Smoking Cessation Flashcards
smoking prevalence in adults
UK population
- 14.1%
Scotland
- 19% , roughly split sexes
Influence of deprivation
- 27% SIMD 1 v 9% SIMD 5
smoking prevalence in young people
Smoking rates for 13- and 15-year olds in Scotland currently very low.
Only 2% of 13-year olds and 7% of 15 year olds were regular smokers (< 1 cig/week)
- Different regular smoker definition in children
97% of 13-year olds and 88% of 15 year olds were non smokers
BUT 17% of children under 16 in Scotland report exposure to smoke in the home
tobacco control Scotland
Scotland very active
- Legislative and fiscal measures
Access to and supply of tobacco
- Age of purchase: 16 to 18
- Plain packaging of tobacco
- Sale of tobacco not visible
- Vending machines
Scotland aims to be tobacco free by 2034
- Chance if current trajectory continues
access to and supply of tobacco in Scotland controls
- Age of purchase: 16 to 18
- Plain packaging of tobacco
- Sale of tobacco not visible
- Vending machines not anymore
dental role in smoking cessation
Tobacco has a profound effect on the mouth.
- Links with oral cancer, perio, implants
3 levels of advice on quitting smoking
Very brief advice (VBA)
- 1 min - opportunistic
Brief advice
- 3-10 min – engage at a slightly higher level
- can include 5As
Detailed advice,
- up to 30 min
- with multiple sessions - -usually not time in dentistry
3As PHE
- ASK:
establish and record smoking status - ADVISE on personal benefits of quitting in light of findings in the mouth
- ACT:
offer help and signpost to local stop smoking service
Smokefree and smiling helping dental patients to quit tobacco
5As brief
ASK your patient
ADVISE your patient
ASSESS your patient
ASSIST your patient
ARRANGE FOLLOW-UP for your patient
3As Scotland Dental (VBA)
Ask your patient about smoking
Advise your patient about smoking
Act by offering individualised help and referral to stop smoking services if appropriate.
what to ASK
ASK about smoking status ( current, ex-, non)
- Once a year, updated in notes
- No of Cigs smoked per day
- No of years a smoker
- Age when started smoking
- What products used ( cigs, cigars, rollups, smokeless)
Measurement of Lifetime exposure/ PACK YEARS
- 1 pack (20) a day = 1 pack year
- 10 cigarettes a day for 10 years = 5 pack years
Quitting history can be quite cyclical – find out where they are
what to ask about Quitting history
- 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
can be quite cyclical – find out where they are
how to work out pack years/measurement of lifetime exposure
need to know
- No of Cigs smoked per day
- No of years a smoker
1 pack (20) a day = 1 pack year 10 cigarettes a day for 10 years = 5 pack years
how to ACT (refer)
Depends on what is available locally re specialist services
- Quit your Way is the national branding
Pharmacy have greater reach, accessibility
Specialist services have greater success
- More experience
CONSIDER - What patient wants - Help/advice given, - Referral Note outcome in patient’s record (important)
Refer Electronically - NHS patients in GDH, for clinicians Trakcare New request ( same as radiology) Other Smoking cessation services
No data yet about no of referrals/successful quits etc
oral side effects of tobacco (4 key)
Smoking causes many oral diseases including oral cancer, potentially malignant lesions
- smokers 2-4 times the risk of non-smokers
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.
epidemiology and oral cancer
In the UK, in 2015-2017, there were 12,238 new cases of head and neck cancer
In Scotland, in 2016, there were 1,240 new cases
More men than women, though the ratio is decreasing
Links with deprivation
risk depends on age, genetics and exposure to risk factors
oral cancer aetiology
Tobacco and alcohol are main determinants
- if both are present, risks are synergistic.
a diet high in ACE vitamins thought to be protective.
sunlight
pre-existing mucosal abnormalities
HPV, younger age groups
potentially malignant lesions
Leukoplakia ‘defined as a white patch that cannot be rubbed off’
- Leukoplakia can occur 6x more frequently in smokers
Strong relationship between smoking and development of LK in floor of mouth
- Tobacco pools in bottom of mouth – thus more exposed
Malignant transformation rate varies (0.6-30%)
- Stop smoking may result in disappearance.
leukoplakia
‘defined as a white patch that cannot be rubbed off’
- Leukoplakia can occur 6x more frequently in smokers
leukoplakia and smoking
Strong relationship between smoking and development of LK in floor of mouth
- Tobacco pools in bottom of mouth – thus more exposed
erythroplakia
Patient has long history of chronic white and red lesions of soft palate
more likely for malignant transformation than white patches
- less common but more likely to be malignant
smoking and periodontal disease
Smoking associated with increased rates of alveolar bone loss, attachment loss and pocket formation
40% of chronic periodontitis is attributable to smoking
Smoking demonstrates a dose-response with PDD, as shown by pack-years (1pack/day for a year = 1 pack year)
Has a masking effect on gingival symptoms of inflammation (bleed less)
Prevalence /severity of PDD in former smokers is less than current smokers
Treatment for PDD is more likely to succeed in non-smokers
tobacco use and dental implants success
Failure rate of implants in smokers is at least 2x that in non-smokers
Implants more likely to fail in maxilla – not evenly distributed between maxilla and mandible
There is evidence that quitting, prior to implantation can improve success
smoking effect on gingival symptoms
masking effect (e.g. on bleeding)
