Tobacco Cessation

 

HOW TO START TOBACCO CESSATION SERVICES 

TARGETS :

 Specific targets -

 Current smokers

 Current SLT users

 Families of these people

 General targets-

 All non smokers

 School children

 College children

 Women

  Aim is to make current users quit and to keep others from getting into the vicious cycle of tobacco

PLANNING

 Infrastructure

One room for OPD services including computer.

Staff recruitment

Doctor

Counseller

Social worker

Computer operator

Attendent

Location

Well connected with road and public transport.

Pre launch publicity

Focus should be drawn towards school and college students.

Launch and post launch publicity

Pubicity of the clinic should b done on a continious basis so that it continues to attract people.

EQUIPMENTS REQUIRED-

• Educational material

• Computer

• Breath CO analyzer

• Telephone connection

• Kit for measuring saliva and urine cotinine levels

• Medicines

• Contact with alcohol de-addiction centres.

OFFICE ENVIORMENT-

• Create smoke free enviorment using NO- SMOKEING posters and banners.

• Slogans to quit smokeing and photos of before and after smokeing conditions shold be displayed.

• Tobacco cessation literature should be placed throughout the office and waiteing room.

• Dentist and staff should be free from tobacco habit, must be well aware of all types of tobacco, attend CDE on tobacco cessation.

• There should be coloum in OPD file having history of tobacco intake , type, duration and frequency of intake.

• Fagerstrom test-

o Waiting room should have self assesment quetionaire papers with marks for each answer option for patients and their relatives to guide and aware them about their tobacco addiction.

RESULTS

• Score 0-3:No/low tobacco dependence

• Score 4-6: Medium tobacco dependence

• Score 7-10:High tobacco dependence

• Low: Patient not need NRT

• Low/moderate: Treated with single agent NRT

• Moderate: Treated with a combination of NRT (long acting with short acting)

• High : Can be treated with a combination of NRT with oral agent. 

Assesment by Dentist

o Dentist should talk to patient in detail,build motivation and gain confidence.

o Motivation can be built by following techniques:

• Linking present illness with tabacco habit.

• Creating awareness on availability of medecine to aid in tobacco cessation.

• Using sucessful ex tobacco users to motivate new patients.

• Emphasizing/demonstrate that tobacco use is an addiction and not a choice.

• If patient is not ready to quite but want to reduce the intake, utilise the time of his treatment visites to build motivation.

• Paradoxical intentional strategy.

Process of cessation- Interventional strategies

 THE 5 A’s

Ask – ask to quit in every visit

Advice- strongly urge all tobacco users to quit

Assess- determine willingness to make a quick attempt

Assist- aid the client to quit

Arrange- arrange follow up contact in 1 week after quiting.

For patients not ready to quit- 5R’S

RELEVANCE- Why quiting is important to them

RISK- Neagtive concequences

REWARD- Benefit of cessation

ROAD BLOCKS- Ideantify impediments to quiteing

REPETATION- Repeat everytime patient comes to clinic.

A 5 DAY PLAN TO GET READY TO QUIT

• The first step to quitting is to decide to quit. Next make an appointment with your health care provider to discuss the options for treatment and to get a quit date.

• Quit date minus 5

- list all the reasons to quit

- Tell your family friends about your Plan

- Stop buying cartons of bidis/cigarette/smokeless tobacco.

• Quit date minus 4

- Pay attention to why and when to use tobacco

- Think new ways to relax

- Think new ways to hold something in mouth and in hand instead of tobacco

- Think of habits or routine you may want to change

- Make list of use when you quit.

