smoking Cessation 1 > Flashcards

Smoking Cessation 1 Flashcards

1
Q

What % of the UK population smoke?

A

14.1%

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2
Q

What % of the Scottish population smoke?

A

19%

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3
Q

Does deprivation have an influence on the % of smokers?

A

Yes - 27% SIMD 1 vs 9% SIMD 5

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4
Q

How is the access to and supply of tobacco controlled in Scotland? (4)

A
  • Age of purchase: 16 to 18
  • Plain packaging of tobacco
  • Sale of tobacco not visible
  • Vending machines (gone)
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5
Q

When does Scotland aim to be tobacco free by?

A

2034

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6
Q

Tobacco has a profound effect on the mouth. What does it have links with? (4)

A
  • Links with oral cancer, perio and implants, poor healing after dental surgery
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7
Q

What is the brief intervention that we as dentists can do for tobacco cessation?

A
  • Aim to trigger a quit attempt
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8
Q

What are the 2 different models we can use for tobacco use cessation?

A
  • 5 A’s

- 3 A’s

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9
Q

What are the 3 categories we can split advice on quitting into?

A
  • Very brief advice (1 min)
  • Brief advice (3-10 mins) - can include 5A’s
  • Detailed advice (up to 30 mins), with multiple sessions - usually not time in dentistry
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10
Q

When might the 3 A’s be used for advice on quitting?

A

When giving very brief advice

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11
Q

A dentist can offer very brief advice using the 3 A’s. What are these?

A
  1. ASK - establish and record smoking status
  2. ADVISE - on personal benefits of quitting in light of findings in the mouth
  3. ACT - offer help and signpost to local stop smoking services
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12
Q

What is the first A of the 3 A’s?

A

ASK - establish and record smoking status

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13
Q

What is the second A of the 3 A’s?

A

ADVISE - on personal benefits of quitting in light of findings in the mouth

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14
Q

What is the third A of the 3 A’s?

A

ACT - offer help and signpost to local stop smoking services

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15
Q

What kind of advice is the 5 A’s used for?

A
  • Brief advice on smoking cessation (1-3 mins)
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16
Q

What are the 5 A’s?

A 
ASK your patient 
ADVISE your patient
ASSESS your patient 
ASSIST your patient 
ARRANGE FOLLOW-UP for your patient
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17
Q

The first A = ask, what would you ask about? (6)

A
  • current, ex-, non
  • Once a year, updated in notes
  • No of cigarettes per day
  • No of years a smoker
  • Age when started smoking
  • What products used (cigs, cigars, rollups, smokeless)
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18
Q

What does 1 pack year equal?

A

1 pack (20) cigarettes a day for a year

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19
Q

IF a patient has 10 cigarettes a day for 10 years, how many pack years is that?

A
  • 5 pack years
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20
Q

When asking the patient about their smoking habits we ask them about their quitting history. What would we include in this? (6)

A
  • Have you tried before?
  • How many attempts?
  • What helped you?
  • Are you interested now?
  • Would you be interested in getting further help and support?
  • If interested, proceed with advice and referral
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21
Q

What is an advantage of the pharmacy service for smoking cessation?

A
  • Patients have greater reach/accessibility
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22
Q

What is an advantage of the specialist services for smoking cessation?

A
  • They have more experience in that area and have greater success
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23
Q

What is the national branding for smoking cessation advice and referrals?

A
  • Quit your way
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24
Q

How would you refer a patient from the dental hospital electronically for smoking cessation services? (5)

A
  • NHS patients in GDH, for clinicians
  • Trakcare
  • New request (same as radiology)
  • Other
  • Smoking cessation services
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25
Q

What are oral side effects of tobacco? (4)

A
  • Smoking causes many oral diseases including oral cancer (Smokers 2-4 times the risk of non-smokers(, potentially malignant lesions
  • Smoking is a modifiable risk factor for periodontal disease (relative risk for smokers 2-6 times that of non-smokers)
  • Smoking increases dental treatment risks and problems (implants/extractions)
  • Smokers have significantly greater medical risks, compromised health and more days of illness
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26
Q

What are 2 main determinants of oral cancer?

A

Alcohol and tobacco - if both are present risk is synergistic

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27
Q

A diet high in what is thought to be protective against oral cancer?

A

A diet high in ACE vitamins

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28
Q

What are some causes of oral cancer? (5)

A
  • Alcohol
  • Smoking
  • Sunlight
  • Pre-existing mucosal abnormalities
  • HPV, younger age groups
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29
Q

What is Leukoplakia defined as?

