○ Enjoyment of tobacco. ○ Being around other tobacco users. ○ Limited knowledge of effective treatment options. 5. Repetition : The clinician should repeat the intervention every time an unmotivated patient visits the clinic/ office if the patient agrees to discuss tobacco use. Repetition without the patient’s permission can be counterproductive. Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful. changes, smoking also results in mucosal changes that can be shown to the patient to provide this teachable moment. The increased use of intraoral cameras has revolutionized the way in which dental practitioners communicate with patients. For example, a case of nicotinic stomatitis can be easily shown to the patient as an ill effect directly related to smoking. In the same way, giving the patient a firsthand view of mucosal changes due to smoking can be a teachable moment that becomes the impetus of change to help the patient quit smoking. Although the teachable moment is not included in the 2008 update of the U.S. DHHS clinical guideline Treating Tobacco Use and Dependence , 9 many dental professionals still consider it as part of their smoking cessation armamentarium.
attempt becomes stronger. Patients are the best source for information on their barriers to quitting as well as ideas for a solution. The clinician may offer potential solutions that could address these barriers, if appropriate to the situation (e.g., problem solving, counseling, medication). Typical barriers might include: ○ Withdrawal symptoms.
○ Fear of failure. ○ Weight gain. ○ Lack of support. ○ Depression.
The teachable moment The term teachable moment characterizes an intervention model put forth by Herbert Severson in 1990 for smokeless tobacco cessation. He proposed that the dental office was an ideal setting for smokeless tobacco cessation programs because the majority of adults receive dental care annually and the effects of smokeless tobacco are often visible upon oral examination. 58 As Severson describes it, the teachable moment is the clear demonstration of oral lesions directly associated with smokeless tobacco use. Although this intervention was originally designed primarily for use with smokeless tobacco cessation, it has evolved considerably over the years and can also be utilized in smoking cessation programs. Even though smokeless tobacco use often produces more immediate mucosal Preventing relapse The former tobacco user should be congratulated on any success and strongly encouraged to remain abstinent. The clinician may assist in addressing specific problems and potential solutions. If the patient reports prolonged craving Use of smartphone application and social media The current generation relies heavily on social media and artificial intelligence for all aspects of decision making and activities 59 . Bricker and colleagues found that the use of a smartphone application was more efficacious than standard smoking cessation methods. The application focused on avoiding smoking triggers. Social media can play a vital
or other withdrawal symptoms, extending the use of an approved medication or adding/combining medications to reduce strong withdrawal symptoms should be considered. 9
role in tobacco prevention and education endeavors while smartphone applications can play therapeutic and behavioral roles in tobacco cessation. Use of social media for tobacco cessation messaging can serve a dual purpose of marketing and public education.
SMOKING CESSATION PHARMACOTHERAPY
The 2008 update of the Treating Tobacco Use and Dependence clinical practice guideline lists the five forms of nicotine replacement therapy, bupropion SR, and varenicline as first-line medications that are approved by the FDA for
the treatment of tobacco dependence. (See Table 2) Other pharmacotherapeutics which have shown potential are Nortriptyline, Clonidine, cycloserine, memantine, baclofen, topiramate, galantamine, and bromocriptine. 60
Table 2: Medications for the Treatment of Tobacco Use Medication
Dosage/ Maximum Usage 1 piece every 1 to 2 hours, dosage keyed to daily cigarette use: • If ≤ 24 cigs: 2 mg, maximum 30 pieces/ day. maximum 24 pieces/ day. • If ≥ 25 cigs: 4 mg,
Duration of Use Up to 12 weeks (use may be extended if necessary to prevent relapse).
U.S. Availability OTC only: • Generic. • Nicorette.
(Dosages Available)
Cautions/Warnings
Side Effects
• Mouth
Nicotine gum (2 mg or 4 mg)
• Not for use with TMJ disorders. • Use with caution with dentures. • Do not eat or drink 15 min before, after, or during use.
soreness.
• Upset
stomach. • Dizziness,
headaches.
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