CDEN Final

history of tobacco

5000 years ago natives cultivated

1492 europeans got it

1880 bonsack manufacture machine

1920 heavy women marketing

150 billion annual sales

tobacco chemicals

7000+ chemicals

250 deemed harmful

hydrogen cyanide

carbon monoxide

ammonia

at least 69 cause cancer

cigar = how many cigs

a pack

hookah v cig

comparable or higher exposure to nicotine and carbon monoxide

tobacco mortality

leading cause of premature death

die 10 years earlier than non-smokers

1/5 deaths directly caused by it

every death = at least 30 alive with serious smoking related illness

3200 young people a day have first cig

quitting smoking

68% want to

decline from 52% adults smoking in 65 to 14% in 2018

high school smokers

declined from 16%>12%

increase in middle school

smokeless tobacco prevalence

4% males

highest in midwest and south

pattern of dual use cigs and smokeless nearly 40% highschoolers

hookah use

declined from 23% > 3% in high schoolers

smoking and healthcare

50k deaths from second hand

300 billion annual cost

smokeless tobacco

high N-nitrosamines

gingival recession

MPOWER measures

monitor tobacco use

protect

offer help to quit

warn

enforce bans

raise taxes

direct advertising

tv, radio, print, billboard, social media

indirect advertising

brand sharing, stretching, free distribution, discounts, displays, promotions

tobacco tax

10% price increase decreases consumption by 4-5%

quitting success

without support only 4% success

help can double chances

transtheoretical stages of change

pre-contemplate

contemplate

prepare

quit

Five A’s

Ask, Advise, Assess, Assist, Arrange follow up

eating or dieting in eating disorder is secondary to

root cause

anorexia nervosa

refusal to maintain healthy weight

intense fear of weight gain and obsession with staying skinny

unrealistic perception of current weight

self esteem related to body image

can be unconcious

anorexia nervosa etiology

adolescent onset

biopsycholgical developmental arrest

family dynamics

increase risk among relatives

anorexia nervosa symptoms

starvation

amenorrhea

bone loss

skin integrity loss

increased risk of MI and death

hair thinning, nails purple, dizzy, low energy

anorexia nervosa clinical signs

telogen effluvium (hair loss)

lanugo (baby hair)

anorexia nervosa stats

90-95% are females

1% of women have it

adolescent

5-20% will die, one of highest death rates of any mental health condition

dental symptoms of anorexia nervosa

atrophic mucosa

xerostomia

swollen salivary glands

bulimia nervosa

byproduct of borderline personality disorder

childhood trauma

recurrent binge eating with purging or fasting

most are normal - 10lbs overweight

feel out of control

dentition erosion

bulimia nervosa etiology

addiction

family

sociocultural

cognitive, behavioral

personality disorder

trauma

bullying

bulimia nervosa signs

staining of teeth

withdrawal from freinds

swelling of cheeks

acid

electrolyte imbalance

laxative abuse

bulimia nervosa stats

80% are female

2% of women suffer

rate is increasing

dental symptoms of bulimia nervosa

perimylosis - enamel demineralization (not caries) - 90% have this

tooth hypersensitivity

mucosal trauma

xerostomia

parotid gland enlargement

binge eating

no compensatory behaviors

most common ED

wider age range and class

shame

binge eating stats

5% populations

60% women

increasing

3400 calories in an hour up to 50k in a day

dental signs of binge eating

increase caries from carbs

perio disease

EDNOS eating disorders not otherwise specified

purging without binging

night eating syndrom-morning anorexia-evening polyphagia

often progresses to bulimia nervosa

additional eating disorders

pica - compuslive craving for non food

rumination - regurgitation

diabulimia - manipulate insulin to control weight

orthoresxia - ‘pure’ diet obession

EDs in men

3rd most common illness in adolescent boys

3% of men

50% of girls and 20% of boys were on diet in 10th grade

34% increase in hospitalizations for men

what ED causes most dental symptoms

bulimia because of erosion

serotonin

inhibitory effect on eating behavior with a link to ED and depression

decreases = cravings in bulimia

nor epi

alteration effects eating behavior, sympathetic release, acts on hypothal

leptin

hormone frm fat cells induces satiety

SCOFF

Sick from eating

Control loss

One stone of weight loss (14lbs in 3 months)

Fat

Food dominates

2 or more = ED

eating disorder systemic conditions

poor nutrition, pellagra (Vit B) xerosis (E+A), scurvy (C) anemia (Fe), edema (Na/K)

renal failure (Na/K)

cardiac arrest (Ca)

brain atrophy

suicide

death

dental tx for ED

prophy

fluoride

OHI

pain palliation

restorative

ED prognosis

full recovery with tx - 50-85%

history of cannabis

2700-chinese

1000-india

1850-US until 1942-taxed in 37

1970-controlled schedule 1 substance - no accepted medical use, high potential for abuse

