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BDS3 PMHP > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

How long is very brief advice

A

1 min

3As

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2
Q

How long is brief advice

A

3-10 mins

can include 5As

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3
Q

How long is detailed advice

A

up to 30 min with multiple sessions but not time for this in dentistry

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4
Q

What are the 3 As

A

Ask
Advise
Act

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5
Q

What do we ask about in the 3As

A

if they smoke - establish and record smoking status

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6
Q

What do we advise on in the 3As

A

advice them on smoking

personal benefits of quitting in light findings in the mouth

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7
Q

What do we act on in the 3As

A

offering individualised help and referral to stop smoking services if appropriate

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8
Q

What are the 5 As

A 
Ask
Advise
Assess
Assist
Arrange follow up
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9
Q

What do we ask about in 5As

A 
smoking status
ask once a year and update in notes
ask how many cigarettes a day and how many years a smoker
what was the age when started smoking
what products are used
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10
Q

How many cigarettes is a pack year

A

1 pack (20) a day for a year

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11
Q

What is the quitting history

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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12
Q

How do we act in the 5As

A

depends on what is availably locally re specialist services

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13
Q

What are the specialist/pharmacy services

A 
pharmacy have greater reach and accessibility 
specialist services have greater success
what does the px one?
refer 
note the outcome in px records
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14
Q

What are the oral side effects of tobacco

A

oral cancer risk 2-4 times the risk of non smokers

modifiable risk factor for periodontal disease (2-6 times risk of non smokers)

increases dental tx risks and problems (implant and extractions)

smokers have significantly greater medical risks, compromised health and more days of illness

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15
Q

What is the aetiology of oral cancer

A

tobacco and alcohol are main determinants & if both are present then risks are synergistic

a diet high in ACE vitamins is thought to be protective

sunlight (lip cancer)

pre-existing mucosal abnormalities

HPV, younger age groups

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16
Q

What is leukoplakia

A

defined as white patch that cannot be rubbed off

occurs 6x more in frequent smokers

strong relationship between smoking and development of LK in floor of mouth

malignant transformation rate varies

stopping smoking may result in disappearance

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17
Q

What is erythroplakia

A

px has long history of chronic white and red lesions of soft palate more likely for malignant transformation than white patches

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18
Q

What is smoking associated with in regards to periodontal disease

A

increased rate of alveolar bone loss, attachment loss and pocket formation

demonstrates a dose response with periodontal disease

has masking effect on gingival symptoms of inflammation (less bleeding)

Prevalence/severity of periodontal disease in former smokers is less than current smokers

treatment is more likely to succeed in non smokers

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19
Q

What is the issue with smoking in relation to implants

A

failure rate of implants is at least 2x than in smokers

implants more likely to fail in the maxilla

evidence that quitting prior to implantation can improve success

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20
Q

What are other tobacco related oral lesions

A

staining of teeth, dental restorations and dentures, halitosis

nicotinic stomatitis (smokers palate)

smokers melanosis (pigmentation)

black hairy tongue

aphthae tend to be less common in smokers

extractions take longer to heal

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21
Q

Why do people continue to smoke?

A 
enjoyment
keep weight off
help concentrate
receive boredom
socialise 
cope with stress
avoid discomfort and manage withdrawal symptoms
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22
Q

What do withdrawal symptoms depend on

A

how long and many you smoked

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23
Q

What are the withdrawal symptoms

A 
nicotine cravings
sweating
nausea/abdominal cramps
headaches
coughing
sore throat
insomnia
difficulty concentrating
anxiety
depression
weight gain
tingling in hands and feet
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24
Q

What is nicotine dependence

A

chronic relapsing disease defined as a compulsive craving to use the drug despite harmful consequences

exhibits tolerance - if you are a smoker you require more to get the same hit as a non smoker

25
Q

What is the addictive element in tobacco and ecigs

A

nicotine

nicotine is not what is responsible for the harmful effect

26
Q

What is smokeless tobacco

A

health risks of it vary

snus and skoal bandits is banned in uk but not illegal to possess

27
Q

What is snus

A

moist powder tobacco that is placed under upper lip

can cause recession

28
Q

What is skoal bandits

A

dipping tobacco, moist

29
Q

What is shisha

A

hookah operates by water filtration and direct heat

scented tobacco is crumbled into the bowl

30
Q

Compared to a single cigatrette, what is 45 min shish use equivalent to

A

doubles Co and triples nicotine exposure (equiv to 10 cigs)