A
  • A white patch that cannot be rubbed off’
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30
Q

How much more frequently is Leukoplakia likely to occur in a patient who smokes?

A

6x more likely

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31
Q

There is a strong relationship between smoking and development of Leukoplakia in the floor of the mouth. Why is this?

A
  • That’s to do with the fact that when you smoke and what’s in tobacco pools in the bottom of the mouth. And so the area of your mouth is subject to many more of the toxins
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32
Q

What is Erythroplakia?

A
  • Patient has a long history of chronic white and red lesions of the soft palate more likely for malignant transformation that white patches
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33
Q

In relation to periodontal disease what is smoking associated with an increase of?

A
  • Associated with increased rates of alveolar bone loss, attachment loss and pocket formation
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34
Q

What % of chronic periodontitis is attributable to smoking?

A

40%

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35
Q

Smoking demonstrates a dose response with periodontal disease. What does this mean?

A
  • The more you smoke the more likely there is to be periodontal damage
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36
Q

What does smoking have a masking effect on in relation to periodontal disease?

A
  • Has a masking effect on gingival symptoms of inflammation (bleed less) - however when they quit smoking this can rebound
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37
Q

IS prevalence/ severity of periodontal disease in former smokers more or less recurrent that current smokers?

A
  • Less
38
Q

Is treatment for periodontal disease more likely to succeed in patients who are non-smokers compared to smokers?

A
  • Yes
39
Q

What is the failure rate of implants like in smokers compared to non-smokers?

A
  • Failure rate in smokers is at least 2x that in non-smokers

- Implants more likely to fail in the maxilla

40
Q

IS there any evidence that quitting smoking prior to implantation of implants can improve the success of the implants?

A
  • Yes
41
Q

Give examples of other tobacco related lesions? (4)

A
  • Staining of teeth, dental restorations and dentures, halitosis
  • Nicotinic stomatitis (smokers palate)
  • Smokers melanosis (pigmentation)
  • Black hairy tongue (where the nicotine stains the papilla on the tongue)
42
Q

What is halitosis?

A

Bad breath

43
Q

What oral lesion tends to be less common in smokers?

A
  • Aphthae

- However recurrent oral aphthae can have an effect on the patient when they quit

44
Q

What takes longer to heal in smokers (oral related)?

A
  • Extractions
45
Q

Why do people smoke (reasons)? (7)

A
  • Enjoyment
  • Keep weight down
  • Help concentrate
  • Relieve boredom
  • Socialise
  • Cope with stress
  • And to avoid discomfort, and manage withdrawal symptoms
46
Q

What will affect the severity of the withdrawal symptoms a person who quits smoking will get?

A
  • How long and how many you smoke will affect the severity
47
Q

What is the main withdrawal symptom do people who quit smoking get?

A
  • Nicotine cravings
48
Q

Give examples of common withdrawal symptoms a patient might get if they quit smoking? (13)

A
  • Nicotine cravings
  • Sweating
  • Nausea/abdominal cramps
  • Headaches
  • Coughing
  • Sore throat
  • Insomnia
  • Difficulty concentrating
  • Anxiety
  • Irritability
  • Depression
  • Weight gain
  • Tingling in hands/feet
  • It is all quite individual on what side effects the person will experience
49
Q

What is nicotine dependence?

A
  • It is a chronic relapsing disease defined as a compulsive craving to use the drug despite harmful consequences (be they social or health)
  • Exhibits tolerance
50
Q

What is the addictive element in tobacco and ecigs?

A

Nicotine

51
Q

IS nicotine the element that causes cancer and all the potential health problems?

A
  • No
52
Q

What is the most lethal form of smokeless tobacco?

A

Tumbac

53
Q

The health risks of smokeless tobacco can vary but how many times (x) the tobacco specific nitrosamines does smokeless tobacco have than cigarettes?

A
  • Can have 100 times the TSNA
54
Q

What is Snus?

A
  • IT is a moist powder tobacco
55
Q

Is Snus more or less lethal than tobacco?

A
  • Less
56
Q

How is Snus taken?

A
  • Placed under the lip, can cause recession (particularly around the upper central incisor region)
57
Q

What is Skoal Bandits?

A
  • Dipping tobacco, moist
58
Q

How is Skoal Bandits taken?

A
  • This is like a teabag

- Can also be put in the buccal sulcus of first molars or central incisors

59
Q

Are Snus and Skoal Bandits legal to sell in the UK?

A

No

60
Q

What is another name for Shisha?

A
  • Hookah
61
Q

How do we operate a Shisha?

