● Hunger/weight gain. ● Restlessness. ● Drowsiness. ● Fatigue. ● Nervousness. ● Sleep disturbance. 55 INTERVENTIONS FOR COMBUSTIBLE TOBACCO USE AND DEPENDENCE
patient has smoked and the number of cigarettes smoked per day. Common symptoms include: ● Anger. ● Irritability.
● Anxiety. ● Craving.
Services’ clinical guideline, Treating Tobacco Use and Dependence: 2008 Update , is divided into three sections, based on the intended audience: (a) current tobacco users ready to quit, (b) current tobacco users not willing to make a quit attempt, and (c) former tobacco users who have recently quit. 11 The guidelines for treating tobacco use and dependence are summarized below. These intervention components constitute the core elements of a tobacco intervention, but they need not be applied in a rigid, invariable manner. dental hygienist can offer recommendations and instructions for the use of over-the-counter nicotine replacement products. The dentist should offer recommendations and/or a prescription for medications to assist in a quit attempt (except when there are contraindications; insufficient evidence of effectiveness; or controversy on the risk-benefit ratio for specific populations such as pregnant women, smokeless tobacco users, light smokers, and adolescents). Striving for total abstinence is essential. Counseling should include practical problem solving skills and training. The provider should assist the patient in identifying lessons learned from past quit attempts and triggers that may prompt automatic smoking. It is also important to discuss future challenges and/or triggers and help the patient develop ways to successfully overcome them (e.g., avoid behaviors associated with smoking, alter routines). Counseling should build on past successes. Because alcohol is associated with relapse, the patient should consider limiting or abstaining from alcohol while quitting. Because quitting is more difficult with other smokers in the household, patients should encourage housemates to quit with them or to refrain from smoking in their presence. 5. Arrange follow-up . A supportive clinical environment will contribute to the patient’s smoking cessation success. For the patient making a quit attempt, follow-up contacts should begin within the first week after the quit date. Patients who remain abstinent should be congratulated on their success. If tobacco use has reoccurred, the circumstances prompting this “slip” should be assessed and recommitment to total abstinence reinforced. For patients unwilling to make a quit attempt at the present time, their tobacco dependence and willingness to quit should be addressed at the next clinic visit. An example of verbal support might be: “Our office is available to assist you when you are ready or to provide you with a list of resources.” of Health and Human Services’ clinical practice guideline, Treating Tobacco Use and Dependence: 2008 Update . 11 A Cochrane review in 2010 found that the effectiveness of MI is much smaller in pregnant females, and management of pregnant females may require additional interventions. 57
With an investment of less than five minutes of their time, dentists and dental hygienists can help reduce death and disease associated with tobacco use. Clinician-delivered intervention enhances motivation and increases the likelihood of future quit attempts even if the message is delivered before the patient is ready or willing to make a quit attempt. 11 Picture warnings regarding the detrimental effects of smoking have been found to be very effective; the display of smoking cessation information can be a first step in the process. To assist clinicians in tobacco cessation intervention, the U.S. Department of Health and Human The Five A’s The term “Five A’s” represents the five key steps in tobacco intervention: ask, advise, assess, assist, and arrange: 9 1. Ask about tobacco use . The clinician should identify and document tobacco use status for every patient at every visit. It is recommended that an office-wide system be implemented to ensure that tobacco use status is queried and documented for every patient at every clinic visit. 2. Advise patients to quit . The clinician should urge every tobacco user to quit. Examples of clear, strong, and personalized messages are: ○ Clear : “It is important that you quit smoking now, and I can help you.” “Cutting down while you are ill is not enough.” “Occasional or light smoking is still dangerous.” ○ Strong : “As your clinician, I need you to know that quitting smoking is the most important thing you can do to protect your health now and in the future. Our office will help you.” ○ Personalized : Tie tobacco use to current symptoms and health concerns, its social and economic costs, and the impact of smoking on children and others in the household. “Continuing to smoke will compromise the success of the periodontal therapy, and quitting will dramatically improve your health.” “Quitting smoking may reduce the risk, severity, and number of ear infections in your child.” 3. Assess the patient’s willingness to make a quit attempt. If the patient is willing to make a quit attempt at the present time, provide assistance. Even if the patient clearly states that he or she is unwilling to make a quit attempt at the present time, intervention has been demonstrated to increase the probability of a future quit attempt. 4. Assist the patient willing to make a quit attempt, offer medication, and provide or refer for counseling or additional treatment. In addition to counseling, smokers ready to make a quit attempt should receive information on tobacco cessation medications. The Motivational interviewing Patients unwilling to quit may respond to brief motivational interventions that are based on principles of motivational interviewing (MI). Developed by Miller and Rollnick, MI is a directive, patient-centered counseling intervention. Its four general principles are: express empathy, develop discrepancy, roll with resistance, and support self-efficacy. 56 These principles are incorporated in the U.S. Department
Page 75
EliteLearning.com/Dental
Powered by FlippingBook