Ch. 32 Tobacco Cessation in Dental Hygiene

What is Nicotine?

• A toxic colorless or yellowish oily liquid that is the chief active part of the tobacco plant.

• It acts as a stimulant in small doses, but in larger amounts blocks the action of autonomic nerve and skeletal muscle cells.

• Nicotine is also used in insecticides.

How You Get Addicted to Nicotine:

• The feeling of pleasure nicotine causes when a cigarette is smoked does not last long. The brain learns to tolerate the nicotine — it "gets used to it."

• When that happens, more puffs are needed to feel the same amount of pleasure.

• More and more cigarettes are needed to feel the pleasure from nicotine AND to avoid feeling the unpleasant symptoms, including cravings, caused by nicotine withdrawal.

Cigarettes contain___ mg of nicotine per cig and through inhaling the smoke, the average smoker takes in 1-2 mg nicotine per cigarette

10

When cigarette smoke is inhaled, __ particles carry nicotine to the lungs, where it is absorbed.

tar

Blood sweeps the nicotine from blood vessels in the lungs to the ____, which pumps it through the arteries to the brain and rest of the bod

heart

Nicotine is absorbed through the skin and mucosal lining of the mouth and nose or by inhalation in the lungs, reaching the brain in _- _seconds, faster than an intravenous injection!

8-10

10 puffs per cig/ 20 cigs in a pack = ___ hits of nicotine to the brain per pack

200

Nicotine is powerful because it can affect in two different ways:

• Can act as a stimulant, giving a "lift" when bored.

• Can act like a sedative, helping to relax when feeling stressed.

Nicotine Replacement Therapy (NRT)?

Delivery system of nicotine to the body in a low, controlled dose — without the tars, toxins, and other cancer-causing substances in cigarettes.

NRT Facts:

• NRT helps reduce withdrawal symptoms like headache, irritability and restlessness.

• It eases discomfort by reproducing some of the effects derived from cigarettes.

• NRT helps take the edge off the craving while eliminating the harmful toxins associated with tobacco, so the desire to smoke is reduced

There is no contraindication to NRT:

• Nicotine replacement therapy is recommended by national experts concerned with the health risks of smoking, including:

• The U.S. Surgeon General

• The Centers for Disease Control and Prevention (CDC)

• The National Cancer Institute

• The National Institute on Drug Abuse

• The World Health Organization

• The Mayo Clinic

Research has shown smokers who use nicotine replacement therapy and participate in a behavior change program can ______ their chances of quitting

double

E Cigs and Vaping:

• E-cigarettes are electronic nicotine-delivery systems (ENDS) that consist of a cartridge containing nicotine and propylene glycol, an atomizer, and a battery.

• When a user inhales, a pressure-sensitive circuit is activated, which heats the atomizer and vaporizes the liquid as it is brought through the mouthpiece.

• The vapor consists of a fine mist that does not contain smoke or carbon monoxide and disperses more quickly than traditional cigarette smoke. The act of using ENDS is often called "vaping" and users are termed "vapers."

When e-cigarettes are inhaled, light- emitting diodes are ______.

illuminated

Tobacco Heating System:

• THS heats the tobacco just enough to release a nicotine-containing tobacco vapor but without burning the tobacco.

• Because the tobacco is heated and not burned, the levels of harmful chemicals are significantly reduced compared to cigarette smoke. However, THS is not risk-free and delivers nicotine which is addictive.

Non-Nicotine Pharmacotherapies:

• zyban (wellbutrin)

• chantix

Nicotine OTC Pharmacotherapies:

• patch

• gum

• lozenge

Prescription Required Nicotone:

• nasal spray

• inhaler

Zyban:

• is the first nicotine-free pill that, as part of a comprehensive program from a physician, can assist in quitting smoking.

• It is prescription (only) medicine for smokers 18 and older.

• Refer to family physician to prescribe due to side effects (causes seizures in 1 out of every 1,000 people).

• *Is NOT covered by insurance as Zyban but IS covered as Wellbutrin.

Patients can start taking ZYBAN and continue to smoke:

• ZYBAN gets the patient ready to put down their cigarettes. Advise patient to start taking ZYBAN and set a quit date to stop smoking by start of the second week.

• Most people should take ZYBAN for at least 7 to 12 weeks.

• After stopping smoking, continue to take ZYBAN as recommended by a physician.

• One pill 2 times a day can help a patient quit smoking.

Chantix:

• CHANTIX is a non-nicotine prescription medicine specifically developed to help adults 18 and over quit smoking.

• It targets nicotine receptors in the brain, attaches to them, and blocks nicotine from reaching them.

• It is believed that CHANTIX also activates these receptors, causing a reduced release of dopamine compared to nicotine.

Nicotine Patch:

transdermal NRT puts nicotine into the bloodstream via a patch applied to the skin. it’s formulated to work for 16-24 hours

What to tell the patient... for nicotine patches

• “Choose a clean, dry, non-hairy area of skin. Upper arm is good for most people.

