Tobacco Consumption & Cessation

• Chapter explores integrating brief tobacco interventions into oral health programs in primary care.
• Objectives are to describe how oral health professionals can support users to quit and propose effective system changes for tobacco cessation services.

Introduction

• Adverse associations exist between tobacco and oral disease, including direct tobacco use and second-hand smoke linked to oral cancer, periodontal diseases, dental caries, and tooth loss.
• National oral health programs should actively support tobacco control efforts at both clinical and community levels.

WHO Oral Health Programme Tobacco Control Policy

• Goals of WHO Global Oral Health Programme have been reoriented for disease prevention and health promotion.
• There is emphasis on global policies in oral health promotion and oral disease prevention, coordinated with other programs and external partners.
• WHO recommends oral health programs embrace "the common risk factor approach" to integrate oral health promotion into broader health promotion.
• Tobacco use is a common risk factor between oral and chronic non-communicable diseases, justifying national oral health programs to support tobacco control.
• The WHO Oral Health Programme aims to ensure oral health professionals routinely increase patient awareness of tobacco risks and help them avoid all forms of tobacco.
• Programme collaborates with WHO Tobacco Free Initiative (TFI) and works with organizations to encourage WHO Framework Convention on Tobacco Control (WHO FCTC) ratification.
• Promoting oral health professionals' involvement in tobacco cessation is a priority, with national programs urged to identify and treat tobacco users, integrating cessation services into routine practice.

WHO Policy on Tobacco Cessation

• Supporting users to quit is part of a comprehensive tobacco control package, consistent with Article 14 of the WHO FCTC.
• This aims to achieve voluntary global targets related to tobacco use and reduce premature mortality.
• Supporting current users to quit and population-level tobacco control measures can change the prevalence of tobacco use and death in the short- to medium-term.
• Reducing adult tobacco consumption by 50% by 2020 could avoid about one-third of global tobacco-related deaths within 30 years.
• Only 15% of the world population has access to tobacco cessation services, and 97 countries provide cessation support in primary care facilities with some cost coverage.
• Technical help for WHO Member States to improve national tobacco cessation and treatment systems is needed.
• Guidelines integrating brief tobacco interventions into health care systems are a first step for Parties to develop comprehensive treatment systems.
• Primary care setting should be the main focus because it can reach most tobacco users and has low service delivery costs.
• National oral health programs are a priority platform for integrating brief tobacco interventions due to oral health professionals' unique position to help tobacco users, especially the young.

The Unique Role of Oral Health Professionals in Helping Tobacco Users

• They can reach many users and persuade them to quit.
• In developed countries over 60% of users visit a dentist/hygienist yearly.
• Ethical, moral, and practical reasons exist for oral health professionals to play a role in helping users quit.
• Oral health professionals are concerned about tobacco's effects in the oropharyngeal area.
• They have access to children/caregivers, influencing individuals to quit or not start tobacco use.
• They have more time with patients than other health professionals, integrating tobacco cessation interventions into practice.
• They often treat women of childbearing age, explaining the potential harm to babies from tobacco use.
• They are as effective as other health professionals in quitting.
• They can build patient interest in stopping tobacco use by showing actual tobacco effects in the mouth.

What Should a National Oral Health Programme Do to Promote Tobacco Cessation?

• National oral health programs can promote tobacco cessation both within and outside the clinical setting.
• Clinical setting programs should strengthen the health care service to identify and provide every patient who uses tobacco with intervention.
• Outside the clinical setting oral health professionals can actively support tobacco control measures and increase the demand for cessation services through professional associations.

Oral Health Professionals Should Routinely Offer Brief Tobacco Interventions to All Tobacco Users in Primary Care

• Effective treatments for tobacco dependence include brief advice, intensive behavioral support, and pharmacological treatments.
• WHO recommends that health professionals deliver brief interventions as part of routine services, following WHO FCTC Article 14 guidelines.
• Behavioral counseling by oral health professionals with an oral exam can increase tobacco abstinence rates by 70% at six months or longer. Helping patients quit smoking as part of routine practice takes three-to-five minutes and is feasible, effective, and efficient, using the 5As and the 5Rs model.
• Every health care provider should educate about second-hand smoke dangers and encourage patients to avoid exposure and create a smoke-free home.

The 5As Model to Help Patients Ready to Quit

• Several models can deliver brief tobacco interventions.
• The 5As and 5Rs are the most widely used for brief intervention in primary care.
• The 5As (Ask, Advise, Assess, Assist, Arrange) summarize activities for providers to help a tobacco user make a quit attempt within three-to-five minutes, with "Ask" needing to be asked of all patients to make it part of the routine.

