Learning Objectives

1. Linking Together to ImproveOral Health through Tobacco CessationGayle Laszewski, MACenter for Tobacco Research & InterventionUniversity of Wisconsin Medical School

2. 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

3. 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

4. Mission of Collaborative Effort:To 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

5. 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

6. 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.

7. Tobacco & Oral Health Facts • Teenage smokers are nearly 3 times as likely as their non-smoking peers to have gum disease in their mid-20’s. • 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.

8. 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.

9. 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.

10. 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.

11. 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

12. 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

13. Effective clinical interventions exist: The Public Health Service Clinical Practice Guideline: Treating Tobacco Use and Dependencewas published in June, 2000 and offers effective treatments for tobacco dependence. Educate Providers Regarding Effective Evidence Based Cessation Interventions • Creation of Tobacco and Oral Health Fact Sheet

14. 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.

15. The 5 A’s • ASKabout tobacco use. • ADVISEto quit. • ASSESSwillingness to make a quit attempt. • ASSISTin quit attempt. • ARRANGEfor follow-up.

16. 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)

17. Brief Interventions • Brief tobacco dependence treatment iseffective • Clinically effective • Cost effective • Should be offered to all patients at every visit

18. Educate Providers RegardingCessation Resources Free Telephone Cessation Counseling for Wisconsin Residents

19. 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

20. 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)

21. 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

22. 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/.