Clinic Theory Ii Smoking Cessation

Front 1

In 2010 what were the 10 leading causes of death?

Back 1

1) Heart Diseases 2) Malignant Neoplasms (cancer)
3) Chronic Lower Respiratory diseases 4) Stroke
5) Accidents 6) Alzheimer's Disease
7) Diabetes 8) Kidney Disease
9) Influenza/Pneumonia 10) Suicide

Front 2

What is the leading cause of pre-mature death in the US?

Back 2

Smoking!

Front 3

On average _____% of adults 18 & older in the US smoke.

Back 3

20%

Front 4

Use of tobacco influences _______ system of the body.

Back 4

Every system

Front 5

Tobacco is responsible for _____% of all lung cancer!

Back 5

87%

Front 6

The nicotine in cigarettes has _________ organic compounds & ________ carcinogens

Back 6

4000 organic compounds & 43 carcinogens

Front 7

How much more nicotine is in smokeless tobacco than in cigarettes?

Back 7

3-4 times the amount of nicotine.

*Smokeless tobacco also has sugar and 28 carcinogens.*

Front 8

How many more times are smokers likely to exhibit periodontal destruction than non-smokers?

Back 8

2.6->6 times more likely.

Front 9

In smokers, is sub or supra G calc seen at a higher load?

Back 9

Supra G Calc is increased.

*Remember smoking is associated with significantly greater levels of inflammatory cytokines (IL-1) in crevicular fluid…this adds to the breakdown of tissue.*

Front 10

Smoking is a major risk factor for periodontitis and responsible for ____% of periodontal cases in the US!

Back 10

50%

Front 11

How is the healing response after flap surgery for a smoker?

Back 11

Less favorable healing if a smoker.

*Improvement is 50-75% if a non smoker.*

Front 12

How much does implant failure increase for a smoker?

Back 12

2-fold.
*And there is a higher risk for peri-implantitis!*

Front 13

Did you know that non-smokers have a 95% success rate with implants but smokers only have a ___% success rate?

Back 13

89%

Front 14

What is the most common place for Oral & Pharyngeal cancer?

Back 14

Base of the tongue along with the lingual & palatine tonsils.

**HPV is now the #1 risk factor for oral/mucosal cancers. Smoking is now #2**

Front 15

What is now the #1 risk factor for oral/pharyngeal cancer?

Back 15

HPV
**Smoking is #2**

Front 16

Why are pipe & cigar smokers ar a higher risk for oral cancer than cigarette smokers?

Back 16

The hot smoke is kept in the mouth longer.

Front 17

Alcohol & tobacco are the #2 known risk factor (controllable) for oral cancer.
Where in the mouth does the cancer tend to show up?

Back 17

Anterior portion of the tongue, lateral borders, floor of the mouth and the palate.

Front 18

For users of smokeless tobacco how to lesions usually appear?

Back 18

As white mucosal lesions in 50% of users.

Front 19

Why is there an increased caries risk for smokeless tobacco?

Back 19

Because sugar is added and stays on the teeth.

Front 20

What is another name for Secondary smoke?

Back 20

Environmental Tobacco Smoke

Front 21

2nd hand smoke can cause the ______ type of illnesses as 1st hand smoke.

Back 21

Same--> some toxins are actually higher in second hand smoke than 1st.

Front 22

True or False: Environmental Tobacco smoke is passed in breast milk.

Back 22

True

*There are also increased rates of asthma & inner ear infections in children.*

Front 23

On average how many times will a smoker try to quit in a lifetime?

Back 23

6-9 times

Front 24

What is the Dental code for Tobacco Counseling (most insurance won't pay)?

Back 24

D1320

Front 25

What are 3 reasons people smoke?

Back 25

1) Chemical Addiction
2) Habit
3) Psychological reasons

Front 26

What are 4 reason's people should quit smoking?

Back 26

1) General Health
2) Effect on family-->role model
3) Cost $$
4) Social Restrictions (Can't go certain places if you're smoking)

Front 27

How quickly is nicotine metabolized?

Back 27

in 30 minutes
(withdrawal is greatest in the morning)

Front 28

While low doses of nicotine stimulate the brain high does of nicotine stimulates the production of __________.

Back 28

Dopamine--> the feeling of pleasure.

