hafdentalclinictraining.ppt

Helping Patients to Quit Using Tobacco

Hill Air Force Base

Dental Clinic

August 11, 2005

Isa Kaluhikaua, CHES

Davis County Health Department

Bureau of Health Promotion

451-3398

isa@daviscountyutah.gov

Why are we here?

• Train dental clinicians in a proven effective 3-minute intervention to help their tobacco using patients to quit.

• Provide consistent tobacco cessation information to all tobacco using patients.

• Introduce The TRUTH Network materials.

• Address ADHA and UDHA goals.

Why is this my job?• More than half of adult smokers see a dentist each year.• Effects of tobacco use are visible in the mouth even in

relatively early stages of use.• Tobacco is the root of many oral health problems.• Dental patients request treatments that counter the effects

of tobacco use on their appearance.• Most dental patients want and expect dental

professionals to provide cessation advice.• Brief tobacco dependence treatment is effective, and

every patient who uses tobacco should be offered at least brief treatment.

Tobacco Use Trends in Utah

• Average age of initiation - 12.5

60% by age 14

90% by age 19

• Tobacco use rate in Davis County 9.8%

• Tobacco use rate at HAFB 28%.

• There are more than 190,000 smokers in Utah.

• 81.5% of Utah smokers report that they would like to quit.

Oral Health Problems caused by Tobacco

• Tooth-loss, jawbone loss and periodontal diseases.

• Impeded effectiveness of periodontal therapy, dental implants, and wound healing.

• Tooth decay for the tobacco-user’s children, results from exposure to secondhand smoke

• 4x the risk of developing oral cavity or oropharyngeal cancer, which kills 49% of its victims within 5 years of diagnosis.

Success Rates of Tobacco Dependence Treatments

• No help = 7-8%• Health care provider advice (<5 minutes) =

10-12%, 15% for pregnant women• Counseling (91-300 minutes) = 10-20%• NRT = 15-30%• NRT + Counseling (91-300 minutes) = 25-

35%• Zyban = 25-35%

How do I help tobacco users quit?

Even a minimal intervention, lasting less than 3 minutes, can significantly increase overall tobacco abstinence rates.

The “5 A’s”• ASK the patient if he or she uses tobacco• ADVISE him or her to quit• ASSESS willingness to make a quit attempt• ASSIST him or her in making a quit attempt• ARRANGE for follow-up

How do I help tobacco users quit? cont.

Use The TRUTH Network materials to help you with your 5A’s intervention.

• Treating Nicotine Dependence, Utah’s Healthcare

Provider Guide

• Brochures (Welcome Guide & Think About It)

• Utah Quit Line & Utah QuitNet

• Fax Referral Form

• Pharmacotherapy Guide

1. ASK

Ask EVERY patient about tobacco use status at EVERY visit.

• Current • Former • Never

This occurs most consistently when there are systems in place, such as question on intake form, chart stickers, or electronic prompts on electronic medical records. Chart stickers are available.

2. ADVISE

Clinicians should urge all tobacco users to quit.Even brief advice to quit by a clinician results in greater quit rates. Smokers cite a clinician's advice to quit as an important motivator for attempting to stop smoking.

Advice should be:• clear• strong• personalized

Specific to the individual 's own situation (e.g. oral health condition, family status, costs of tobacco).

ADVISE cont.

“I can’t see what tobacco is doing to your heart, lungs, brain and other organs, but I would like to show you some changes in your mouth.”

Gingival recessionGingivitis

Leukoplakia Oral CancerPeriodontitis, Stained teeth

Nicotine Stomatitis “Smoker’s

Palate”

Black, hairy tongue

3. ASSESS

"Are you willing to try to quit at this time?"

What if they are not willing?

• Provide patient with “Think About It” brochure from The TRUTH Network.

4. ASSIST

• Provide patient with “Welcome Guide” brochure from The TRUTH Network.

• Discuss the quitting process.• Set a quit date.• Tell family and friends. • Review past quit attempt experiences. • Anticipate challenges. • Remove tobacco products. • Avoid alcohol. • Recommend pharmacotherapy.

Pharmacotherapy

• Use the Pharmacotherapy Guide from The TRUTH Network.

• Many medications have been approved by the FDA for smoking cessation and have been shown to significantly improve abstinence rates.

• They work to reduce cravings and other withdrawal symptoms.

ASSIST cont.

“Would you like the Utah Tobacco Quit Line to help you quit?”

ASSIST cont.

YES

Have patient fill out the Utah Tobacco Quit Line Fax Referral Form.

1. Clinician writes name on item 1 of the form. 2. Patient fills out items 2-12.

3. The client must sign the form.

NO

If the patient does not want to fill out the form, give the patient the Quit Line's toll free telephone number (1-888-567-TRUTH) or offer a Utah Tobacco Quit Line card so that the patient can contact the Quit Line when they are ready.

ASSIST cont.

UTAH TOBACCO QUIT LINE1-888-567-TRUTH (8788)

• The Quit Line triple or quadruples quitting rates of Utah tobacco users.

• Free Cessation Services:• Telephone Counseling

• Quit Kits

• Referrals

• Nicotine Replacement Therapy (NRT) if eligible and appropriate

UTAH QUITNET http://utahquitnet.com

All Utah QuitNet services are available to all Utahns free of charge.

• Personalized quitting plans• Quitting information• Peer support• Expert advice• Pharmaceutical product support

5. ARRANGE FOLLOW-UP

Fax the form to the Utah Tobacco Quit Line's toll free fax number:

1-800-483-3114The Utah Tobacco Quit Line faxes your clinic so that you know what type of services your patients received.

Review1. Ask2. Advise3. Assess4. Assist

• Provide “Welcome Guide” brochure & Fax Referral Form• Brief discussion of quitting process• Pharmacotherapy

5. Arrange follow-up• Fax referral form to Utah Tobacco Quit Line

American Dental Hygienists’ Association’s American Dental Hygienists’ Association’s Smoking Cessation InitiativeSmoking Cessation Initiative

Goal: 50% of dental hygienists screen their clients regarding tobacco use by 2006

www.askadviserefer.org

The Current Trend

Utah Dental Hygientists’ AssociationGold Card Program

Goal: One referral to Utah Tobacco Quit Line for each hygienist.

Tobacco Cessation Websites for Health Care Providers

1. Tobacco Cessation Guideline Publications: http://www.surgeongeneral.gov/tobacco/default.htm

2. Dr. Fiore's course in the 5 A's: http://www.cme.wisc.edu/online/ctri/index.htm

3. Utah Department of Health, Tobacco Prevention & Control Program

http://www.tobaccofreeutah.org/healthcare.html