Tobacco use and prevention and cessation + Motivational Interviewing

Question 1

What is a motivational interview?

Answer 1

It is an effective (evidence based) way to communicate with an individual about change

Question 2

What is the main “enemy” of making a change?

Answer 2

Ambivalence

Question 3

What is the spirit of motivational interviewing?

Answer 3

4 concepts are the:
1. Partnership or collaboration between individual and councillor
2. Acceptance - respecting the client’s autonomy
3. Compassion - keep clients best interest in mind
4. Evocation - the best ideas come from the client

Question 4

What are the 4 basic counselling skills?

Answer 4

1. Open questioning
2. Affirmations
3. Reflections
4. Summaries

Question 5

What are the four processes of motivational interviewing?

Answer 5

1. Engaging
2. Focusing
3. Evoking
4. Planning

Question 6

What is change talk?

Answer 6

It is the client speech that favors movement in the direction of change. When clinet says “I wish” or “I want” it is important to reinforce those believes.

Question 7

What type of plan works the best for client who would like to change?

Answer 7

A SMART plan:
Specific
Measurable
Achievable
Relevant
Timed

Question 8

What is the role of dental practitioner in terms of reducing smoking rates in patients?

Answer 8

1. Take the time to talk to your patient
2. Provide smoking cessation materials in the waiting room
3. NRT doubles the chance of success for smoking cessation
4. NRT + behavioural support further increases the chance of success

Question 9

What are some of the barriers to quitting smoking?

Answer 9

1. High nicotine dependence
2. Lack of knowledge
3. Not ready to quit
4. Psychological or emotional concerns
5. Fear of weight gain
6. Fear that quit attempt will be unsuccessful
7. Substance use
8. Living with other smokers
9. Giving quitting a low priority due to other circumstances

Question 10

What is in a cigarette?

Answer 10

1. tar - residue from burning tobacco
2. Carbon monoxide
3. Nicotine
4. Ammonia
5. Flavours
6. Leaf blends

Question 11

What is the basis of nicotine metabolisms and how do we relate it back to nicotine addiction?

Answer 11

1. Nicotine is able to reach the brain in 7 seconds
2. It attaches to nicotine receptors and releases dopamine
3. It also attaches to nicotine receptors in adrenal glands and release adrenaline

This cause a relaxing effect to the mind. Overtime nicotine receptors increase in number thus more nicotine is required to maintain the same level of “euphoria” thus smokers require more and more smokes.

Question 12

What are the two basic categories that make someone a smoker

Answer 12

1. Individual inflences - beliefs about smoking, self-esteem, rebellion, curisosity
2. Environental influences - parents & siblings, peers, media, availability

Question 13

What is the relationship between smoking and socioeconomic status?

Answer 13

People of lower socioeconomic status are more likely to smokes, around 3 times more likely

Question 14

Why do people of lower socieconomic status smoke?

Answer 14

1. Socioeconomic inequity
2. Priority other than quitting smoking
3. Less access to services

Question 15

What is the relationship between smoking and people with mental illnesses?

Answer 15

People with mental illnesses (either general or severe) were significantly more likely to be smokers than people living without either general mental illness or severe mental illness.

Question 16

What are some of the general health effects for long term users of cigarettes?

Answer 16

1. Peripheral vascular and heart disease
2. Causes the release of glucose in the bloodstream
3. Decreases neutrophil chemotaxis and phagocytosis
4. Reduced secretion of immunoglobins form pmns
5. Increased secretion of pro-inflammatory cytokines
6. Impedes fibroblast activity
7. Oxygen depletion for cellular activity

Question 17

What is the process of vitamin C depletion related to smoking?

Answer 17

1. Vitamin C is a water soluble vitamin that acts as an anti-oxidant to eradicate cancer causing free radicals in the body
2. Cigarette smoking speeds up the production of free radicals
3. This depletes the levels of free Vitamin C in the system

There is evidence that reduction in Vitamin C also relates to poor dietary intake.

