Smoking cessation strategies: what works, what doesn't
Article Abstract:
Dentists can be very effective in helping patients stop smoking by keeping certain facts in mind. Smokers are driven by psychological dependence and physical addiction to nicotine. They associate cigarettes with situations such as coffee drinking or driving and with reduction of unpleasant emotions such as anger. Smokers usually regulate their blood levels of nicotine within a narrow range so that the central nervous system is exposed to a constant level. Treatment aimed at stopping smoking should be regarded suspiciously if high (more than 50 percent) rates of success are reported; relapse during the first six months is usually high. Results for smoking-cessation programs are reported in two ways: point prevalence results, which determine how many people smoke at three, six, and 12 months after their program ends; and sustained abstinence results, which measure the number of people who do not smoke from the time the program ends until the time the survey is performed. Sustained abstinence results are always lower than point prevalence results, since any relapse disqualifies a person. When assessing a program, it is important to determine how it records its successes. Tables summarizing over 350 scientific studies on smoking control are presented. The most relevant techniques for the dentist appear to be advising the patient not to smoke, carrying out a good follow-up program, and use of nicotine polacrilex gum (Nicorette). The dentist should advise the patient to quit in a clear, unambiguous manner, and the dentist's office should reflect a no-smoking policy. Nicotine reduction therapy (so named because the gum contains less nicotine than cigarettes) is effective, but it must be used correctly. Patients must fill their prescriptions and use an adequate dose. Follow-up visits to the physician have been shown to increase abstinence rates. Nicotine polacrilex is the only substance approved by the Food and Drug Administration for treating tobacco dependence. It is not really a chewing gum, but, rather, a sustained-release medication. Special chewing methods are required to use the product properly and the dentist can help the patient learn them. A definite target quit date should be set. Treatment should continue for several weeks or months. The gum should not be combined with beverage drinking, since nicotine's absorption rate is affected by most beverages. Dentists can play a major role in fighting tobacco dependency. Tables comparing the effectiveness of many programs and techniques for quitting smoking are included. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of the American Dental Association
Subject: Health
ISSN: 0002-8177
Year: 1990
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Drinking coffee and carbonated beverages blocks absorption of nicotine from Polacrilex gum
Article Abstract:
Nicotine-laced gum (Polacrilex) has been found to be useful in controlling the desire to smoke while a person is attempting to withdraw from nicotine addiction. Much of the absorption of the nicotine occurs from the epithelium (lining) of the mouth, which is facilitated by the local acid-base balance of saliva. As the volume of saliva is small, the physical and chemical conditions of the mouth can also be influenced by a comparatively modest amount of other liquids, including coffee or soda. The present study examines the effect of cola and coffee on the local pH (an index of acidity) and the rate of absorption of nicotine as assayed by blood chemistry. Eight cigarette-smoking adults were used in a crossover experiment in which they were exposed to coffee, soda, or distilled water (a control) sequentially while undergoing measurements of their saliva pH and blood nicotine. The study demonstrates a gross reduction of nicotine absorption (approaching virtually none) from the Polacrilex when chewing immediately follows drinking either coffee or cola. The absorption of nicotine seems to depend upon the mildly basic (alkaline) condition of the saliva, which is disturbed by the acidic cola and coffee beverages. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: JAMA, The Journal of the American Medical Association
Subject: Health
ISSN: 0098-7484
Year: 1990
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