United we stand against tobacco

Volume 6 Issue 2 February 2016

Consultation Liaison Psychiatry Focus: ‘Dentistry’

Dentists polish teeth to remove stains and take biopsies from the so called ‘red and white lesions’ of oral mucosa, onco-surgeons treat oro-pharyngeal carcinomas and de-addiction centers strive to help patients quit their habit of tobacco usage by counseling and nicotine replacement therapy (NRT). All the three specialists are different stake-holders in dealing with patients with tobacco usage, which has become excessive and presents with the risk of developing a neoplasm.

Estimates suggest that tobacco use is present in one third of the population. Usage of tobacco can become problematic and lead to dependence. Tobacco dependence is defined as a behavioral pattern in which the use tobacco is given a much higher priority than other behaviors that once had higher value. The features that can present include those of by craving, tolerance, withdrawal, preoccupation, use despite harm, and loss of control. Presence of any three of the six characteristic features can be used to make a diagnosis of tobacco dependence. Chewable tobacco use is seemingly more common in India than smoked tobacco use.

Treatment of tobacco dependence is multi-faceted. Patients who have been taking tobacco often approach to dental surgeons and physicians. Interaction with such health-care providers gives an opportunity to provide brief counseling to such patients. It has been observed that brief counseling is as effective as nicotine replacement and other medications for the treatment of tobacco dependence.

The other means of cessation of tobacco use involves roping in of mass-communication media to provide information to the lay public. Already, the packets of tobacco products contain statutory warnings, with the aim of deterring potential users. Quit-lines are available where patients can dial the number and receive counseling for their substance taking behavior. Furthermore, smart-phone applications can be developed that aims to provide counseling to through the phone itself. Besides, each tobacco intervention initiative designed should have a team of health professionals from all the concerned streams and in hospital scenarios, cross-consultations among specialties while treating a patient with tobacco-use should be a routine practice. This may help in better catering to the needs of patients with tobacco dependence, who are likely to benefit from some form of intervention.