5/24/11 Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs

Department of Pediatric Dentistry
Resident’s Name:Murphy Program: Lutheran Medical Center - Providence
Article title: Tobacco Use by Adolescents: The Role of the Oral Health Professional in Evidence-based Cessation Programs
Author(s): David Alert, DDS Herbert Severson, PhD, Judy Andrews, PhD
Journal: Ped Dent.
Year. Volume (number). Page #’s: 2006. vol 28 #2. 177-186
Major topic: How we can help stop tobacco use by adol.
Minor topic(s): Health effects of tobacco
Main Purpose: To provide clinicians with info on tobacco and health, the epidemiology of adol tobacco use, and cessation programs for parents and patients.
Overview of method of research: Review

Findings:
The use of tobacco products, particularly smoking represents the leading cause of preventable illness and death in the developed world (this was a question on the boards this year). Major gains have been made to reduce smoking in adults, however similar gains have not been realized in adolescents. Most tobacco users admit to starting when they were an adol. Every year more than 1 million teenagers become habitual smokers. We, as clinicians, should start screening for smoking and tobacco product risk factors at age 10(this was a question on the boards this year). Also, we should encourage parents who smoke to quit smoking. If they cannot or will not quit, we should advice them to not smoke around the kids, to have a smoke free home, and to watch their kids for smoking signs.
Tobacco is bad for you. It can cause a number of cancers, cardiovascular disease, respiratory disease, reproductive complications, etc. Adol who smoke have a reduced rate of lung growth and level of maximum lung function. Exposure to second hand smoke can also hinder lung growth, and increase the incidence of developing lung cancer. Chronic smoking can lead to increased prevalence and severity of perio disease. Studies have shown that approx. 50% of all perio cases can be attributed to smoking. Smoking and smokeless tobacco use can cause the following oral health issues.
1.Loss of taste
2. perio disease
3. stained teeth
4. altered taste perception
5. intraoral lesions
5. gum recession
7. drifting of teeth
8. abrasion to tooth enamel
9. oral malodor
Tobacco use by youths is assoc. with many risk factors, including having parents/friends who smoke, comorbid psych disorders, weight concerns, and ADD.

Tobacco Cessation
The best public health strategy is to prevent tobacco use completely, or to intervene as early as possible. Most cessation programs are implemented by schools and in the community. However, the effectiveness of these programs decrease over time. Dentists are in a unique position of being able to associate cessation advice with readily visible changes in oral health and status. Brief tobacco cessation in the dental office has been found to be effective when directed at adults. Since nearly 75% of all adol see the dentist at least yearly for care, the dental office is the ideal place to implement cessation programs. However, more research is necessary in terms of directing the advice towards adol.
The “5 A’s” is a recommended process that clinicians can follow. They can be applied and completed in up to 3 minutes. However, the adol. Needs to be a willing participant. The five A’s include
1. Ask about tobacco use
2. Advise to quit
3.Asses willingness to quit
4. Assist in quitting
5. Arranging follow up
6. Anticipatory guidance
(Don’t ask me why they call it the “5” A’s, when there are actually 6…)

Various pharmacological therapies have been shown to be effective in tobacco cessation. Bupropion SR, nicotine gums and inhalers and sprays and patches are all available on the market today. The FDA does not condone the use of these drugs in adol, however they are still prescribed to children to aid in cessation. The AAPD does NOT approve of children using these medications (this was a question on the boards this year).

Key points/Summary:
1. Tobacco is bad for you.
2. As physicians, particularly ones who see children multiple times a year, it is our duty to screen for and to assess tobacco use and risk. We should be asking EVERY adol about tobacco use and exposure at every visit.
3. Adol who use tobacco are likely to use it in adulthood

Assessment of Article:
Great conference review. I’m sure all of you ask every adol. You treat about tobacco use every time you see them, I however do not. I need to do a better job, and be more aware of it. In the past tobacco use and cessation programs have been a focus on the boards. It was on the boards this year, but only for a few questions.