• Quit day minus 3

- Make use of things you could do with extra money you save

- Think whom to reach when you need help

• Quite Day minus 2

- Clean your clothes to get rid of smell of smoke

• Quite Day minus 1

- Think of reward you will get yourself after you quit

- Get you teeth cleaned

- Throw away all your tobacco products

- Put away lighters and astrays

• Quit day

- Keep yourself busy

- Change your routine when possible

- Do the things which don’t remind you to use tobacco

- Tell your family, friends that you have quit and ask them to help

- Avoid alcohol

• Quit day Plus one

- Congratulate yourself

Withdrawal Symptoms

1. Insomnia

2. Restlessness

3. Anxiety

4. Craving, difficulty in concentration

5. Irritability, frustration , anger

6. Decreased heart rate

7. Increased appetite or weight gain

8. Depressed mood 

Common symptoms and coping strategies

 Symptom                            Coping Strategy

Irritability -                Walk, hot bath, relaxation

Fatigue-                            Take naps, exercise

Insomnia -                    Avoid caffeine after 6pm

Cough-                                  Drink plenty of fluids

Nasal Drip-                       Drink plenty of fluids

Dizziness-                         Change positions slowly

Lack of Concentration-  Plan workload, avoid stress

Constipation-                   Add fiber to your diet

Gas-                                   Add fiber to your diet

Hunger-                            Low calorie snacks

Craving-                            Delay,Distract, Drink, breath

Headaches-                       Drink fluid, and relaxation

Effect of tobacco cessation on body

Hiccups

GIT problems

Jaw pain

Sensitivity of skin

Excessive heat feeling

Problem in digestion

Difficulty in concentration

Weight gain

Depression

Tension

Oral Problems

Halitosis

Calculus

Hairy tongue

Periodontitis

Abrasion

Discolouration

Soft tissue changes

Sinusitis

Delayed healing

Leukoplakia

Oral cancer

Acute necrotising ulcerative gingivitis

Yellow teeth Causes of yellow teeth

Health effect of tobacco use

• Eyes : macular degeneration

• Hair : Hair loss

• Skin : ageing, wrinkles, wound infection

• Brain : stroke

• Mouth & pharynx : cancer, gum disease

• Lungs : cancer, emphysema, pneumonia

• Heart : coronary artery disease

• Stomach : cancer, ulcer

• Pancreas : Cancer

• Bladder : Cancer

• Women :cervical cancer, early menopause, irregular and periods.

STAGES

During time patient undergoes series of stages of willingness and preparedness to quit-

STAGE 1 - PRE-CONTEMPLATION

STAGE 2- CONTEMPLATION

STAGE3- PREPRATION

STAGE 4- ACTION

STAGE 5- ACTIVE PERIOD

Role of Physiatrist

 - Physiatrist try to rule out the cause because of which the patient started the habit like having faliure , divorce, depression etc and treat him for the same.

 -Physiatrist helps patient to overcome the withdrawl symptoms and mood changes.

Pharmacotherapy used by physiatrist:

Antidepressent drugs -

1. Brupropion 2. Nortriptyline

Partial agonist nicotinic receptor-

1.Cystisine 2. Dianicline 3. Varenicline

Antihypertensive drugs – Clonidine

Contraindications

  The following conditions need the help of Physician for consultation and dose monitering-

Heart diseases

Pregnancy

Lactating women

Endocrinal disorders

Gastrointestinal disorders

Vascular diseases

Drug Allergy

FOLLOW UP

  First Month- weekly contact

  2nd and 3rd Month- Monthly contact

  1st year- Quarterly contact

  At each visit dentist has to check for typical issues that arises in tobacco cessation therapy & address them before they result in relapse.

Techniques Helpful In Relapse Prevention

             ISSUE

1. Stronge or prolonged symptoms

 2. Depression

 3. Anxiety, irritation depression.

 4. Weight gain

           SOLUTION

Extend pharmacotherapy

Medication, refer to specialist.

Reassure the patient that these feelings are common.

Reassure the patient and diet councelling.

 Some other forms of therapy-

 Acupuncture

 Hypnotherapy

 Yoga therapy

 Spiritualism

   once you are sure patient has quit tobacco habit successfully congratulate and encourage the patient on his/her effort.Keep follow ups.