Smoking Cessation

Question 1

what type of intervention should we carry out as the dentist?

Answer 1

brief intervention (10 mins)

Question 2

what are the oral side effects of smoking? (6)

Answer 2

Increases oral cancer risk

Risk for periodontal disease

Limits healing and success for extractions/implants etc

Stains the teeth
Tooth loss
Halitosis

Question 3

what are the models for smoking cessation? (2)

Answer 3

3 A’s or 5 A’s

Ask:
Establish and record smoking status

Advise:
Personal benefits - use what you’ve found in the mouth to provide supporting evidence

Act:
Offer to help and signpost services

5:
Ask:
Advise:
Assess:
Assist:
Arrange follow up:

Question 4

what should we ask the patient about in regards to smoking? (10)

Answer 4

Carried out once a year and updated in notes to provide evidence;
Do they smoke/are they an ex smoker
Number per day 
Number of years a smoker 
Age when patient started 
What products do they use 

Quitting history: 
Have you tried quitting before? 
How many attempts have you had?
What helped you?
Are you interested now? 
Would you be interested in the future?
If getting positive response  - proceed with advice and referral.

Question 5

where can we refer smokers who want to quit for support? (3)

Answer 5

Phone trained advisor that will provide advice
Specialist services - greater success
Pharmacy services - greater reach

Always note outcome in patients record!!!

Question 6

why do people smoke? (7)

Answer 6

Addicted - cant stop
Enjoyment
Help concentrate
Relieve stress
Socialise - peer bonding (all of family/friends smoke etc)
Keep weight down - nicotine is an appetite suppressor.
Managing withdrawal symptoms

Question 7

describe the effects of shish in comparison to smoking.

Answer 7

45 mins of use = doubles the carbon monoxide and triples the nicotine exposure (same as 10 cigarettes in a row)

Question 8

what form of tobacco has the highest levels of carbon monoxide?

Answer 8

Shisha

Question 9

what are the health risks associated with shisha? (4)

Answer 9

Health risks such as TB, Hep A, helicobacter pylori and pulmonary aspergillosis

Question 10

what is NRT used to manage?

Answer 10

withdrawals from cigarettes - increases likelihood of quitting

Question 11

name examples of NRT’s (4)

Answer 11

Patches, gum, nasal spray, lozerngers, oral strips etc
Champix
Zyban
e cigarettes

Question 12

list the types of second hand/environmental smoke. (3)

Answer 12

Mainstream smoke - inhaled by the smoker

Side stream smoke - (fills the room) Contains more carcinogens

Third hand smoke - Carcinogen laden residue on surfaces.

Question 13

what are the benefits of E cigarettes?

Answer 13

Less toxic/safer than cigarettes - but long term effects not known! (NHS)

95% less harmful but still 5% harmful.

Question 14

who uses E cigs? (3)

Answer 14

Ex smokers are the highest percentage of users

Some current smokers are using them (17.4% use together)

Low numbers of non-smokers

Question 15

why do people use E cigs? (6)

Answer 15

Ex smokers - helping them to quit
Current smokers - harm reduction by lowering the amount of cigarettes they’re smoking
Less toxic
Cheaper
Psychosocial aspect of addiction maintained
Socialisation

Question 16

what are the disadvantages of E cigs from a public health point of view? (2)

Answer 16

Renormalising smoking

Gateway or pathway - particularly for young individuals

Question 17

what should be the driving force behind the use of E cigs?

Answer 17

Helping people to quit completely

Question 18

what are the advantages of E cigs from a public health point of view? (1)

Answer 18

E cigs are said to be less harmful than cigarettes therefore they are helping to reduce the Public health costs of smoking.

Question 19

describe the triangle of addiction (3)

Answer 19

emotional attachment

habit

chemical addiction

Question 20

what are the smoking withdrawal symptoms? (10)

Answer 20

Craving 
Depression 
Headaches 
Disturbed sleep 
Wreath gain - slower metabolism
Irritability
Mouth ulcers - chemicals in the lining of the mouth change 
Dizziness 
Constipated 
Lack of concentration

Question 21

what are the benefits of stopping smoking. (5)

Answer 21

Carbon monoxide levels return to normal within 48 hours
Nicotine leaves body within 24 hours
Breathing improves between 2 weeks and 3 months
Financial benefits
Risk of heart attack and stroke decreases

Question 22

list the general health risks for smoking (4)

Answer 22

reduces fertility

increases risk of cancer throughout the whole body

narrows vessels = increased risk of stroke

ages the skin