This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.
4. INTRODUCTION
Prevention of oral cancer mainly focuses on
modifying habits associated with the use of
tobacco
India is the largest consumer of tobacco and
third largest producer of tobacco
There are about 250 million tobacco users in
India
In India, at least 800,000 deaths every year
are related to tobacco use, and 700,000
them due to smoking
of
5.
There are three well-known approaches
Regulatory
approach
1975
: Cigarette Act
1985
: National Cancer Control Program
2003
:
Cigarettes
Products Act
2004
: WHO-FCTC
Service
approach
screening
and
other
Tobacco
6.
Educational approach
Role of the dentist
harmful
effects of tobacco
counsel
patients
tobacco-free
tobacco
spend
lifestyle
use during pregnancy
more time with patients
reinforce
messages given to patients
8. Guide to counseling for tobacco
cessation (5 A’s)
ASK about
patient’s habit
• Identify and document tobacco user
status of every patient at every visit
ADVICE of
consequence
of smoking
• In a clear, strong and personalized
manner urge every tobacco user to quit
ASSESS
willingness to
quit
• Is the tobacco user willing to make a quit
attempt at this time ?
9. ASSIST with • For the patient willing to make
a quit attempt, use counseling
cessation
and pharmacotherapy to help
plant
him quit
development
ARRANGE
for follow-up
• Schedule follow-up contact,
preferably within the first week
after the quit date
11.
Basic principles for prescribing NRTs
Medical
Use
supervision is important
a lower dose for less dependent
tobacco users
Contraindicated
,
:
lactation,
diseases,
disease,
,
in
cardiovascular
peripheral
endocrine
inflammation
throat,
pregnancy
of
the
oesophagitis,
vascular
disorders
mouth
and
gastric
12.
Nicotine gum
use
under medical supervision for a
predefined limited period, e.g. 6 weeks
, after which the patient has to face
withdrawal
13.
Nicotine withdrawal symptoms
Craving for tobacco
Depressed mood
Insomnia
Irritability
Frustration
Anxiety
Difficulty in concentration
Restlessness
Decreased heart rate
Increased appetite and weight gain
14.
Antidepressants
Function
as anti-craving medications
Available
therapies :
First-line
therapies
Buproprion SR
Selegeline
Second-line
Clonidine
nortryptiline
therapies
15.
Counseling those unwilling to quit
Relevance
Risks
of quitting
of continuing tobacco use
Rewards
of quitting
Roadblocks
Repeat
to quitting
these at each visit
18. ACTION IN THE COMMUNITY
Public education
Media advocacy
ACTION AT THE STATE AND NATIONAL
LEVELS
Making the profession and dental
facilities tobacco-free
Advocacy with the state and national
governments
19. CONCLUSION
A majority of cancer deaths worldwide
are due to tobacco. These are easily
avoidable since the factors associated
with the disease have long been
identified.