TOBACCO CESSATION

AMRITA SCHOOL OF DENTISTRY

1. TOBACCO CESSATION

2. Contents Introduction Steps in treating tobacco use and dependence Psycho- behavioral therapy Pharmacotherapy Nicotine replacement therapy Antidepressants Key counselling concepts Action in the community Action at the state and national level Conclusion References 2

3. Introduction Prevention of oral cancer mainly focuses on modifying habits associated with the use of tobacco. Deaths due to tobacco use – 800,000 Deaths due to smoking – 700,000 3

4. 130 million tobacco users in India 4

5. Leading tobacco-producing countries worldwide in 2020 (in 1,000 metric tons)* 5

6. The first step in treating tobacco use and dependence is to identify tobacco users. Screening for current or past tobacco use will result in four possible responses: 1. The patient uses tobacco and is now willing to make a quit attempt. 2. The patient uses tobacco but is not now willing to make a quit attempt. 3. The patient once used tobacco but has since quit. 4. The patient never regularly used tobacco. 6

7. For the Patient Willing to Quit Guide to counseling for tobacco cessation (5 A’s) 7

8. Check for the oral signs: stained teeth, halitosis, periodontal diseases, tooth mobility, discolored patches on the mucosa(white, red, dark precancerous lesions) Encourage never-users to stay away from tobacco. Affirm and congratulate those who have quit tobacco use. 8

9. Level of dependence Description High Individuals who use tobacco within 30 minutes of waking up or who use it 25 or more times per day Moderate Individuals who use tobacco more than 30 minutes after waking up or less than 25 times per day Low Those who neither use tobacco before 30 minutes of waking up or use it more than 25 times a day. 9

10. Assess the risk of relapse: Lower risk – quit before or even for just 30 days Higher level of dependence usually needs a more intensive intervention to avoid relapse Individuals with depression or habit of drinking alcohol may increase the risk of relapse. Rigorous follow-up reduces the risk of relapse 10

11. Assist your patients with a quit plan. Give advice on successful quitting Provide resources for your patient. Assist your patient to quit by setting a quit date, ideally within 2 weeks of the visit. Have the patient arrange support from family, friends and co-workers. 11

12. 1. 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, and gastric Use of Pharmacotherapy 12

13. Nicotine gum: Use under medical supervision for a predefined limited period, e.g. 6 weeks after which the patient has to face withdrawal 13 2. Anti-depressants Function as anti-craving medications Available therapies : First-line therapies Bupropion SR Selegeline Second-line therapies Clonidine Nortryptyline

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17. Global Initiatives The Crete Declaration on Oral cancer Prevention 2005 WHO Framework Convention On Tobacco Control (WHO FCTC) Bloomberg Initiative to Reduce Tobacco Use Campaign for tobacco-free kids. Centre for disease control and prevention foundation. John Hopkins Bloomberg School of Public Health Education/training. WHO -Tobacco Free Initiative (TFI) World Lung Foundation. 17

18. Conclusion A majority of cancer deaths worldwide are due to tobacco. The suffering, disfigurement and death due to oral cancer are easily avoidable since the factors associated with the disease have long been identified. World No Tobacco Day theme (2022) " Protect the environment" 18

19. Suggested Reading Soben , Peter. "Essentials of Public Health Dentistry." (2014). Marya , C. M. A textbook of public health dentistry. JP Medical Ltd, 2011. 19

20. " Protect the environment" 20