AGD Provider #321355 Code D3019

California Dental Provider #4301

Course #03-4301-10017 Florida Dental CE Broker #50-1997

Florida Dental CE Broker Course Tracking #20-265495

The Institute for Advanced Therapeutics, Inc. P.O. Box 848152

Pembroke Pines, Florida 33084 1-954-441-9553

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TOBACCO USE FOR THE DENTAL PROFESSIONAL

Consultant:

Mark D. Blum, D.D.S.

Research and Development:

Charles Edwin Cook, L.M. T., C.R.T.

By:

Renee J. Setzer, C.R.T.

©2010 Renee J. Setzer All Rights Reserved

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TOBACCO USE FOR THE DENTAL PROFESSIONAL

Published By:

The Institute for Advanced Therapeutics, Inc. P.O. Box 848152

Pembroke Pines, Florida 33084 1-954-441-9553 tel 1-954-432-1824 fax

This course was developed to help expand the knowledge and skills of dental health professionals with respect to the subject of tobacco use. The information in this course has been derived from various professional sources. It is the responsibility of the dental health professional to determine which principles and theories contained herein are appropriate with respect to his/her personal limitations and scope of practice. The information in this course has been carefully researched and is generally accepted as factual at the time of publication. The Institute for Advanced Therapeutics, Inc. disclaims responsibility for any contradictory data prior to the publication of the next revision of this course.

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TABLE OF CONTENTS

COURSE DIRECTIONS MAILING INSTRUCTIONS COURSE OBJECTIVES CHAPTER 1 – OVERVIEW CHAPTER 2 – ADVERSE HEALTH EFFECTS OF TOBACCO USE CHAPTER 3 – SECONDHAND SMOKE CHAPTER 4 – SMOKELESS TOBACCO CHAPTER 5 – MARIJUANA CHAPTER 6 - TREATMENT OPTIONS FOR TOBACCO ADDICTION CHAPTER 7 – TOBACCO USE AND THE WORKPLACE TOBACCO USE TEST TEST ANSWER CARD/COURSE EVALUATION GLOSSARY RESOURCES REFERENCES

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COURSE DIRECTIONS

HOW TO BEST PROCEED WITH THIS COURSE Each chapter should be approached systematically in a careful and objective manner. It is important to master each chapter before going on to the next. Relax, take your time, and go at your own pace. As 3 credits of continuing education is rewarded after successfully completing this course, the reading of this manual and completion of the test questions should not take less than 3 hours. Only after you have successfully mastered all the material in the course should you proceed to the test questions. COMPLETING THE TEST Read each question carefully before answering. Keep in mind that each question has only one correct answer. The test consists of 20 questions. For a passing grade, you must correctly answer 14 questions. We encourage your input and would welcome any suggestions to improve our course or test questions. Please feel free to note your suggestions or comments on the course evaluation page.

INFORMATION FOR CERTIFICATION

In order to receive your 3 hours of tobacco use continuing education credit, you must be a registered purchaser of this course. Only one person per purchase of this course is eligible to receive credit. Please notify us of any address or name changes as we keep permanent records for certification and licensure.

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The Institute for Advanced Therapeutics, Inc.

P .0. Box 848152 Pembroke Pines, Florida 33084

If you have any questions regarding this course, please contact our

Customer Service Department at 1-954-441-9553 or fax us at 1-954-432- 1824 or support@iatonline.com .

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COURSE OBJECTIVES Upon completion of this course, you will be able to: 1. Understand how individuals become addicted to tobacco. 2. Recognize the health consequences of tobacco use. 3. Identify the risks associated with smokeless tobacco. 4. Learn that marijuana smoke contains some of the same, and

sometimes even more, of the cancer-causing chemicals found in tobacco smoke.