*Tolerance is developed which then stimulates the desire for more.*

Front 29

___________ has a higher addiction than alcohol, cocaine & heroine.

Back 29

Smoking!
*Relapse rate is 1 year, the same as heroin.*

Front 30

What are 3 psychological reasons people smoke?

Back 30

1) Stress
2) Relaxation --> actually it increases the B/P so they aren't really "relaxed"
3) Rewards

Front 31

What are the 5 A's about smoking cessation?

Back 31

1) Ask--> Are they willing to quit
2) Advise--> If PT doesn't want to quit then teach them the oral head & neck screening and advise them to do it once a month.
3) Assess--> is PT ready to attempt to quit in the next 30 days?
4) Assist-->Provide helpful info & resources to the PT. (Quit lines, website, dealing w/stress, Nicotine Replacement Therapy
5) Arrange-->follow up.
Understand that quitting is a process. Document Pt usage & attempts to quit in chart notes.

Front 32

If a Pt is using NRT (Nicotine Replacement Therapy) can they smoke?

Back 32

No!

Front 33

What are the 5 R's used for?

Back 33

Enhanced motivation to quit.

Front 34

What are the 5 R's?

Back 34

1) Relevance
2) Risk--> of totobacco use to yourself and those around you
3) Rewards-->of quitting
4) Roadblocks
5) Repitition-->Repeat info at each visit.

Front 35

Recognize, as a clinition that relapse into tobacco use is high and even higher if the user also uses alcohol.
65% relapse w/in 3 months 10% relapse w/in 3-6 months. Relapse shouldn't be considered failure.
What are some reasons people do relapse? (5)

Back 35

1) Stress
2) Avoiding weight gain
3) Thinking that just 1 cigarette won't hurt.
4) Alcohol use reduces the ability to say "no".
5) Friends & associated activities…(Barry at the bowling alley with his friends.)

Front 36

What can I do to help the PT who has relapsed?

Back 36

Set a new quit date and make a list of substitute behaviors-> go for a walk, chew gum.

*Remember the average smoker will try to quit 6-9 times in a lifetime.*

Front 37

How should I follow up with a PT who has decided to quit?

Back 37

Contact the Pt 1-2 days prior to quit date.
Ask how they have prepared
Ask if I should contact them again? By phone or in person?

Front 38

How can I assist the Pt with quiting?

Back 38

Anticipate & review smoking triggers
Get the PT's teeth cleaned, have them clean house or car-->anywhere there has been smoking
Avoid Smoking situations
Have them keep busy
Help them set up an exercise program.

*Help the Pt get support outside of a clinical environment.*

Front 39

What things can I suggest to a Pt?

Back 39

Throw out all cigarettes
Put away all the ash trays
Clean House to get rid of smoke odor
Get their teeth cleaned
Put the saved money in a jar.

Front 40

Name off some symptoms your Pt may experience after quitting.

Back 40

Anxiety
Craving for tobacco
Depression/difficulty concentrating
Headache
Hostility/Irritability/Restlessness
Increased appetite/weight gain

*Rememberr these only last a few days after quitting and will subside!*

Front 41

If your Pt has put on some weight since quitting how can I address this concern?

Back 41

The average weight gain is 5-10 lbs.
Reassure the Pt that some weight gain is common and will probably be limited.
Encourage them to eat right and exercise.
This could be a good time to review their nutritin intake with them. Add fruits/ veggies.

Front 42

What happens to the body with in 20 minutes of quitting?

Back 42

BP decreases
Pulse decreases
Body temp of hands & feet increase

Front 43

What happens to the body with in 8 hours after quitting?

Back 43

Carbon monoxide levels in the blood drop to normal. Oxygen level in the blood increase to normal.

Front 44

24 hours after quitting does the chance of a heart attack decrease?

Back 44

Yes!

Front 45

48 hours after quitting smoking what is happening in the body?

Back 45

Nerve endings are beginning to repair.
The ability to smell & taste is enhanced.

Front 46

What types of improvements happen in the body over the 1st year of quitting?

Back 46

Circulation improves
Walking is easier
Lung Function increases
Coughing, sinus congestion, fatigue & shortness of breath decreases.
Excess risk of coronary heart disease is decreased to half that of a smoker!

Front 47

How is the risk of stroke reduced after 5 years of not smoking?

Back 47

Stroke is reduced to that of people who have never smoked.

Front 48

After 10 years of not smoking how is the risk of lung cancer changed?

