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1. SMOKING CESSATION
Adeyemi Aderinsola
Adungbe Oluwadahunsi
Adeyanju Ayoade

2. OUTLINE
• Introduction
• Common constituents of Tobacco Smoke
• Different forms of smoking
• Effects of Smoking on Oral Health
• Effects of Smoking on General Health
• Smoking Cessation
• Alternatives to smoking
• Coping Strategies while quitting Smoking
• Conclusion
• References

3. Introduction
• Smoking is one of the most common forms of recreational drug use.
• Tobacco today is by far the most popular form of smoking and is
practiced by over 1 billion people in the majority of all human
societies.

4. What is smoking?
• Tobacco smoking is the practice of burning tobacco and ingesting the
smoke that is produced.
• The smoke may be inhaled or simply released from the mouth.

5. Common Constituents of tobacco smoke
1. Nicotine;
The addictive drug that produces the effect in the brain people are
looking for.
2. Aldehydes (acrolein,formaldehyde)
3. Carbon monoxide
4.Hydrogen cyanide
5 Nitrogen oxides
6. Benzene
7. Toluene

6. 8. Phenols (phenol,cresol)
9. Harmala alkaloids
10. Cadium
11. Methanol
12.Lead
13. Hexamine
These and many more are seen to be constituents of tobacco smoke

7. Different forms of smoking
• Cigarettes;
• A cigarette is a roll of tobacco
• It is the most widespread means of nicotine delivery.

8. • Cigars and Pipes;
• A cigar contains half an ounce of tobacco which is roughly as much as
a pack of cigarettes.
• Also, a cigar will have between 100-200mg nicotine while an average
cigarette contains 12mg.

9. • Hookahs;
• Hookahs pose the same danger to your health as cigarettes. An
average hookah session lasts 1 hour and during that time, 90,000ml
of smoke as opposed to 500-600ml a smoker smoking cigarette
inhales.
• Tobacco in hookahs is heated by charcoal and studies suggests that
this method of delivery puts smokers at risk of inhaling much larger
quantity of harmful CO, heavy metals as well as nicotine

11. • Bidis and Clove Cigarettes
• Bidis hail from india . They are hand-rolledand the tobacco is covered
in kendu or a temburni leaf. They can be flavored or unflavoured
• Clove cigarettes (also called Kreteks) are from Indonesia . They
contain 6O% tobacco and 40% cloves.

13. Effects of smoking on the Oral Health
1. Halitosis
2. Tooth discolouration
3. Increased build up of plaque and tartar
4. Increased bone loss within the jaw
5. Increased risk of leukoplakia

14. 6. Increased risk of developing gum disease
7. Delayed healing process following extraction
8. Increased risk of developing oral cancer.

15. Effects of smoking on the General Health
• Eyes
• They have a higher chance of developing cataract
• lungs
• Smokers are at a higher risk of developing lung cancer. Smoking
causes emphysema and other COPD, it is related to asthma among
children and teens
• Heart
• A leading cause of coronary artery disease
• Causes atherosclerosis

16. • Also causes abdominal aortic aneurysm
• Stomach
• Stomach cancer
• More likelihood of peptic ulcer
• Pancreas
• Causes pancreatic cancer
• Kidneys
• Causes kidney cancer

17. • Bladder
Causes bladder cancer
• Pregnancy
• Sudden infant death syndrome
• Premature delivery
• Limits oxygen getting to the foetus
• Erectile dysfunction risk in males
• Damage to the genetic material in sperm.

18. • Bones
Increased likelihood to gevelop osteoporosis.

19. What is smoking cessation?
• Smoking cessation is the process involving conselling, behavior
therapy and pharmacotherapy with the sole aim of discontinuing
tobacco smoking
• It is known as quitting smoking

20. Statistics
• In the US, about 70% of smokers would like to quit smoking
• 50% report having made an attempt to do so
• As at 2012, WHO estimated 13 million smokers.
• In 2015, an estimate of 11 million current smokers and 20 million ever
smokers.
• The overall prevalence of smoking was estimated at 19.7% - Adeoye
et al 2018
• Most current smokers started smokin at age 14 of which majority are
males and geographically, more cases are in northern Nigeria

21. Control of the Epidemic –
WHO's MPOWER strategy (2007)
• Monitoring tobacco use and prevention
• Protecting people from tobacco smoke
• Offering help to quit tobacco use
• Warning people of the dangers of tobacco
• Enforcing bans on tobacco advertising, promotion and sponsorship
• Raising taxes on tobacco

22. Stages of change model as applied to smoking
cessation
• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance and relapse prevention

24. Approach to smoking Cessation
• Unassisted
Very common. Smokers make an attempt to stop smoking especially
without assistance (cold turkey)
Practised by many ex smokers.
• Cold Turkey
Abrupt cessation of smoking without assistance or medication.
Has low success rate 4-7%

