Tobacco Use Cessation (TUC) care pathway for dental practice

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Description: A decision support tool to assist dental clinicians in helping patients quit tobacco use

Publet Introduction:

Key Points

  • Use of tobacco is one of the leading causes of preventable illness in the U.S.; smoking accounts for approximately 20% of deaths.  
  • When tobacco is smoked, nicotine rapidly reaches peak levels in the bloodstream and enters the brain; if the smoke is not directly inhaled into the lungs, nicotine is absorbed through mucous membranes and reaches peak blood levels and the brain more slowly.
  • Although cigarettes are the most commonly used form of tobacco, other recreational tobacco formulations include conventional smokeless tobacco; compressed dissolvable tobacco; cigars; tobacco pipes and water pipes (i.e., hookahs); and electronic cigarettes (e-cigarettes).
  • The 2008 U.S. Public Health Service clinical practice guideline for treating tobacco use and dependence found that counseling and medication are effective when used by themselves for treating tobacco dependence; however, the combination of counseling plus medication was more effective than either method alone.
  • Because of the oral health implications of tobacco use, dental practices may provide a uniquely effective setting for tobacco use recognition, prevention, and cessation; dental professionals can help smokers quit by consistently identifying patients who smoke, advising them to quit, and offering them information about cessation treatmen

Source ADA


  Information
Guideline objectives
  1. Ask:  Identify and document tobacco use status for every patient at every visit.
  2. Advise:  In a clear, strong, and personalized manner, urge every tobacco user to quit.
  3. Assess:  Is the tobacco user willing to make a quit attempt at this time?
  4. Assist: For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit. 
  5. Arrange:  Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.

Source ADA

  • Determine current tobacco use of patient
  • Determine the patient's attitudes towards tobacco cessation
  • Help the patient quit tobacco by identifying and recommending tobacco cessation resources
Target setting Primary care dentistry
Target users Primary care dental clinicians
Overview

Oral Effects of Tobacco Use
All of the major forms of tobacco used in the U.S. have oral health consequences. Cigarette smoking can lead to a variety of adverse oral effects, including gingival recession, impaired healing following periodontal therapy, oral cancer, mucosal lesions (e.g., oral leukoplakia, nicotine stomatitis), periodontal disease, and tooth staining. Use of smokeless tobacco is associated with increased risks of oral cancer and oral mucosal lesions (e.g., oral leukoplakia). Smokeless tobacco use also causes oral conditions such as gingival keratosis, tooth discoloration, halitosis, enamel erosion, gingival recession, alveolar bone damage, periodontal disease, coronal or root-surface dental caries due to sugars added to the product, and tooth loss.

Cessation Counseling
Because of the oral health implications of tobacco use, dental practices may provide a uniquely effective setting for tobacco use recognition, prevention, and cessation. Health-care professionals, including dental professionals, can help smokers quit by consistently identifying patients who smoke, advising them to quit, and offering them information about cessation treatment. The U.S. Department of Health and Human Services and Agency for Healthcare Research and Quality has published a 5-step algorithm for health-care professionals to use when engaging patients who are dependent on nicotine called “the 5As. The 5 steps are as follows:

  1. Ask:  Identify and document tobacco use status for every patient at every visit.
  2. Advise:  In a clear, strong, and personalized manner, urge every tobacco user to quit.
  3. Assess:  Is the tobacco user willing to make a quit attempt at this time?
  4. Assist: For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit. 
  5. Arrange:  Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.

Source ADA

Provenance 7.No provenance has been assigned (default value)
Management
  • Author: Gopikrishnan Chandrasekharan
  • Release date:
  • Status: Draft - Under Review
  • History: Edited on 23/10/2017
Safety case
Sources

 

  1. West, R., A. McNeill, et al. (2000). Smoking cessation guidelinesfor health professionals: An update. Thorax 55: 987-999.
  2. Sutherland G. Evidence for counselling effectiveness for smokingcessation. J Clin Psych Monograph 2003; 18: 22-34.
  3. http://www.tobacco-oralhealth.net/news/news.asp
References
  1. Couch ET, Chaffee BW, Gansky SA, Walsh MM. The changing tobacco landscape: What dental professionals need to know. J Am Dent Assoc 2016;147(7):561-9.
  2. Winn DM. Tobacco use and oral disease. J Dent Educ 2001;65(4):306-12.
  3. Agency for Healthcare Research and Quality. Five Major Steps to Intervention (The "5 A's"). U.S. Department of Health and Human Services. December 2012.