• Open the sealed foil pouch.

• Take out the patch. The sticky side is covered with a clear plastic liner.

• Pull the liner off, one side at a time. Try not to touch the silver part.

• Press the patch firmly on your skin with the heel of your hand for at least 10 seconds.”

Nicotine Gum (polocrilex):

• Nicorette comes in 6 flavors:

• Fruit Chill™, White Ice Mint®, Mint Fresh Mint, and Cinnamon Surge

Avoid using nicotine gum immediately after..

drinking soda, juice, coffee, or other acidic beverages. They can neutralize the effect of the gum

Which strength is right? Nicorette Gum:

• Nicorette® gum comes in 2 strengths.

• If more than 25 cigarettes a day are used, recommend the 4mg. strength.

• If less than 25 cigarettes a day are used, recommend the 2mg. strength.

Nicorette Lozenges Dosage:

• Weeks 1-6: 1 piece every 1-2 hours (about 500 pieces)

• Weeks 7-9: 1 piece every 2-4 hours (about 100 pieces)

• Weeks 10-12: 1 piece every 4-8 hours (about 50 pieces)

How to Use Nicorette Lozenges:

• Have patient quit smoking completely before starting to using Commit Lozenges as a stop- smoking quit aid adjunct.

• Nicotine lozenges are medicine and must be used in a certain way to get results.

• Get physician approval for patients under 18.

• Nicorette contains nicotine resin, so as it dissolves in the mouth, small amounts of nicotine are released and absorbed through the soft tissues.

• Because Nicorette nicotine lozenges do not contain the tar or carbon monoxide found in cigarette smoke, it is not the same health risk as smoking.

• Nicorette lozenges are marketed in 72-lozenge packets, for $39.95.

Nicotrol NS-Nicotine Nasal Spray:

• prime the pump (before first use)

  • re-prime (1-2 sprays) if spray not used for 24 hours

• blow nose (if not clear)

• tilt head back slightly and insert tip of bottle into nostril as far as comfortable

How does Nicotrol NS work?

• Nicotrol Nasal Spray (NS) is a solution of nicotine in water that is sprayed into each nostril. The rich blood supply in the membranes of the nose rapidly absorbs the nicotine.

• Nicotrol NS has a fast onset of action to reduce cravings quickly.

• This is for the highly dependent smoker.

Directions for Nicotrol NS Works:

With one spray into each nostril, a single 1-mg dose of nicotine is released and absorbed through the nasal membranes.

• Directions: 1 spray in each Nostril/ hour, or as needed.

• Not to exceed 5 doses in an hr Or 40 doses in a day.

• Taper as withdrawal symptoms reduce.

Possible side effects of Nicotrol NS: 

• During the first week or so, most people experience the following: hot, peppery feeling in the back of the throat or nose, sneezing, coughing, watery eyes, or runny nose.

• Using Nicotrol NS regularly for the first week and following instructions exactly will help the patient adapt to the spray.

Nicotrol Inhaler:

• The delivery device resembles a cigarette and holds a. cotton plug impregnated with 10 mg of nicotine.

• 6 cartridges /package- short acting

• 80 puffs are needed to obtain 2 mg of nicotine, and the patient can use this for about 3 months.

How many cigarettes does a Nicotrol cartridge equal?

One Nicotrol Inhaler cartridge contains 10 mg of nicotine, of which approximately 4 mg is delivered.

• That is equivalent to about 2 cigarettes.

Combination Nicotine Replacement Therapy

• Combining the nicotine patch with a self- administered form of nicotine replacement therapy --either the nicotine gum or nicotine nasal spray-- is more efficacious than a single form of nicotine replacement.

• Patients should be encouraged to use such combined treatments if they are unable to quit using a single type of first-line pharmacotherapy.

NRT Is Safe:

• NRT products are safe for the great majority of smokers. They don’t contain tar or carbon monoxide, the two components that cause the major diseases associated with tobacco use.

• They distribute nicotine more evenly than the quick- hit pattern of cigarette smoking.

• This reduces any cardiovascular effects. They have also been extensively tested and proven safe and effective in dozens of clinical trials.

• NRT products are far less likely to lead to a dependence on nicotine.

• Use as directed, 18 yrs and up 

Patients should be urged to…

stop smoking completely when initiating NRT

Patient should be informed if they continue to smoke while using any product, they may experience …

adverse effects due to peak nicotine levels higher than those experienced from smoking alone

Symptoms of Excess Nicotine

• Bad headaches

• Dizziness

• Upset stomach

• Drooling

• Vomiting

• Diarrhea

• Cold sweat

• Blurred vision

• Hearing difficulties

• Mental confusion

• Weakness

• Fainting

Chances for success are increased with a behavioral support program. This includes…

• group support sessions,

• one-to-one counseling, standardized self-help manuals,

• personalized manuals matched to the patient’s needs