5. Identify treatment options for tobacco addiction.

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CHAPTER 1 OVERVIEW

Tobacco is a plant with leaves that have high levels of the addictive chemical nicotine. The leaves may be smoked (in cigarettes, cigars, and pipes), applied to the gums (as dipping and chewing tobacco), or inhaled (as snuff). Tobacco leaves also contain many cancer-causing chemicals, and tobacco use and exposure to secondhand tobacco smoke have been linked to many types of cancer and other diseases. The scientific name is Nicotiana tabacum. Tobacco use is the single most preventable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke, and another 8.6 million have a serious illness caused by smoking. For every person who dies from smoking, 20 more people suffer from at least one serious tobacco-related illness. Despite these risks, approximately 43.4 million U.S. adults smoke cigarettes. Smokeless tobacco, cigars, and pipes also have deadly consequences, including lung, larynx, esophageal, and oral cancers. The harmful effects of smoking do not end with the smoker. More than 126 million nonsmoking Americans, including children and adults, are regularly exposed to secondhand smoke. Even brief exposure can be dangerous because nonsmokers inhale many of the same carcinogens and toxins in cigarette smoke as smokers. Secondhand smoke exposure causes serious disease and death, including heart disease and lung cancer in nonsmoking adults and sudden infant death syndrome, acute respiratory infections, ear problems, and more frequent and severe asthma attacks in children. Each year, primarily because of exposure to secondhand smoke, an estimated 3,000 nonsmoking Americans die of lung cancer, more than 46,000 (range: 22,700–69,600) die of heart disease, and about 150,000–300,000 children younger than 18 months have lower respiratory tract infections. Coupled with this enormous health toll is the significant economic burden of tobacco use—more than $96 billion per year in medical expenditures and another $97 billion per year resulting from lost productivity.

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CHAPTER 2

ADVERSE HEALTH EFFECTS OF TOBACCO USE

The adverse health effects from cigarette smoking account for an estimated 443,000 deaths, or nearly 1 of every 5 deaths, each year in the United States. More deaths are caused each year by tobacco use than by all deaths from human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined. Compared with nonsmokers smoking increases the risk of—

Coronary heart disease by 2 to 4 times

Stroke by 2 to 4 times

Men developing lung caner by 23 times

Women developing lung cancer by 13 times

Dying from chronic obstructive lung diseases by 12 to 13 times such as chronic bronchitis and emphysema SMOKING AND CARDIOVASCULAR DISEASE

Smoking causes coronary heart disease, the leading cause of death in the United States.

Cigarette smoking causes reduced circulation by narrowing the blood vessels (arteries) and puts smokers at risk for developing peripheral vascular disease (i.e., obstruction of the large arteries in the arms and legs that can cause a range of problems from pain to tissue loss or gangrene).

Smoking causes abdominal aortic aneurysm (i.e., a swelling or weakening of the main artery of the body—the aorta—where it runs through the abdomen).

SMOKING AND RESPIRATORY DISEASE

Smoking causes lung cancer.

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Smoking causes the following lung diseases by damaging the airways and alveoli (i.e., small air sacs) of the lungs:

Emphysema

Bronchitis

Chronic airway obstruction SMOKING AND CANCER Smoking causes the following cancers:

acute myeloid leukemia kidney cancer, cancer of the pancreas

bladder cancer, cancer of the larynx (voice box), cancer of the pharynx (throat)

cancer of the cervix, lung cancer, stomach cancer

cancer of the esophagus, cancer of the oral cavity (mouth), cancer of the uterus

SMOKING AND OTHER HEALTH EFFECTS

Cigarette smoking has many adverse reproductive and early childhood effects, including increased risk for—

Infertility

Preterm delivery

Stillbirth

Low birth weight

Sudden infant death syndrome (SIDS).

Postmenopausal women who smoke have lower bone density than women who never smoked.

Women who smoke have an increased risk for hip fracture than women who never smoked.

How Does Tobacco Affect the Brain?

Cigarettes and other forms of tobacco—including cigars, pipe tobacco, snuff, and chewing tobacco—contain the addictive drug nicotine. Nicotine is readily absorbed into the bloodstream when a tobacco product is chewed, inhaled, or smoked.

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A typical smoker will take 10 puffs on a cigarette over a period of 5 minutes that the cigarette is lit. Thus, a person who smokes about 1 1/2 packs (30 cigarettes) daily gets 300 ―hits‖ of nicotine each day. Upon entering the bloodstream, nicotine immediately stimulates the adrenal glands to release the hormone epinephrine (adrenaline). Epinephrine stimulates the central nervous system and increases blood pressure, respiration, and heart rate. Glucose is released into the blood while nicotine suppresses insulin output from the pancreas, which means that smokers have chronically elevated blood sugar levels. Like cocaine, heroin, and marijuana, nicotine increases levels of the neurotransmitter dopamine, which affects the brain pathways that control reward and pleasure. For many tobacco users, long-term brain changes induced by continued nicotine exposure result in addiction—a condition of compulsive drug seeking and use, even in the face of negative consequences. Studies suggest that additional compounds in tobacco smoke, such as acetaldehyde, may enhance nicotine’s effects on the brain. A number of studies indicate that adolescents are especially vulnerable to these effects and may be more likely than adults to develop an addiction to tobacco. When an addicted user tries to quit, he or she experiences withdrawal symptoms including powerful cravings for tobacco, irritability, difficulty paying attention, sleep disturbances, and increased appetite. Treatments can help smokers manage these symptoms and improve the likelihood of successfully quitting.

