GOOD MORNING !

SEMINAR

TOBACCO CESSATION

YASMIN MOIDIN 2008 BATCH

AL AZHAR DENTAL COLLEGETHODUPUZHA

INTRODUCTION Prevention of oral cancer mainly focuses on

modifying habits associated with the use of

tobacco

India is the largest consumer of tobacco and

third largest producer of tobacco

There are about 250 million tobacco users in

India

In India, at least 800,000 deaths every year are

related to tobacco use, and 700,000 of them

due to smoking

There are three well-known

approaches

Regulatory approach

1975 : Cigarette Act

1985 : National Cancer Control Program

2003 : Cigarettes and other Tobacco

Products Act

2004 : WHO-FCTC

Service approach

screening

Educational approach

Role of the dentist

harmful effects of tobacco

counsel patients

tobacco-free lifestyle

tobacco use during pregnancy

spend more time with patients

reinforce messages given to patients

build their patient’s interest to

discontinue

promote oral health and healthy

lifestyles

speak with authority in the

community

effective advocates for tobacco

control in the community

•Identify and document tobacco user status of every patient at every visit

ASK about patient’s

habit

•In a clear, strong and personalized manner urge every tobacco user to quit

ADVICE of consequence of smoking

•Is the tobacco user willing to make a quit attempt at this time ?

ASSESS willingness

to quit

Guide to counseling for tobacco cessation (5 A’s)

•For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him quit

ASSIST with cessation

plant developme

nt

•Schedule follow-up contact, preferably within the first week after the quit date

ARRANGE for

follow-up

NICOTINE REPLACEMENT THERAPY

Nicotine replacement therapies (NRT) for

tobacco use cessation are :

Nicotine gum

Nicotine patch

Nicotine inhaler

Nicotine nasal spray

Nicotine lozenges

Basic principles for prescribing NRTs

Medical supervision is important

Use a lower dose for less dependent

tobacco users

Contraindicated in : pregnancy , lactation,

cardiovascular diseases, peripheral

vascular disease, endocrine disorders ,

inflammation of the mouth and throat,

oesophagitis, gastric ulcers, diabetes

Nicotine gum

use under medical supervision for

a predefined limited period, e.g. 6

weeks , after which the patient

has to face withdrawal

Nicotine withdrawal symptoms

Craving for tobacco

Depressed mood

Insomnia

Irritability

Frustration

Anxiety

Difficulty in concentration

Restlessness

Decreased heart rate

Increased appetite and weight gain

Antidepressants

Function as anti-craving medications

Available therapies :

First-line therapies

Buproprion SR

Selegeline

Second-line therapies

Clonidine

nortryptiline

Counseling those unwilling to quit

Relevance of quitting

Risks of continuing tobacco use

Rewards of quitting

Roadblocks to quitting

Repeat these at each visit

Key counseling concepts

A non judgmental attitude

Caring

Empathy

Listening

Raising awareness

Prompting self-evaluation

Offering support

Asking open-ended questions

Clarifying

Reflecting feelings

Summarizing

Affirming

Eliciting self-motivational statements

Setting realistic goals

Responding to tricky questions

Tailoring messages to the patients

stage of change

ACTION IN THE COMMUNITY

Public educationMedia advocacy

ACTION AT THE STATE AND NATIONAL LEVELS

Making the profession and dental facilities tobacco-free

Advocacy with the state and national governments

CONCLUSION

A majority of cancer deaths

worldwide are due to tobacco.

These are easily avoidable since

the factors associated with the

disease have long been

identified.

REFERENCES

Essentials of Preventive and

Community Dentistry – Fourth

Edition 2009 SOBEN PETER

Textbook of Public Health

Dentistry – First Edition 2011 C M

MARYA

THANK YOU !THANK YOU !