Smoking Cessation Flashcards
How long is very brief advice
1 min
3As
How long is brief advice
3-10 mins
can include 5As
How long is detailed advice
up to 30 min with multiple sessions but not time for this in dentistry
What are the 3 As
Ask
Advise
Act
What do we ask about in the 3As
if they smoke - establish and record smoking status
What do we advise on in the 3As
advice them on smoking
personal benefits of quitting in light findings in the mouth
What do we act on in the 3As
offering individualised help and referral to stop smoking services if appropriate
What are the 5 As
Ask Advise Assess Assist Arrange follow up
What do we ask about in 5As
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
How many cigarettes is a pack year
1 pack (20) a day for a year
What is the 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
How do we act in the 5As
depends on what is availably locally re specialist services
What are the specialist/pharmacy services
pharmacy have greater reach and accessibility specialist services have greater success what does the px one? refer note the outcome in px records
What are the oral side effects of tobacco
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
What is the aetiology of oral cancer
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
What is leukoplakia
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
What is erythroplakia
px has long history of chronic white and red lesions of soft palate more likely for malignant transformation than white patches
What is smoking associated with in regards to periodontal disease
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
What is the issue with smoking in relation to implants
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
What are other tobacco related oral lesions
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
Why do people continue to smoke?
enjoyment keep weight off help concentrate receive boredom socialise cope with stress avoid discomfort and manage withdrawal symptoms
What do withdrawal symptoms depend on
how long and many you smoked
What are the withdrawal symptoms
nicotine cravings sweating nausea/abdominal cramps headaches coughing sore throat insomnia difficulty concentrating anxiety depression weight gain tingling in hands and feet
What is nicotine dependence
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
What is the addictive element in tobacco and ecigs
nicotine
nicotine is not what is responsible for the harmful effect
What is smokeless tobacco
health risks of it vary
snus and skoal bandits is banned in uk but not illegal to possess
What is snus
moist powder tobacco that is placed under upper lip
can cause recession
What is skoal bandits
dipping tobacco, moist
What is shisha
hookah operates by water filtration and direct heat
scented tobacco is crumbled into the bowl
Compared to a single cigatrette, what is 45 min shish use equivalent to
doubles Co and triples nicotine exposure (equiv to 10 cigs)
What are the health risks of hookah
TB airborne trasmisison
hep A
h. pylori
pulmonary aspergillosis
What are examples of nicotine replacement therapy
patches gum inhalers nasal spray lozenges microtabs oral strips
varenicline (champix)
bupropion (zyban)
What is the benefit of NRT
increases likelihood of successful quit attempt
What are side effects of NRT
skin irritation from patch
oral irritation from gum/tabs
What are side effects of varenciline
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
What is vaping
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
What is the liquid in e liquid
propylene glycol
vegetable glycerine
natural artificial flavourings
nicotine level
What is the % of nicotine for a heavy smoker in e cig
12-18mg/ml
What is the % of nicotine for a light smoker in e cig
6mg/ml
What is second hand smoke
smoke that non smokers are exposed to
mainstream/sidestream/third hand
What is mainstream smoke
the smoke smokers inhale then exhale
What is side stream smoke
the smoke that wafts off the end of a lit cigarette
85% of smoke in a room is this and contains more carcinogens
What is third hand smoke
has carcinogen residue that builds up at surfaces
What does heaviness of smoking index look at
how many cigs a day
how quickly in the day do u light up
What are ecigs composed of
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
What is the max strength of liquid nicotine
20mg/ml
Why do people use ecigs
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
What are pros to e cigs
public health costs of smoking are vast
consideration must be given to harm reduction argument bc tobacco is so lethal
What are cons to e cigs
is it renormalisation of smoking
is it a gateway or pathway to smoking
What is NICE info on e cigs
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
What is NHS info on e cigs
more cautious advice in favor of e cigs
outlines them as a route to quiting
not risk free
What are oral side effects of e cigs
largely unknown mouth and throat dryness oral cancer? periodontal disease? benign mucosal lesions? lichenoid eruptions
risk of soft tissue damage
What is advise for smokers who want to quit
ask advise refer
ask advise assist
What is advise for co users
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
What is advice for e cig users (ex smoker)
strong encouragement that they have quit tobacco
evidence base still developing with regards to e cig
What is the triangle of addiction
chemical addiction
emotional attachment
habit
What is tar
What is the % of nicotine for a heavy smoker in e cig
What are the benefits of quitting smoking
Co returns to normal within 48hrs
nicotine leaves body within 72 hrs
breathing improves between 2 weeks and 3 months