What Other Adverse Effects Does Tobacco Have on Health?

Cigarette smoking accounts for about one-third of all cancers, including 90 percent of lung cancer cases. In addition to cancer, smoking causes lung diseases such as chronic bronchitis and emphysema, and increases the risk of heart disease, including stroke, heart attack, vascular disease, and aneurysm. Smoking has also been linked to leukemia, cataracts, and pneumonia. On average, adults who smoke die 14 years earlier than nonsmokers.

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Although nicotine is addictive and can be toxic if ingested in high doses, it does not cause cancer—other chemicals are responsible for most of the severe health consequences of tobacco use. Tobacco smoke is a complex mixture of chemicals such as carbon monoxide, tar, formaldehyde, cyanide, and ammonia—many of which are known carcinogens. Carbon monoxide increases the chance of cardiovascular diseases. Tar exposes the user to an increased risk of lung cancer, emphysema, and bronchial disorders. Smokeless tobacco (such as chewing tobacco and snuff) also increases the risk of cancer, especially oral cancers. Pregnant women who smoke cigarettes run an increased risk of miscarriage, stillborn or premature infants, or infants with low birthweight. Maternal smoking may also be associated with learning and behavioral problems in children. Smoking more than one pack of cigarettes per day during pregnancy nearly doubles the risk that the affected child will become addicted to tobacco if that child starts smoking. Smoking harms nearly every organ of the body. Smoking causes many diseases and reduces the health of smokers in general. Although quitting can be difficult, the health benefits of smoking cessation are immediate and substantial—including reduced risk for cancers, heart disease, and stroke. A 35-year-old man who quits smoking will, on average, increase his life expectancy by 5 years.

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CHAPTER 3 SECONDHAND SMOKE

While we often think of medical consequences that result from direct use of tobacco products, passive or secondary smoke also increases the risk for many diseases. Secondhand smoke, also known as environmental tobacco smoke, consists of exhaled smoke and smoke given off by the burning end of tobacco products. According to CDC, approximately 38,000 deaths per year can be attributed to secondhand smoke. Nonsmokers exposed to secondhand smoke at home or work increase their risk of developing heart disease by 25 to 30 percent and lung cancer by 20 to 30 percent. In addition, secondhand smoke causes respiratory problems in nonsmokers, such as coughing, phlegm, and reduced lung function. Children exposed to secondhand smoke are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear problems, and more severe asthma.

What Is Secondhand Smoke?

Secondhand smoke is composed of sidestream smoke (the smoke released from the burning end of a cigarette) and exhaled mainstream smoke (the smoke exhaled by the smoker).

While secondhand smoke has been referred to as environmental tobacco smoke (ETS) in the past, the term ―secondhand‖ smoke better captures the involuntary nature of the exposure.

Cigarette smoke contains more than 4,000 chemical compounds.

Secondhand smoke contains many of the same chemicals that are present in the smoke inhaled by smokers.

Because sidestream smoke is generated at lower temperatures and under different conditions than mainstream smoke, it contains higher concentrations of many of the toxins found in cigarette smoke.

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The National Toxicology Program estimates that at least 250 chemicals in secondhand smoke are known to be toxic or carcinogenic.

Secondhand smoke has been designated as a known human carcinogen (cancer-causing agent) by the U.S. Environmental Protection Agency, the National Toxicology Program, and the International Agency for Research on Cancer, and an occupational carcinogen by the National Institute for Occupational Safety and Health.

Secondhand smoke contains more than 50 cancer-causing chemicals.

When nonsmokers are exposed to secondhand smoke, they inhale many of the same cancer-causing chemicals that smokers inhale.

The Surgeon General has concluded that:

There is no risk-free level of exposure to secondhand smoke: even small amounts of secondhand smoke exposure can be harmful to people’s health.

Many millions of Americans continue to be exposed to secondhand smoke.

