fostering a more empathetic and unbiased approach to patient care. Additionally, implementing policies and procedures prioritizing equitable treatment for all patients can play a pivotal role in reducing healthcare disparities. Ultimately, confronting implicit bias in healthcare is essential to creating a more just and equitable healthcare system where everyone receives fair and equal treatment regardless of their background or characteristics.
or make assumptions about their medical needs based on race, gender, or age. The unconscious assumptions can lead to delayed or inadequate care, misdiagnoses, or inappropriate treatments, all of which can adversely impact health outcomes. Addressing implicit bias in healthcare is crucial for achieving equity in medical treatment. Strategies to combat these biases involve education and awareness programs for healthcare professionals. These programs help individuals recognize and acknowledge their biases,
INTRODUCTION
likely to have regular dental visits than physician visits and can benefit from dental practice cessation efforts. 9 Patient interest in esthetics and cosmetic dentistry is very common today, and tobacco cessation can enhance the short- and long-term results of such treatments. Standard six-month recall appointments in dental offices offer opportunities for convenient follow-up to evaluate cessation progress, to reinforce positive changes, and to review readiness to quit in patients who were not ready to make a quit attempt at a previous appointment. Although there has been enormous progress toward decreasing the incidence of smoking since the 1964 release of the first report of the Surgeon General’s Advisory Committee on Smoking and Health, tobacco use remains the leading preventable cause of death and disability in the United States today 10 *. The clinical practice guideline Treating Tobacco Use and Dependence: 2008 Update was published by the U.S. Department of Health and Human Services, Public Health Service. 11 The development of the guideline was sponsored by a consortium of eight U.S. federal government agencies and nonprofit organizations. The expert panel employed an explicit, science-based methodology to evaluate 8,700 research articles on tobacco treatment. The resulting 256-page publication is a distillation of the evidence-based literature on the treatment of tobacco use. This landmark publication provides the most current information on the treatment of tobacco dependence. The introduction acknowledges the progress that has been made in multiple areas of tobacco intervention. Tobacco use is now accurately viewed as a chronic disease rather than a habit. Tobacco use cessation must address nicotine dependence as well as the social and psychological components of tobacco use. 11 This course provides dentists, dental hygienists, and dental assistants with the information to practice tobacco cessation intervention. *Note : This course addresses the topic of tobacco use. With the exception of the last section of the course, all references to smoking refer to the use of combustible tobacco products. The last section of the course addresses the unique issues involved in the prevalence and health risks of smokeless tobacco use.
Tobacco use is an enormous problem and health burden for people worldwide. A history of smoking has been widely associated with increased morbidity and motility in COVID sufferers 1 . An unusual observation regarding smoking in COVID times has been an increased smoking in a subset and a decrease in another subset 2 . It may be due to the influence of stress, boredom, lifestyle, and motivation. Although the prevalence of smoking in the United States has declined slightly in recent years, there has been an increase in the use of smokeless tobacco products. As a result, along with targeting individuals who use smokeless tobacco products, healthcare professionals must redouble their efforts to intervene with all patients who continue to smoke. The purpose of this basic-level course is to provide dentists, dental hygienists, and dental assistants with background and guidelines for tobacco interventions in clinical practice. The course will discuss the prevalence of smoking of combustible tobacco and use of smokeless tobacco products as well as the health risks of tobacco use and tobacco exposure. The effects of nicotine on human physiology and their implications for nicotine dependence and withdrawal will be examined. Techniques for tobacco intervention will be described in detail, including the pharmacotherapy used in tobacco cessation both for the smoking of combustible tobacco and the use of smokeless tobacco. The U.S. Department of Health and Human Services has developed new long-range goals for oral health interventions, Healthy People 2020 . Objective 14 (OH14.1) proposes preventive interventions in dental offices to “increase the proportion of adults who receive information from a dentist or dental hygienist focusing on reducing tobacco use or on smoking cessation.” 3 Almost one third of smokers visit a dentist each year. 4 Approximately 70% of smokers report wanting to quit 5 and almost two thirds of smokers who relapse want to try quitting again within 30 days. 6 Evidence suggests that more than 50% of dental patients believe dentists and dental hygienists should routinely offer such tobacco intervention. 7,8 Advice from a healthcare professional can be an important source of motivation in quitting tobacco use. The dental team is ideally positioned to assist patients in quitting tobacco. In particular, individuals who are 22 to 40 years old are more
SMOKING PREVALENCE
In the United States alone, smoking causes approximately 480,000 premature deaths each year, accounts for up to 30% of cancer deaths annually, and is the single most preventable cause of disease and death. 12 Despite the adverse health effects of smoking cigarettes, about 12.5% of U.S. adults (30.8 million men and women) currently smoke. The good news is that the proportion of U.S. adults who were current cigarette smokers declined in the early years of the twenty-first century (20.9% in 2005 to 12.5% in 2020). 13 Youth smoking is a particularly important indicator of future tobacco use because 80% of adult smokers report having started smoking before the age of 18. The decline
in smoking among high school students has slowed in comparison to earlier reports. 14 It is estimated that of those individuals who start smoking before the age of 18, more than six million will die prematurely from a smoking-related disease. 15,16 Tobacco use by teens is not only the result of psychosocial influences, such as peer pressure. 17 Research shows that adolescents are especially vulnerable to nicotine addiction: The prefrontal cortex does not fully mature until an individual is in his or her 20s, so the adolescent brain may be less able to override impulsive decisions or cravings for drugs. In addition, adolescents may be especially sensitive to acetaldehyde, a compound found in tobacco smoke that
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