rate of weed use

20% of adults used in last 30 days

abuse

excessive use + misusede

dependence

a biological process

addiction

loss of control + compulsive use

cannabis use disorder

large amounts, can’t cut down

lot of time spent, craving, can’t fulfill obligations

social issues

given up acitvities

used when hazardous

persitent physical problems

tolerance, withdrawl

cannabis use disorder severity

2-3 symptoms = mild

4-5 = moderate

6+ = severe

30% will develop some level of disorder

1 in 10 will become addicted

before 18 it raises to 1 in 6

adolescents who smoke cigs are __ more likely to use cannabis

9-15x more likely

legalization had no effect on

suicide rates

crime rates

opioid admission rates BUT it does increase risk of opioid use disorder (may prime receptors for addiction)

it did decrease opioid Rx by 10% and decrease deaths by 25%

weed + oxycodone =

opioid

cannabis hyperemsis syndrome

prolonged use of weed causes vaumiting and nausea

cannabinoids

THC - psychoactive

CBD - Non-psychoactive

weed has 100s

CB receptors

CB1: CNS + immune system, cardiovascular, whole body

CB2: immune system and musculoskeletal

G-protein receptors similar to opioid receptors

Anandamide in body naturally binds but THC has stronger affinity

weed metabolism

P450

CYP2C9 + CYP34A

biotransformed into active metaboite 11-hydroxy-THC

inhibitors of CYP2C9

potentially accumulates weed

amiodarone, cimetidine, metronidazole

flueoxetine, fluvoxamine, fluconazole

cannabidiol

inhibitors of CYP3A4

potential accumulation of weed

ketoconazole

clarthromycin, erythromycin

cyclosporin

verapamil

itraconazole

grapefruit juice

weed syngerism

opioids

sleep medications

muscle relaxants

alcohol

weed increased bleeding with

apsirin

anticoagulants

antiplatelets

NSAIDs

strong evidence for CBD therapeutics

epilepsy treatment

particularly childhood syndromes like Dravet, lennox-gastaut

CBD (cannabidiol) according to WHO

no abuse or dependence potential

low toxicity, good safety

no psychomotor response

low oral bioavailability

will not affect HR+BP normally (under stress will decrease)

weak evidence for CBD

addiction treatment

alzheimers

analgesia

anxiety

cancer

cardiovascular

depression

huntingtons

insomnia

MRSA

MS

nausea

pain

parkinsons

rheumatoid

inflammation

authorized CBD medical products

there are currently none - they are all supplements not medications, outside of FDA

CBD and neurology

low CB1+2 receptor affinity

enhances endocannabinoid system

anxiolytic, antidepressant, neuroprotective, antinausea

CB1

attenuation of impaired learning, memory, psychosis effects by THC

anti-inflammatory components

CB2

TPVR-1

Adenosine

acute cannabis reactions

sympathetic (bp+hr)

cognitive impairment

euphoria, time distortion

reduction in nausea and vomiting

analgesia

anxiolysis or anxiety

chronic cannabis reactions

HTN, bronchitis, hyperemesis syndrome

executive dysfunction

dependence, disorder

depression, anxiety

pychosis, schizophrenia

cannabis and cardivascular

elevated BP

tachycardia

sympathetic

decreased angina threshold

increased MI risk for first hour

driving and weed

doubles chance of crash

.08% blood content triples risk

led to decrease in speed

breathing and weed

bronchodilation

minimal depression

stimualtes ventilation

chron bron

respiratory immunosuppression

weed tobacco ratio

1:5 (IDK)

weed and bones

CBD - inhibit resorption, promote deposition

THC - promote resorption

heavy use = low bone density, low BMI, high bone turnover, increase fracture

smoking and immune

causes immunosuppression

THC can be pro and anti-inflammatory

CBD is anti-inflammatory

weed and reproduction

females - decreased folic acid uptake

males - decreased sperm and libido

weed and digestion

percieved improvement of IBS, crohns and ulverative colitis but no decrease in inflammation

weed and eyes

used to reduce ocular pressure for glaucoma

cannabis stomatitis

leukoedema

hyperkertosis (can become neoplasia)

candidiasis

laryngeal cancer

weed + cancer associations

head + neck

oral SSC

HPV

naso+oropharyngeal

weed + cancer non-associations

head+neck

oral tongue

esophageal

carcinogens in weed

aromatic hydrocarbons

benzopyrenes

nitrosamines

weed may slow cancer growth

true

weed and perio

up to 20 years is associated with perio but no other physical health problems in early midlife

weed and saliva

relax myoepithelial cells

inhibition of signaling secretory cells

affects symp and parasymp

69% of user have xerostomia (vs 17% of non-users)

weed and hunger

inhibits leptin (more hunger)

increases dopamine (food more desireable)

21% regularly visit dentist

weed and anesthesia

should promote it

if it doesnt it is probably from desensitization

more intense N2O effects (do not need more sedation unlike opioid users)

acute intoxication = additave affects

chronic users = cross tolerance

5 steps of whatever

pre contemplation > contemplation > preparation > action > maintenance

four tasks of guiding

engaging, focusing, evoking, planning

motivation components

desire

ability

reason

need

motivational interviewing stats

greatest amount of research on substance abuse

takes 100 minutes less time than traditional

age or gender makes no difference in outcome

minorities benefit more

prevalence of ACEs

64% at least one

17% 4 or more

6 principles of TIA

safety

turstworthiness+transparency

peer support

collaboration and mutuality

empowerment

cultural, historical, gender