A smoke-free environment is the only way to fully protect nonsmokers from the dangers of secondhand smoke. Separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot eliminate exposure of nonsmokers to secondhand smoke.

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CHAPTER 4 SMOKELESS TOBACCO

Smokeless tobacco is a significant health risk and is not a safe substitute for smoking cigarettes. The two main types of smokeless tobacco in the United States are chewing tobacco and snuff. Chewing tobacco comes in the form of loose leaf, plug, or twist. LOOSE LEAF Description – Cured tobacco strips typically sweetened and packaged in foil pouches. Use – Piece taken from pouch and placed between cheek and gums. PLUG Description – Cured tobacco leaves pressed together into a cake or ―plug‖ form and wrapped in a tobacco leaf. Use – Piece taken from pouch and placed between cheek and gums. TWIST Description - Cured tobacco leaves twisted together to resemble rope. Use – Piece cut off from twist and placed between cheek and gums. SNUFF Description – Finely ground tobacco that can be dry, moist or packaged in sachets. Moist Snuff Description – Cured and fermented tobacco processed into fine particles and often packaged in round cans.

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Moist Snuff Use – Pinch or ―dip‖ is placed between cheek or lip and gums. Dry Snuff Description – Fire-cured tobacco processed into a powder. Dry Snuff Use – Pinch of powder is taken orally or inhaled through the nostrils. Sachet Description – Moist snuff packaged in ready-to-use pouches that resemble small tea bags. Sachet Use – Sachet is placed between cheek or teeth and gums.

Although some forms of snuff can be used by sniffing or inhaling into the nose, most smokeless tobacco users place the product between their gum and cheek. Users suck or chew on the tobacco, and saliva can be spat out or swallowed. The tobacco industry has also developed newer smokeless tobacco products such as lozenges, tablets, tabs, strips, and sticks.

Health Effects of Smokeless Tobacco

Smokeless Tobacco and Cancer

Smokeless tobacco contains 28 cancer-causing agents (carcinogens).

Smokeless tobacco is a known cause of human cancer; it increases the risk of developing cancer of the oral cavity and pancreas.

Smokeless Tobacco and Oral Health

Smokeless tobacco is also strongly associated with leukoplakia—a precancerous lesion of the soft tissue in the mouth that consists of a white patch or plaque that cannot be scraped off.

Smokeless tobacco is associated with recession of the gums, gum disease, and tooth decay.

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Smokeless Tobacco and Reproductive Health

Smokeless tobacco use during pregnancy increases the risks for preeclampsia (i.e., a condition that may include high blood pressure, fluid retention, and swelling), premature birth, and low birth weight.4

Smokeless tobacco use by men causes reduced sperm count and abnormal sperm cells.

Smokeless Tobacco and Nicotine Addiction

Smokeless tobacco use can lead to nicotine addiction and dependence.

Adolescents who use smokeless tobacco are more likely to become cigarette smokers.

Smokeless Tobacco Use in the United States

Smokeless tobacco use in the United States is higher among—

Young white males

American Indians/Alaska Natives

People living in southern and north central states, and

People who are employed in blue collar occupations or service/laborer jobs or who are unemployed

Adults and Smokeless Tobacco

Current Smokeless Tobacco Users

3.3% of adults (aged 18 years and older)

6.5% of men

0.4% of women

7.0% of American Indian/Alaska Natives

4.3% of whites

1.3% of Hispanics

0.7% of African Americans

0.6% of Asian Americans

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High School Students and Smokeless Tobacco

Current Smokeless Tobacco Users

7.9% of all high school students

13.4% of male high school students

2.3% of female high school students

10.3% of white high school students

4.7% of Hispanic high school students

1.2% of African-American high school students

Middle School Students and Smokeless Tobacco

Current Smokeless Tobacco Users

2.6% of middle school students

4.1% of male middle school students

1.2% of female middle school students

3.4% of Hispanic middle school students

2.8% of white middle school students

2.0% of Asian middle school students

1.7% of African-American middle school students NOTE: For all data above, "current" user is defined as using smokeless tobacco products on 1 or more of the 30 days preceding the survey.

