Linking Together to Improve Oral Health through Tobacco Cessation Gayle Laszewski, MA Center for Tob

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Linking Together to ImproveOral Health through
Tobacco CessationGayle Laszewski, MACenter for
Tobacco Research InterventionUniversity of
Wisconsin Medical School
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Learning Objectives

• Recognize the effect of tobacco use on oral
  health
• Identify barriers to dental providers in
  addressing tobacco use
• How to assist dental providers in overcoming
  barriers to helping patients quit tobacco

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The UW Center for Tobacco Research and
Intervention (UW-CTRI)

• A nationally-recognized research center
  specializing in understanding treating tobacco
  dependence
• Research Center - focus on relapse prevention
• Smoking Cessation Clinic
• Education Outreach - translating research into
  practice
• Wisconsin Tobacco Quit Line

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Mission of Collaborative EffortTo Promote
Tobacco Cessation Education and Intervention in
the Dental Setting

• Collaborators
• Wisconsin Dental Association
• UW-Center for Tobacco Research and Intervention
• Madison Public Health Dental Services Department

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First Steps of Collaborative Effort

• Summarized Research On...
• Tobacco use and oral health
• Effectiveness of dental settings for cessation
  interventions
• Barriers to addressing tobacco use with dental
  patients
• Initiated Efforts to Overcome Identified Barriers

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Tobacco Oral Health Facts

• The leading cause of oral cancer is tobacco use.
• Tobacco use is a known risk factor for tooth
  loss. Smokers lose more teeth than non-smokers
  at a younger age.
• Smoking is now recognized as a major risk factor
  for periodontitis and may be responsible for more
  than half of peridontitis cases among adults in
  the U.S.
• More than 75 of American adults over age 35 have
  some form of periodontal disease.

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Tobacco Oral Health Facts

• Teenage smokers are nearly 3 times as likely as
  their non-smoking peers to have gum disease in
  their mid-20s.
• Recent studies now link periodontal diseases to
  major health issues such as diabetes, heart
  disease, pneumonia, stroke and pre-term labor
  resulting in low birth weight babies.
• Young children who are exposed to secondhand
  smoke have a much higher rate of tooth decay than
  children who do not grow up around smokers.

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Why Dental Providers ShouldTreat Tobacco Use

• Dental providers are in a unique position to SHOW
  patients visible effects of tobacco use.
• Dental providers can be AS effective or in some
  studies MORE effective than physicians in helping
  smokers quit.

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Why Dental Providers Should Treat Tobacco Use

• More than 50 of smokers make an annual visit to
  the dentist.
• Dentists/hygienists are more likely to see adults
  for routine care on annual basis (especially
  males).
• General Dental Office 2 times/year
• Periodontal Office 3-4 times/year
• Patients have increased success rates in tobacco
  cessation with dentist/hygienist interventions.

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Why Dental Providers ShouldTreat Tobacco Use

• 65-72 of smokers are interested in help from
  their dental hygienist or dentist.
• 75 of dental patients indicate a willingness to
  hear tobacco cessation advice from their dental
  provider.

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ADA Recognizes the Importance of Addressing
Tobacco Use

• Dental code already exists (D1320) tobacco
  counseling for the control and provision of oral
  disease
• However, code is not being reimbursed by health
  insurers.
• Other organizations which encourage cessation
  interventions by dental teams
• Agency for Healthcare Research Quality
• Centers of Disease Control and Prevention
• Public Health Service

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Identified Barriers for Cessation Counseling in
Dental Settings90 Dental providers cite not
knowing how to provide an effective cessation
intervention.

• Barriers
• Lack of Training
• Lack of knowledge regarding cessation resources
• Lack of Time
• Lack of Reimbursement

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Educate Providers Regarding Effective Evidence
Based Cessation Interventions

• Creation of Tobacco and Oral Health Fact Sheet

• Effective clinical interventions exist The
  Public Health Service Clinical Practice
  Guideline Treating Tobacco Use and Dependence
  was published in June, 2000 and offers effective
  treatments for tobacco dependence.

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Components of anEffective Cessation Intervention

• Counseling and Support/Resources
• Cessation medications
• System changes within clinic setting to address
  tobacco use
• Counseling cessation medications can double if
  not triple success rates in quitting.
• Clinic procedures which identify tobacco users
  increase the likelihood of provider interventions.

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The 5 As

• ASK about tobacco use.
• ADVISE to quit.
• ASSESS willingness to make a quit attempt.
• ASSIST in quit attempt.
• ARRANGE for follow-up.

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Educate Providers Regarding Effectiveness of
Brief Interventions

• Minimal interventions lasting less than 3
  minutes increase overall tobacco abstinence
  rates.
• The PHS Guideline
• (Strength of Evidence A)

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Brief Interventions

• Brief tobacco dependence treatment is effective
• Clinically effective
• Cost effective
• Should be offered to all patients at every visit

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Educate Providers RegardingCessation Resources
Free Telephone Cessation Counseling for Wisconsin
Residents
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Educate Providers RegardingCost Effectiveness
and Benefits of Cessation Interventions

• Cost of Cessation vs. Cost of Treatment for
  periodontal disease
• Cost Benefit Cessation Counseling Reimbursement
  Handout
• Smoking
• Reduces the success of both non-surgical and
  surgical periodontal therapy
• Reduces success of oral implants
• Delays healing of oral surgery sites

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Next Steps

• Focus on 1 Barrier Lack of Training
• Standardized Evidence-Based Cessation
  Intervention Guideline for Dental Settings
• USPHS Guideline referenced in dental journals
• Accreditation thru ADA?
• Current national efforts to standardize a
  guideline for dental settings
• Integration of Cessation Interventions into Oral
  Health Curriculum
• UW Medical School CME/CEU
• Several dental schools have included cessation in
  their curriculum (ie. Harvard)

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Next Steps

• A Secondary Barrier - Lack of reimbursement
• Utilization of ADA code for cessation counseling
  (D1320) regardless of reimbursement--to
  familiarize insurance companies with this practice

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Resources

• Local Dental Societies
• Bring dental providers together
• Support your efforts
• UW-CTRI Website
• www.ctri.wisc.edu
• USPHS Guideline Materials
• www.surgeon general.gov/tobacco
• Cessation Activities for Dental Settings
• www.umn.edu/perio/tobacco/.