5As Defined

• Ask: Systematically identify all tobacco users at every visit.
• Advise: Advise all tobacco users that they need to quit.
• Assess: Determine readiness to make a quit attempt.
• Assist: Assist the patient with a quit plan/provide information on specialist support.
• Arrange: Schedule follow-up contacts/referral to specialist support.

The 5As in Detail

• Advice should be clear and positive, and tailored to the patient's circumstances.
• Assessment will be determined on whether the patient is ready to quit, then the patient will need assistance.
• Arranging for a follow up can cement a commitment to quitting.
• The 5As model can guide providers to talk about tobacco use and deliver advice to patients who are ready to quit.
• The 5As are systematically identify all tobacco users at every visit, persuade all users that to quit, and determining readiness.

Table 1

• Strategies for implementation include the fact that tobacco use is a friendly way to ask patients, "Do you smoke cigarettes?".

• Nicotine use status should be recorded, using the implementation methods of asking patients if they smoke cigarettes.

• Asking, "Do you use any tobacco products?".

• Persuade all tobacco users that they need to quit, they should be told a clear, strong and personalized manner.

• The Clear implementation strategy is saying, “It is important that you quit smoking, if you are ill, if will not be enough.”

• Strength is important for implementation, dentists need to inform patients that there is a duty to protect patient health both now and in the future.

• Asking about any demographics, such as women being more susceptible to fertility affects.

• Asses determining a readiness to make a quit attempt, with two questions relation to “importance” and “self-efficacy”.

• Those questions should be, "Would you like to be a non-tobacco user?" and "Do you think you have a chance of quitting successfully?".

• "“What do you not like about being a smoker?”, can determine implementation, with “Well, I don’t like how much I spend on tobacco”.". Any answer that a the tobacco user isn't ready for the quit attempt is to use the 5R's intervention.

5A(s) defined

• Help the patient to develop the assistance of the action plan and implement a strategy for implementation,.
• Use the STAR method or facilitating and helping in developing a plan includes Set a quit date for within 2 weeks, and tell your family, friends, co workers, and ask for supportive.
• For all patients or help, you should see if identify any problems already encountered to make up for lost time, remind patients, assess medication problems, schedule, and congratulate patients.
• Reminds have view of the relapse, review, circumstances, or available intensive treatment available.,

The 5Rs Model to Increase the Motivation to Quit

• 5Rs (relevance, risks, rewards, roadblocks, and repetition) should be addressed during counseling for those not ready to quite because they they do not consider quitting important.

• It is critical to provide the Five R(s) in motivational speech, after discussing the benefits of tobacco, and encourage individuals who make a quitting effort, should be assisted.

• Risk in tobacco use should be discussed because if the patient doesn't think quitting is important, you must show them the danger of smoking.

• Roadblocks should be assessed as the patient has a feel confident to make the ability to quit, you should use the Roadblocks strategy.

• It is critical to end on a positive note when patients are not prepared to quit while still providing an invitation to return if they change their mind.

• motivational and brief. Table 2 discusses effective ideas for implementing brief motivational assistance in primary care.

• You shou8ld encourage a patient to show how quitting will be helpful for them. "How is quitting most relevant to you?" , or if you suppose smoking is bad, for your health".'

• Motivating a person through providing the greatest and most effective assistance in improving their disease status situation .

• Social situations include home, with the family or other close people, which is a important factor, ,

• The the medical professional should make sure that they express that it is bad to have cancer.

• An example is, "what do you know about the risks."

• Shortness can be a great way of providing more context so that people will see the truth in smoking, or an implication of harm on pregnancy or in fertility,

• examples can cause strokes or some cancers or other health issues.

• Improved health will be effective

• "How often do you stop the taste of tobacco" Rewards are to make patients get to feel better, can improve, such as getting a home that does not have strong odors and a a well body.

• Roadblocks of asking, "How will it affect you?", and should provide problem solving counseling and medication that can address barriers.

• An example is nicotine replacing other substances which allow cravings to not be a problem and gives the determination to carry on.

• Repetition includes a repeat evaluation and in being ready and to repeat it with more dates.

Strengthening Oral Health Care Systems to improve integrated delivery of Brief Intervention By Professionals

• More than two-thirds of the health-care professionals dont think it is effective to have a whole healthcare program as they are concerned about patient tobacco usage. These are important to have health professionals who are responsible in handling.
• The building plans are to provide service, workers, information, medical things, financing , and governance.