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CHAPTER 5 MARIJUANA

Marijuana is a green, brown, or gray mixture of dried, shredded leaves, stems, seeds, and flowers of the Cannabis sativa hemp plant. All forms of marijuana are mind-altering (psychoactive). In other words, they change how the brain works. They all contain THC (delta-9-tetrahydrocannabinol), the main active chemical in marijuana. They also contain more than 400 other chemicals. Marijuana’s effects on the user depend on it’s strength or potency, which is related to the amount of THC it contains. Most users roll loose marijuana into a cigarette (called a joint or a nail) or smoke it in a pipe or water pipe, sometimes referred to as a bong. Some users mix marijuana into foods or use it to brew a tea. Another method is to slice open a cigar and replace the tobacco with marijuana, making what's called a blunt. Marijuana cigarettes or blunts sometimes contain other substances as well including crack cocaine. THC in marijuana is rapidly absorbed by fatty tissues in various organs. Generally, traces (metabolites) of THC can be detected by standard urine testing methods several days after a smoking session. In heavy users, however, traces can sometimes be detected for weeks after they have stopped using marijuana. The short-term effects of marijuana include:

problems with memory and learning;

distorted perception (sights, sounds, time, touch);

trouble with thinking and problem solving;

loss of motor coordination; and

increased heart rate. Effects can be unpredictable, especially when other drugs are mixed with marijuana.

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LONG TERM EFFECTS OF MARIJUANA USE Findings so far show that regular use of marijuana or THC may play a role in some kinds of cancer and in problems with the respiratory and immune systems.

Cancer It’s hard to know for sure whether marijuana use alone causes cancer, because many people who smoke marijuana also smoke cigarettes and use other drugs. But it is known that marijuana smoke contains some of the same, and sometimes even more, of the cancer-causing chemicals found in tobacco smoke. Studies show that someone who smokes five joints per day may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day.

Lungs and airways People who smoke marijuana often develop the same kinds of breathing problems that cigarette smokers have: coughing and wheezing. They tend to have more chest colds than nonusers. They are also at greater risk of getting lung infections like pneumonia.

Immune system Our immune system protects the body from many agents that cause disease. It is not certain whether marijuana damages the immune system of people, but both animal and human studies have shown that marijuana impairs the ability of T-cells in the lungs' immune system to fight off some infections. THE EFFECT OF MARIJUANA ON THE BRAIN Some studies show that when people have smoked large amounts of marijuana for years, the drug takes its toll on mental functions. Heavy or daily use of marijuana affects the parts of the brain that control memory, attention, and learning. A working short-term memory is needed to learn and perform tasks that call for more than one or two steps.

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Smoking marijuana causes some changes in the brain that are like those caused by cocaine, heroin, and alcohol. Scientists are still learning about the many ways that marijuana can affect the brain. MARIJUANA USE AND ADDICTION Long-term marijuana use leads to addiction in some people. That is, they cannot control their urges to seek out and use marijuana, even though it negatively affects their family relationships, school performance, and recreational activities. According to one study, marijuana use by teenagers who have prior antisocial problems can quickly lead to addiction. In addition, some frequent, heavy marijuana users develop ―tolerance‖ to its effects. This means they need larger and larger amounts of marijuana to get the same desired effects as they used to get from smaller amounts.

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CHAPTER 6 TREATMENT OPTIONS FOR TOBACCO ADDICTION

Tobacco addiction is a chronic disease that often requires multiple attempts to quit. Although some smokers are able to quit without help, many others need assistance. Generally, rates of relapse for smoking cessation are highest in the first few weeks and months and diminish considerably after about 3 months. Both behavioral interventions (counseling) and medication can help smokers quit; the combination of medication with counseling is more effective than either alone. What are the health benefits of quitting smoking/tobacco use? ▪ Stroke risk is reduced to that of a person who never smoked after 5 to 15 years of not smoking. ▪ Cancers of the mouth, throat, and esophagus risks are halved 5 years after quitting. ▪ Cancer of the larynx risk is reduced after quitting. ▪ Coronary heart disease risk is cut by half 1 year after quitting and is nearly the same as someone who never smoked 15 years after quitting. ▪ Chronic obstructive pulmonary disease risk for death is reduced after quitting. ▪ Lung cancer risk drops by as much as half 10 years after quitting. ▪ Ulcer risk drops after quitting. ▪ Bladder cancer risk is halved a few years after quitting. ▪ Peripheral artery disease declines after quitting. ▪ Cervical cancer risk is reduced a few years after quitting.