25. • Advice and Counselling
1. Community Interventions
2. Psychosocial support
3. Psychosocial support + self help materials
4. Competitions and incentives
5. Cutting down to quit (should work)

26. • Use of Pharmacotherapy (NRTs, antidepressants, Clonidine,
Varenicline)

27. The role of dental team in proving smoking
cessation advice
• Members of the dental team are in an ideal position to identify
patients who smoke and who are contemplating giving up. Dentists
are often the only healthcare professionals who see healthy young
adults who are smokers on a regular basis.
• Smoking status should form a core question in taking a patient’s
medical history. This can act as a prompt to discussing the effects of
smoking on oral health

28. The role of dental team in proving smoking
cessation advice
• Having identified patients who are interested in stopping smoking,
dentists should refer them to the local smoking‐cessation services,
who have the expertise to provide appropriate counselling and can
prescribe effective medication to help overcome nicotine withdrawal

29. 5 As of tobacco cessation
• Ask
• Advice
• Assess
• Assist
• Arrange

30. 5 As of tobacco cessation cont’d
• ASK
• Ask all patients about tobacco use/smoking status and document
answers at every visit. Take a history; current smoker, ever used
tobacco
• Have you tried to stop in the past?
• The technique for inquiring about tobacco use will be divided into
two categories
• Smoked and smokeless tobacco

31. 5 As of tobacco cessation cont’d
• The direct approach is best, and questions should be asked in a non-
accusatory fashion. Ask: "Do you smoke cigarettes, cigars, or a pipe?“
• If the patient answers no, then ask: "Have you ever smoked?" and
"When did you stop smoking?" Both questions are important and
relate to cancer risk and severity of lung disease.

32. 5 As of tobacco cessation cont’d
• If the patient answers affirmatively, then try accurately to quantify
the amount.
• Cigarette smoking is quantified by inquiring about what portion of a
pack or how many packs are smoked per day and for how many years.
• A standard package contains 20 cigarettes. This can be translated into
pack years:

33. 5 As of tobacco cessation cont’d
• Pack years = No of packs per day x no of years smoked.
• 2 packs per day for 15 yrs = 2 x 15 = 30 pack yrs
• Pipe smoking is more difficult to quantify because many pipe smokers
do not actually have their pipe lit all the time.

34. 5 As of tobacco cessation cont’d
• The easiest way to quantify pipe smoking is the number of bowlsful of
tobacco used per day, or how long a pouch of tobacco lasts.
• It is also important to quantify the degree of smoke inhalation, best
done by categorizing as no inhalation, mild or moderate inhalation,
and deep inhalation.

35. 5 As of tobacco cessation cont’d
• ADVISE
• Advise all smokers to stop. Advice should be:
• Clear: provide an unambiguous message to quit
• Strong: stress importance of quitting
• Personalized: tie tobacco use to current oral or other health problems
and consequences; social, familial and economic costs; and
motivation level or readiness to quit

36. 5 As of tobacco cessation cont’d
• ASSESS
• Determine willingness to make a quit attempt
• Ask if tobacco user is willing to quit in the next 30days.
• -If willing to make an attempt, provide help:
• - If willing to participate in intensive treatment, deliver treatment or
refer patient to an intensive intervention
• - If unwilling, provide a motivational intervention
• - If the patient is a member of a special population—adolescent,
pregnant, consider providing additional information.

37. 5 As of tobacco cessation cont’d
• Assist the patient in stopping.
• 1. HELP TO PREPARE FOR QUITTING.(STAR)
• - Set: a quit date, ideally within two weeks
• - Tell: Have patient tell family, friends and co-workers and ask for
understanding and support.
• - Anticipate: challenges such as nicotine withdrawal symptoms,
particularly during the critical first weeks
• - Remove: tobacco products from environment especially where they
spend a lot of time like work place, home or car.

38. 5 As of tobacco cessation cont’d
• 2.PROVIDE PRACTICAL COUNSELING, PROBLEM SOLVING AND SKILLS
TRAINING.
• - Total abstinence is essential and should be emphasized.
• - Identify what helped and hurt in previous quit attempts
• - Anticipate and discuss triggers or challenges in the upcoming
attempt and how the patient will successfully overcome them
(RELAPSE PREVENTION) eg coping skills

39. 5 As of tobacco cessation cont’d
• - Since alcohol can cause relapse, the patient should consider limiting
or abstaining from alcohol while quitting
• - Quitting is more difficult when there is another smoker in the
household; patients should encourage housemates to quit with them
or to avoid smoking in their presence
• Provide supplementary materials: Provide self-help literature

40. 5 As of tobacco cessation cont’d
• 3. RECOMMEND THE USE OF APPROVED PHARMACOTHERAPY.
• Pharmacotherapy increases smoking cessation success and reduces
withdrawal symptoms
• The withdrawal symptoms include anger, anxiety, depressed mood,
difficulty concentrating, increased appetite, and craving for nicotine.
• Most of these symptoms subside within 3 to 4 weeks, except for the
craving and hunger, which may persist for months.

