TABLE 2. Tobacco Cessation Resources to Use During the Assist Phase of Tobacco Cessation Intervention Tobacco Cessation Resources U.S. Food and Drug Administration National Institutes of Health FDA 101: Smoking Cessation Products Centers for Disease Control and Prevention Quit Smoking Smokefree.gov Telephone and Live Chat Counseling Quitline National Cancer Institute Text Messaging Programs Smokefree.gov smokefree.gov/smokefree-text- messaging-programs Cell Phone Apps Smokefree.gov smokefree.gov/tools-tips/apps 800-QUIT-NOW (800-784-8669) LiveHelp SmokefreeTXT fda.gov/ForConsumers/ConsumerUpdates/ucm198176.htm cdc.gov/tobacco/quit_smoking/index.htm Evidence-based smoking cessation resources Free quit coaching, quit plan, educational materials and referrals to local resources. All states have quitlines, with services available livehelp.cancer.gov/app/chat/chat_launch Available Monday through Friday For adults SmokefreeTeen For teens age 13 to 19 SmokefreeEspañol For Spanish speakers quitSTART QuitGuide Free app designed for teens who want to quit smoking Free app to track cravings, mood, triggers, provide motivational messages, tips for success, and monitoring of progress Risk assessment should include exposure to parental smoking, access to tobacco products, peers who use tobacco, and exposure to tobacco advertising.27 should focus on assessing risk, interventions to prevent tobacco use, and tobacco cessation.27 Oral health professionals can provide preventive messages about tobacco use that address oral and systemic health. Messages need to be meaningful for youth in order to make a difference. Highlighting the short- term effects of tobacco use, such as staining of teeth, breath malodor or shortness of breath — which may impact endurance during athletic events — may be an effective stratagem when addressing young tobacco users. According to the USPSTF, however, there is limited evidence related to the most effective approach to tobacco cessation in youth, and there are no pharmaceutical agents approved for this age group.27 Current USPSTF guidelines for adults continue to recommend the “5 A’s” framework for tobacco intervention: asking about tobacco use; advising tobacco users to quit; assessing readiness to quit; assisting with quitting; and arranging follow-up.28 A modified version focused on ask, advise, and refer has also been proposed for oral health professionals, but research suggests patients are more successful in quit attempts when using the “5 A’s” approach.29 Screening patients for tobacco use, including ATPs, may be more chal- lenging than for more traditional cigarette or smokeless tobacco products, because ATPs are not normally included on the medical history. Considering that individuals who report never using tobacco may, in fact, use ENDS, cli- nicians should takes steps to gather comprehensive information. Ask. The health history should list the actual types of ATPs to prompt questions by the oral health professional about the various types of tobacco products and frequency of use. Table 1 (page 45) provides a sample of the information needed for tobacco use assessment. Advise. Providers should advise patients to quit tobacco as a means of supporting oral and systemic health. Patients should be educated about cessation efforts in clear language that is personalized according to the 46 Decisions IN DENTISTRY • December 2017 individual’s needs at each ap - pointment.30 Clinicians should ex - pect ambivalence (conflicted feelings about tobacco use) and listen nonjudgmentally to the patient’s concerns about tobacco cessation. Assess. Oral health profession- als are advised to assess patients’ readiness to quit tobacco use. This readiness to change behavior is a component of the Transtheoretical Model of Behavior Change, which is foundational to motivational interviewing and is widely used to help patients quit smoking.31 In motivational interviewing, oral health professionals act as guides to assist patients in choosing to change behavior and support self- efficacy. While an in-depth discus- sion of motivational interviewing is beyond the scope of this article, many resources are available on this topic. Patients may be in various stages of quitting, including precontemplation (not interested in quitting), contemplation (thinking about quitting), prepa- ration (planning to quit in the next 30 days), action (quitting successfully for up to six months), and maintenance (quitting successfully for more than six months). The stage of readiness to quit should also be recorded in the patient’s chart. Assist. Table 2 provides a sampling of tobacco cessation resources. The resources for clinicians provide information on behavioral and pharmaco- logic approaches to assist patients in tobacco cessation. If the office or clinic has a website, links can be provided for tobacco cessation resources. Given the time constraints and expertise of the dental team, ideally, collaboration by an interprofessional team to assist patients in successfully quitting tobacco is the preferred approach. The team may include the patient’s physician, nurse practitioner, physician assistant, pharmacist and/or sub- stance abuse counselor, as well as others. Oral health professionals should bear in mind that even individuals who smoke only one cigarette per day have a 64% higher risk of early death (primarily from lung cancer) than never smokers.32 Arrange. Clinicians should follow up with patients a week after a planned quit date, as well as at each recare appointment, to reassess or provide support for another quit attempt or relapse prevention.30 In 2006, approximately 44% of adults reported a quit attempt in the past year, yet, without formal treatment, 95% to 98% resumed tobacco use. This underscores the need for oral health professionals to be actively involved in relapse prevention,33 which involves sharing strategies to help patients avoid or recover from lapses or relapses. Avoiding blame and guilt for a relapse is essential because negative emotions reduce the chances of success.33 Patients should be encouraged to examine the relapse to identify the trigger(s) and find approaches to avoid or over- come these trigger(s).33 DecisionsInDentistry.com