A
  • Operates by water filtration and direct heat

- Scented tobacco is crumbled into the bowl

62
Q

Compared to a single cigarette, what is the CO and nicotine exposure in 45 min of water pipe?

A
  • 45 Mins of water pipe uses approx double CO and triples nicotine exposure (equivalent to 10 cigarettes)
63
Q

Is a Shisha a safe alternative to tobacco?

A
  • NO
64
Q

Smoking Shishas poses many health risks, what are they? (4)

A
  • TB airborne transmission
  • Hepatitis A
  • Helicobacter Pylori
  • Pulmonary aspergillosis (pipe sharing)
65
Q

Give examples of forms of pharmacotherapy for smoking cessation? (3)

A
  • Nicotine replacement therapy (main one)
  • Varenicline (Champix)
  • Bupropion (Zyban)
  • E-cigarettes
66
Q

Give examples of types of nicotine replacement therapy? (7)

A
  • Patches
  • Gum
  • Inhalers
  • Nasal spray
  • Lozenges
  • Microtabs
  • Oral strips/sprays
67
Q

Nicotine replacement therapy increases the likelihood of successful quit attempts. By how much does it increase the likelihood?

A
  • All forms of NRT increase success of quitting by 50%-70%
  • No difference between types of NRT
  • No benefit after 8 weeks (meant to be a short term therapy)
68
Q

What are possible side effects of nicotine replacement therapy? (3)

A
  • Skin irritation (patch)
  • Oral irritation gum/tabs
  • No evidence that NRT increases heart attacks
69
Q

Compared to willpower alone , how much does using Varenicline (Champix) increase your chances of quitting?

A
  • 2-3x
70
Q

Are the quit rates better when a person uses Champix or Zyban?

A

Champix

71
Q

With Verenicline how much more likely is there to be adverse effects compared to Zyban?

A
  • 25% increased chance of serious adverse effect
  • Lower dose, lower risk of adverse effects
  • Most reported side effect is nausea, mostly mild which wears off
72
Q

Are e-cigarettes to be used by non-smokers?

A
  • No they are not for non-smokers
73
Q

Who are the main users of e-cigarettes?

A
  • Ex-current smoker, users
74
Q

Under what age are e-cigarettes banned?

A
  • Under the age of 18
75
Q

Are e-cigarettes safer then cigarettes?

A
  • Ecigs safer than cigarettes but safety in longer term not known
76
Q

What is Vaping?

A
  • Vaping is the act of inhaling and exhaling the water vapour produces by an electronic device
77
Q

What is the smoke in E-cigarettes like? (3)

A
  • E-liquid in gaseous form
  • Looks like thick smoke but dissipates more quickly
  • Smells better
78
Q

What is in the liquid in e-cigarettes? (4)

A
  • Propylene glycol
  • Vegetable glycerine
  • Natural/artificial flavourings
  • Nicotine
79
Q

What does the propylene glycol in e-cigarette liquid do?

A
  • Thinner, more flavour, throat hit
80
Q

What does the vegetable glycerine in e-cigarette liquid do?

A
  • Thicker, big clouds, smooth
81
Q

What are the different nicotine levels in in e-cigarette liquids?

A

0%, 1.5%, 0.15%, 3, 6, 12, 18 mg/ml

82
Q

How many mg/ml of nicotine would a heavy smoker have in an e-cigarette?

A

12-18mg/ml

83
Q

How many mg/ml of nicotine would a light smoker have in an e-cigarette?

A
  • No higher than 6mg/ml
84
Q

What is second hand smoke?

A
  • Term for smoke that non-smokers are exposed to
85
Q

Most smoke is mainstream smoke. What is this?

A
  • This is the smoke that smokers inhale then exhale
86
Q

What is sidestream smoke?

A
  • Wafts off the end of a lit cigarette (goes to the people who aren’t smoking)
87
Q

What % of smoke in a room is sidestream smoke?

A

85% of smoke in room is sidestream smoke and contains more carcinogens

88
Q

What is third hand smoke?

A
  • This is carcinogen laden residue that builds up on surfaces
89
Q

What would you ask when assessing heaviness of smoking index? (2)

A
  • How many cigs/day?
  • How quickly light up? (we want to know that if you light up very quickly after you wake up, you’re more addicted than someone who has the first cigarette at a lunchtime)
90
Q

What would you ask when asking about a quitting history? (5)

A
  • Have you tried before?
  • How many attempts?
  • What helped you?
  • Are you interested now?
  • What’s motivating you now?

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