31
Q

What are the health risks of hookah

A

TB airborne trasmisison
hep A
h. pylori
pulmonary aspergillosis

32
Q

What are examples of nicotine replacement therapy

A 
patches
gum
inhalers
nasal spray
lozenges
microtabs
oral strips

varenicline (champix)
bupropion (zyban)

33
Q

What is the benefit of NRT

A

increases likelihood of successful quit attempt

34
Q

What are side effects of NRT

A

skin irritation from patch

oral irritation from gum/tabs

35
Q

What are side effects of varenciline

A

25% increased chance of serious adverse effect
lower dose, lower risk of adverse effects
most reported side effect is nausea which is mostly mild and wears off

36
Q

What is vaping

A

act of inhaling and exhaling water vapor produced by an electronic device
e liquid in gas form
looks like thick smoke but dissipates more quickly and smells better

37
Q

What is the liquid in e liquid

A

propylene glycol
vegetable glycerine
natural artificial flavourings
nicotine level

38
Q

What is the % of nicotine for a heavy smoker in e cig

A

12-18mg/ml

39
Q

What is the % of nicotine for a light smoker in e cig

A

6mg/ml

40
Q

What is second hand smoke

A

smoke that non smokers are exposed to

mainstream/sidestream/third hand

41
Q

What is mainstream smoke

A

the smoke smokers inhale then exhale

42
Q

What is side stream smoke

A

the smoke that wafts off the end of a lit cigarette

85% of smoke in a room is this and contains more carcinogens

43
Q

What is third hand smoke

A

has carcinogen residue that builds up at surfaces

44
Q

What does heaviness of smoking index look at

A

how many cigs a day

how quickly in the day do u light up

45
Q

What are ecigs composed of

A

have a mouthpiece, battery, cartridge, atomizer or cartomiser
current passes through a resistance coil that is in contact with a fluid and the heat generates an aerosol, the vapor

46
Q

What is the max strength of liquid nicotine

A

20mg/ml

47
Q

Why do people use ecigs

A 
aid to quitting
less toxic alternative
cheaper alternative
harm reduction/reduce smoking
alternative to cigs when cigs are banned
hand to mouth habit maintained
psychological aspect of addiction maintained 
recreation and socialisation
vaping community
48
Q

What are pros to e cigs

A

public health costs of smoking are vast

consideration must be given to harm reduction argument bc tobacco is so lethal

49
Q

What are cons to e cigs

A

is it renormalisation of smoking

is it a gateway or pathway to smoking

50
Q

What is NICE info on e cigs

A

encourage those who can’t quit to cut down
good communication about safety of nicotine
e cigs are useful to quit smoking. people using e cigs should stop smoking completely

51
Q

What is NHS info on e cigs

A

more cautious advice in favor of e cigs

outlines them as a route to quiting

not risk free

52
Q

What are oral side effects of e cigs

A 
largely unknown 
mouth and throat dryness
oral cancer?
periodontal disease?
benign mucosal lesions?
lichenoid eruptions

risk of soft tissue damage

53
Q

What is advise for smokers who want to quit

A

ask advise refer

ask advise assist

54
Q

What is advise for co users

A

encouragement that they are reducing their exposure to tobacco by using e cigs
while it is likely they are safer, evidence base is still developing particularly to oral health

55
Q

What is advice for e cig users (ex smoker)

A

strong encouragement that they have quit tobacco

evidence base still developing with regards to e cig

56
Q

What is the triangle of addiction

A

chemical addiction
emotional attachment
habit

57
Q

What is tar

A

What is the % of nicotine for a heavy smoker in e cig

58
Q

What are the benefits of quitting smoking

A

Co returns to normal within 48hrs
nicotine leaves body within 72 hrs
breathing improves between 2 weeks and 3 months

BDS3 PMHP (10 decks)

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