3A's Approach

• Smoking Cessation legislations?

  • smoking kills - white paper in tobacco DoH 1998
  • Helping smokers to stop HEA 1999
  • Modernising NHS dentistry DoH 2000
  • NHS dentistry: options for change DoH 2002
  • Helping smoker to stop a guide for the dental team HDA & BDA 2004
  • Smoke free and smiling DoH 2007
  • GDC learning outcomes 2011
• Studies in SC in dental settings

  • 85% dentist advise a pt to stop smoking at some time
  • 82% thought DP should encourage pt to stop smoking
  • Dental teams have +++ positive attitude towards cessation and are becoming more involved
• Why should the dental team be involved?

  smoking RF for +++ OC

  • link to perio
  • oral cancer = 2000 new cases per year
  • smokers respond less well to Tx

  Dental team in good position for brief intervention

  • reg health checks
  • trained in prevention and health promotion
  • excellent communication and good pt relationships
• What introduced the 3As

  smoke free and smiling: helping dental patient to quit tobacco DoH 2007
• ASK

  ask abt smoking at every op

  • establish smoking status and history
  • rv at appropriate intervals
  • record info in notes
• Taking a smoking history - ex or non smoker

  note in records and rv periodically
• Taking smoking history - current smoker ?

  • how many do they smoke
  • what type is used (even smokeless tobacco)
  • how long have they been smoking (oral signs and perio incidence is dose dependent)
• Is perio dose dependent

  yes
• Test for motivation for SS?

  1. have you ever stopped before
  2. do you want to stop for good
  3. interested in making a serious attempt in near future
  4. interested in receiving help with attempt
• Advise

  all smokers of risks and to stop

  • + risk of OC
  • +risk of perio and poor response to Tx
  • bias towards - signs of inflammation

  Emphasise SS most effective step towards improving health and health or those around them
• if pt not interested in advise

  record in notes and rv interest at appropriate point in future
• If pt interested in advise

  move to next A - remember give a personalised strong message but dont nag
• If a pt is interested in quitting what should be done?

  assess pts smoking dependency and support needs

  • how many smoked
  • how quickly after waking do they smoke
  • smoking pattern
  • rv prev attempts and support wishes
  • fagerstrom test can be used
• Fagerstrom test for nicotine dependence

  
  

  points scored from 0-3

  1. how soon after waking do you first smoke
  2. do you find it hard to refrain from smoking in prohibited places
  3. which cigarette would you have to give up most
  4. how many do you smoke per day
  5. do you smoke more in first few hours of day than the rest
  6. do you smoke even if you are so ill you are in bed most of the day
• Fagerstrom test results

  highest score = 10

  1-3 = low dependence

  4-6 = medium dependence

  7-10 = high dependence
• Act


  act on pt response by referring and assisting
• arranging a referral to NHS stop smoking services ?

  • 4x more liekly to quit
  • locator found online at smokefree.nhs.uk or call smoke free
  • one to one or group counselling
  • 6-8 sessions of withdrawal orientated Tx
• Birmingham quit services?

  • access through primary care services
  • can be found on public health website with a postcode locator service
• What should be considered when referring?

  • is indv rlly motivated to quit
  • will pt enter 8 week programme at SSS
  • does pt have any q's
  • how can you encourage pt to attend
  • monitor how it went at SSS at later stage
• Assisting when pt wont attend SSS ?

  • still important, points can be covered in 5-20 mins
  • set a dat to stop (prepare env and make date appropriate)
  • rv past attempts and what helped/hindered
  • ID potential issues and plan how to deal
  • answer q's (weight gain, duration of withdrawals and cravings)
  • practical advice ie. support from friends
  • delay acting on urges with deep breathes, water sips etc
• Follow ups ?

  • monitoring essential
  • 4-5 appointments of monitoring
  • first follow up 1-2 weeks after chosen SS date
  • successfully stopped = encourage + continue to monitor
  • unsuccessful = id why and discuss how to overcome, ask for recommitment either now or in future
• Monitoring tests ?

  • CO monitor (eg. bedfont smokerlyzer)
  • continine test
  • saliva sample
  • cant be used while using NRT
• dentist role ?

  • active
  • Ask, Advise, Act
• DHT role?

  • active and supportive
  • Ask, Advise, Act
• Nurse?

  • supportive role
  • Act
  • opportunist advice
  • answer Q's