Question 18

What are some of the oral effects of cigarette smoking?

Answer 18

1. Oral cancer and pre-malignant changes
2. Implant failures
3. Conditions associated with xerostomia
4. Increase instance of Necrotising gingivitis
5. Increases instances of periodontitis
6. Reduced healing and treatment response
7. Masking signs of gingivitis

Question 19

What is an important point we need to deliver to the patient who is a chronic smoker?

Answer 19

Smokers should understand that they are at increased risk for treatment failure, treatment complications and increased time to treat periodontal disease.

Question 20

What is the difference between the old and the new theories of plaque differentiation due to smoking?

Answer 20

In old theory: it was understood that smoking causes the biofilm to become more pathogenic thus causing periodontal damage

In new theory: it is understood that smoking itself causes periodontal damage resulting in creation of new ecological niches, thus promoting increased pathogenity of biofilm

Question 21

What are the oral effects of tobacco use?

Answer 21

1. Changes in oral environment:
   - Reduced salivary flow
   - Pocket formation
   - Altered oral physiology
   - Promotion of pathogenic oral microflora
2. Direct effects on oral mucosa
   - Reactive changes to mucosa
   - Dysplasia
   - Neoplasia
   - Changes to the immune functions of the oral environment - e.g. Oral candidosis

Question 22

What is nicotinic stomatitis?

Answer 22

It is a hard palate lesion that occurs in some smokers. It presents as a diffused hyperkeratosis of the palate. It is not considered pre-malignant and is reversible

Question 23

How would you describe the relationship between tobacco, alcohol and poor nutrition in terms of influence on oral cancer?

Answer 23

All three, can be considered compounding factors, as occurrence of one increases the potential for occurrence of the other factors.

Question 24

Identify three oral lesions that have direct relation to smoking?

Answer 24

Nicotinic stomatitis, oral leukoplakia and oral candidosis lesion

Question 25

Why are pregnant women are more likely to quit smoking than non-pregnant women?

Answer 25

1. Huge health benefit 2. Huge economic benefit

Question 26

What are some of the symptoms of nicotine withdrawal?

Answer 26

1. Difficulty concentrating 2. Headache of dizziness 3. Irritable 4. Tiredness 5. Excessive Sweating 6. Coughing 7. Feeling hungry 8. Diarrhoea or constipation 9. Tingling Fingers 10. Feeling tense or angry 11. Restlessness

Question 27

What are the three main stages of change?

Answer 27

1. Pre-contemplation 2. Contemplation, preparation, action, maintenance 3. Lapse/relapse

Question 28

What is the gold standard test for nicotine dependence?

Answer 28

It is the Fagerstrom test for Nicotine dependence - a questionnaire that gives us a numerical basis that will allow us to determine what is the person's level of nicotine addiction

Question 29

What is the 5 As framework?

Answer 29

1. Ask - ask if they smoke 2. Assess - assess their stages of change 3. Advise - information is the key 4. Assist - discuss the benefits of quitting 5. Arrange - arrange for follow-up

Question 30

What are some of the negative effects of smoking and using drugs?

Answer 30

1. Tooth decay 2. Reduced blood flow 3. Reduced amount of saliva 4. Staining on teeth 5. Erosion due to teeth grinding other

Question 31

Why do people smoke nicotine?

Answer 31

Nicotine is a major CNS-active compound in tobacco smoke.

Question 32

When do nicotine withdrawal symptoms peak?

Answer 32

2-3 days after last cigarette

Question 33

What are some of the treatment and support available to help someone quit smoking?

Answer 33

Important to approach it in a biopsychosocial ways: 1. Nicotine replacement therapy 2. Non-nicotine containing drugs 3. Psychotherapy and other

Question 34

What are the goals of treatment for a person with nicotine addiction?

Answer 34

1. To increase motivation 2. To reduce withdrawal intensity 3. To decrease exposure to tobacco smoke 4. To improve coping responses to stress and anxiety 5. To facilitate abstinence from tobacco smoking

Question 35

What is the advantages of NRT?