41. 5 As of tobacco cessation cont’d
• According to the CDC, use of cessation medications is appropriate for
most adult smokers, with the exception of pregnant women, light
smokers (i.e., persons who smoke fewer than 5 to 10 cigarettes daily),
and persons with specific medical contraindications (e.g., seizure
disorders).
• A combination of behavioural counselling and pharmacotherapy is
more effective than pharmacotherapy alone

42. First line pharmacotherapy
• 1. Nicotine gum 2. Nicotine patch
• 3. Nicotine inhaler 4. Nicotine nasal spray
• 5. Nicotine Lozenges
• 6. Bupropion SR
• 7. Varenicline
• There is evidence that combining the nicotine patch with either
nicotine gum or nicotine nasal spray increases long-term abstinence
rates over those produced by a single form of NRT.

43. Second line pharmacotherapy
• These are for patients unable to use first-line medications because of
contraindications or for patients for whom first-line medications are
not helpful.
• Clonidine
• Nortriptyline.

44. 5 As of tobacco cessation cont’d
• Arrange a follow up
• Follow up soon after the quit date, preferably during the first week;
• Make a second follow-up contact within the first month; schedule
further follow-up contacts as indicated
• Congratulate success if patient is abstinent.
• If tobacco use has occurred, review circumstances
• Elicit recommitment to total abstinence

45. 5 As of tobacco cessation cont’d
• Remind patient that a lapse can be a learning experience
• Identify problems already encountered and anticipate challenges in
the immediate future
• Assess pharmacotherapy use and problems
• Consider use of or referral to more intensive treatment
• Review periodically

46. Motivational interview
• Is nonjudgemental and non confrontational.
• Its a patient-centered interviewing style,
• During motivational interviewing, the role of the dental professional
is to increase the patient's awareness of potential problems and
consequences of their behaviour but to meet the patient where they
are, and help reduce ambivalence.
• In addition, the goal is to help patients identify what obstacles or
concerns they have regarding tobacco cessation, and provide support
to assist with those obstacles.

47. 5 Rs of Motivation
• Relevance: encourage the patient to indicate why quitting is
personally relevant
• Risks: ask patient to identify potential negative consequences of
tobacco use
• Rewards: ask the patient to identify potential benefits of stopping
tobacco use
• Roadblocks: ask the patient to identify barriers to quitting
• Repetition: motivational intervention should be repeated everytime
an unmotivated patient has interaction with the clinician

48. Alternatives to Smoking
• There are many alternatives to smoking
• Some of these alternatives include:
• Electronic Cigarette- It is possible to take a nicotine free
cigarette as this comes in two forms.
• Some others still contain nicotine.
• The nicotine free type still produces the signature vapour
effect.

49. Alternatives to Smoking

50. • Patches: These patches are worn on skin and then the nicotine is
absorbed subcutaneously.
• Nicotine Gum: This gum is chewed slowly until the nicotine is tasted and
released into the body.
• Lozenges: These are candy tablets that are dissolved in the mouth and
then releasing nicotine into the body.
• Inhalers: Vapour is released into the mouth through a mouthpiece. It
delivers nicotine relatively slower than the traditional cigarette.

51. • Nasal Spray: A small bottle is sprayed by a medical professional into the
nose. It comes as a liquid.
• Hypnotherapy: It is a popular form of treatment to help achieve the goals
of smoking cessation. It works by putting the patient in a deep, relaxed
state where your mind is opened to suggestion
• Acupuncture: This is a system of complementary medicine in which fine
needles are inserted at specific points of the body(Tim Mee). It is used to
specifically stop smoking and helps change the way cigarettes taste.

52. • Smartphone Apps: Many popular smartphone apps help quit smoking by
means of distraction in a way that the apps give inspirational and
motivational routines, keeping track of the financial benefits of swapping
cigarette for something cheaper.

53. Coping Strategies while quitting smoking
• Eat a healthy snack or chew gum
• Find something to do with your hands
• Connect with people you love
• Find a healthy new habit
• Minimize stress if you can
• Think about why you quit
• Don’t give up if you have a setback

54. Conclusion
• Smoking has numerous effects not desirable for health
• It is important to encourage smokers to quit before several health
complications set in.

55. References
• “Take steps Now to stop smoking”. nhs.uk April 2018
• “Quit methods used by US adult Cigarette smokers” Carabello et al
(April 2017).
• “WHO Report on global tobacco epidemic” World Health
Organisation. 2015
• Dental public health at a glance by Ivor G. Chestnutt 1st edition
• “Patient not ready to make a quit attempt now (the 5 Rs). Agency for
Healthcare Research and quality. 2012
• www.cdc.gov/tobacco