Back 48

It drops to as little as 1/2 that of continuing smokers

Front 49

After 10 years of not smoking, how is the risk of mouth, throat, esophagus, bladder, kidney & pancreas cancer? What about the risk of ulcer?

Back 49

They all decrease!

Front 50

After 15 years of not smoking what is the risk of coronary heart disease like?

Back 50

Its now similar to that of people who have never smoked.

*The risk of death returns to Nearly the level of people who have never smoked too.*

Front 51

What are 3 Prescription products for NRT?

Back 51

1) Zyban
2) Chantix
3) Oral Inhalers

Front 52

What are 4 OTC products I can recommend to quit smoking?

Back 52

1) Transdermal Patch
2) Gums
3) Lozenges
4) Nasal Spray (many are Rx only but some are OTC)

Front 53

What is the purpose of psychosocial therapy?

Back 53

Behavior modification--> can be done in a group or individual setting.

Front 54

What are 3 alternative therapy's for smoking cessation?

Back 54

1) Acupuncture
2) Hypnosis
3) E-Cigarettes

Front 55

NRT can affect the availability of prescription drugs in a person's body.
Who needs to know if the PT is utilizing any NRT?

Back 55

The Physician!

Front 56

When using most NRT products what does the PT need to do 1st?

Back 56

Stop smoking!
** Zyban & Chantix allow you to smoke early on in the Tx but other products don't.**

Front 57

Has the FDA approved E-Cigarettes?

Back 57

NO!
They may actually have more nicotine than regular cigarettes.
Often are flavored chocolate, mint etc. and they target young people.
They are easily accessible.

Front 58

How do cigarette filters work as a tool for cessation?

Back 58

They remove about 90% of the tar & nicotine without affecting taste or temperature.

Front 59

Concerning Nicorette gum, when should you eat or drink when using it?

Back 59

Don’t eat or drink at least 15 minutes before use as it decreases absorption.

*It can help with Pt's who experience weight gain.*

Front 60

Concerning Nicorette lozenge, when should you eat or drink when using it?

Back 60

Don't eat or drink at least 15 minutes before use.
Can help w/weight gain.
Need to let dissolve slowing in the mouth (20-30 mins).

Front 61

Is the transdermal patch available from a prescription or OTC?

Back 61

Both-->depends on the strength??
*There are 3 levels of strength for a step down approach.*

Front 62

What can the patch disrupt if its not removed…

Back 62

Sleep!
Needs to be removed at bedtime.

*The patch delivers 24 Hour constant nicotine coverage with 1 patch. It’s a good idea to move the patch around when its applied so as to avoid any allergic reaction to the adhesive.

Front 63

What is the recommended duration of the patch?

Back 63

8-10 weeks

FYI-->$4.00 per patch.

Front 64

Which products are gotten via Rx?

Back 64

Zybam, Chantrix, Nasal Spray & Inhaler

Front 65

What are non Rx methods of cessation?

Back 65

Nicotime gum or lozenges,
Transdermal patch,
Filters.
Can also try hypnosis, counseling or acupuncture.

Front 66

Is a Nicotrol Nasal Spray gotten via OTC or Rx?

Back 66

Rx!
Can use it up to 3-6 months.

*Use Caution w/Heart conditions.*

Front 67

What about a nicotrol inhaler? OTC or Rx?

Back 67

Rx
Can use up to 6 months.
Don't eat or drink 15 minutes prior to use.

Front 68

How does Zyban "work" as a smoking cessation product?

Back 68

It helps to change the receptor site by blocking the nicotine from attaching.
Its an anti-depressant medication found to aid in smoking cessation.

Front 69

Can Zyban be used in conjunction with NRT?

Back 69

Yes
Zyban is not nicotene!
Chantinx should NOT be taken with other NRT!

Front 70

While you can smoke in the early stages of using Chantix its not recommended to be taken with other _____ products.

Back 70

NRT

Be aware Chantix is spendy! $$$
Usually one begins taking Chantix 1 week prior to quit date.

Front 71

What is kept in the lungs longer? Cigarette smoke or Marijuana smoke?

Back 71

Marijuana.
*Most perceive marijuana as a safe drug but it is associated with increased risk of :
Cancer,
Lung damage,
Periodontitis and
Dental Caries-->Xerostomia & appetite enhancer