Answer 35

1. Increase quit rates 2-fold on average 2. Cost less comparing to smoking

Question 36

What is addiction?

Answer 36

It is a chronic, often relapsing brain disease that causes compulsive drug seeking and use, despite harmful consequences.

Question 37

What are e-cigarettes?

Answer 37

They are lithium battery powered device that uses cartridges/pods with 'e'-liquids. The e-liquid is heated into an aerosol/vapour and inhaled into the lungs by the user and then exhaled. Some of the residue smoke may stay in the oral cavity.

Question 38

Why do people use e-cigarettes/vape?

Answer 38

1. Smoking cessation 2. Perceive vaping is less harmful than smoking 3. Circumvent smoke free areas 4. Experimentation/curiosity 5. Recreational enjoyment/social 6. Attractive flavours 7. Peer or social pressure

Question 39

What are the basic components of e-cigarettes?

Answer 39

1. Base: Propylene glycol or vegetable glycerine 2. Nicotine 3. Flavourings, other chemicals and heavy metals

Question 40

What is important to tell patients who are vaping about the vapes?

Answer 40

There is no clear labelling of contents on the products or e-liquids thus it is just a lie to claim that vape aerosol is just water vapour. In fact studies show that the vapour aerosol contain a lot of carcinogenic elements.

Question 41

What is the danger of e-liquid base for the oral environment?

Answer 41

Some e-liquids use propylene glycol. When heated, propylene glycol it breaks down into acetic acid, lactic acid and propinaldehyde. These compounds can cause tissue desiccation as well as cause demineralisation.

Question 42

What are some of the other chemical compounds found in e-cigarettes that maybe be harmful to the user?

Answer 42

1. Formaldehyde - a known carcinogen that is toxic to human cells 2. Acetone - a product that is found in nail polish remover or paint remover products 3. Polycyclic aromatic hydrocarbons - carcinogen and many many many more

Question 43

What are some of the implications of e-cigarette use?

Answer 43

1. Respiratory conditions - like lung inflammation and lung injuries 2. Gastrointestinal contiditions - like nausea 3. Cardiac conditions - such as chest pain 4. Brain development - such as mental health conditions and even an increase risk of anxiety 5. Potential toxicity and overdose on nicotine 6. Increased risk of taking up smoking later 7. Overheat and explosion on lithium batteries in unstable devises

Question 44

What are the oral implications from use of e-cigarettes?

Answer 44

Studies show that approximately 4% of e-cigarette constituents like nicotine, propylene glycol, glycerine were deposited in the mouth/oral cavity and throat with the rest of the constituents being deposited in the airways. Some of the oral health effects are: 1. Dental caries 2. Dry mouth 3. cracked/broken teeth 4. Periodontal disease 5. Negative effects on tissue and bone around implants 6. Oral cancer 7. Oral soft/hard tissue damage if lithium battery explodes

Question 45

Why are user of e-cigarettes more likely to develop dental caries than users of conventional cigarettes?

Answer 45

Because many of the e-liquids contain flavours that have sucrose, sucralose and ethyl maltol - which are all simple sugars that promote bacterial acid productions. Furthermore, the vapour that is produced is thick and viscous and can be retained on oral tissues; the vapour can also allow S.Mutants to stick to enamel thus favour biofilm acccumulation. There are also evidence that vapour could cause: changes in the saliva antimicrobial activity, dry mouth, change in oral biome and alter gustation.

Question 46

What are the potential implications for e-cigarette smokers in terms of periodontal disease?

Answer 46

There are some research that suggests that e-cigarette smokers are at higher risk of periodontal disease than non-e-cigarette smokers due to increase in inflammation, cell injury and impaired cell repair. It is also worth mentioning that e-cigarette smokers are at a lower risk of periodontal disease than conventional cigarettes users - more research is needed!