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▪ Low birth weight baby risk drops to normal if pregnant women quit before pregnancy or during their first trimester. When a person quits smoking or using smokeless tobacco, they often experience one or more of the following symptoms: ▪ Experiencing a strong urge to smoke, dip, or chew ▪ Feeling angry or frustrated ▪ Feeling anxious or depressed ▪ Finding it hard to concentrate ▪ Feeling headachy, restless, or tired ▪ Being hungry or gaining weight ▪ Having trouble sleeping These symptoms are temporary, and they vary from person to person. Symptoms usually peak about 1 to 3 weeks after quitting. Cravings or urges to use tobacco may last much longer than other symptoms. Behavioral Treatments Behavioral treatments employ a variety of methods to assist smokers in quitting, ranging from self-help materials to individual counseling. These interventions teach individuals to recognize high-risk situations and develop coping strategies to deal with them. The U.S. Department of Health and Human Services’ (HHS) national toll-free quitline, 800-QUIT-NOW, is an access point for any smoker seeking information and assistance in quitting. Nicotine Replacement Treatments Nicotine replacement therapies (NRTs), such as nicotine gum and the nicotine patch, were the first pharmacological treatments approved by the Food and Drug Administration (FDA) for use in smoking cessation therapy. NRTs deliver a controlled dose of nicotine to a smoker in order to relieve withdrawal symptoms during the smoking cessation process. They are most successful when used in combination with behavioral treatments. FDA-approved NRT products include nicotine chewing gum, the nicotine transdermal patch, nasal sprays, inhalers, and lozenges.

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Other Medications Bupropion and varenicline are two FDA-approved non-nicotine medications that effectively increase rates of long-term abstinence from smoking. Bupropion, a medication that goes by the trade name Zyban, was approved by the FDA in 1997 for use in smoking cessation. Varenicline tartrate (trade name: Chantix) targets nicotine receptors in the brain, easing withdrawal symptoms and blocking the effects of nicotine if people resume smoking. Current Treatment Research Scientists are currently pursuing many other avenues of research to develop new tobacco cessation therapies. One promising intervention is a vaccine that targets nicotine, blocking the drug’s access to the brain and preventing its reinforcing effects. Preliminary trials of this vaccine have yielded promising results.

END OF COURSE

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GLOSSARY

ADDICTION – A complex brain disease characterized by drug craving, seeking, and use that can persist even in the face of extremely negative consequences. BUPROPION - A substance that is used to treat depression, and to help people quit smoking. It belongs to the family of drugs called antidepressants. It is also called Zyban. CARCINOGEN – A cancer-causing substance. NICOTINE - An addictive, poisonous chemical found in tobacco. It can also be made in the laboratory. When it enters the body, nicotine causes an increased heart rate and use of oxygen by the heart, and a sense of well-being and relaxation. It is also used as an insecticide. VARENICLINE TARTRATE – A drug used to help people stop smoking by acting the same way nicotine acts in the brain. It is a type of nicotine receptor partial agonist. It is also called Chantix. WITHDRAWAL - Withdrawal is the variety of symptoms that occur after use of some addictive drugs including nicotine is reduced or stopped.

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RESOURCES Title: The Health Consequences of Smoking: A Report of the Surgeon General Source: CDC http://www.cdc.gov/tobacco/data_statistics/sgr/2004/index.htm Title: The Benefits of Quitting (poster) Source: CDC http://www.cdc.gov/tobacco/data_statistics/sgr/2004/posters/benefits/index.htm Title: Within 20 Minutes of Quitting (poster) Source: CDC http://www.cdc.gov/tobacco/data_statistics/sgr/2004/posters/20mins/index.htm National Network of Tobacco Cessation Quitlines 1-800-QUITNOW (1-800-784-8669) TTY 1-800-332-8615 Smokefree.gov Web Site http://www.smokefree.gov American Lung Association 1-800-LUNG-USA (1-800-586-4872) http://www.lungusa.org

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and Health Promotion, Office on Smoking and Health, 1990. Available at: http://profiles.nlm.nih.gov/NN/B/B/C/T/. Centers for Disease Control and Prevention. Annual Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity Losses—United States, 2000–2004. Morbidity and Mortality Weekly Report 2008;57(45):1226–1228 [accessed 2010 February]. Centers for Disease Control and Prevention. Health, United States, 2008. Hyattsville (MD): Centers for Disease Control and Prevention, National Center for Health Statistics, 2009 [accessed 2010 February ]. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual Causes of Death in the United States. JAMA: Journal of the American Medical Association 2004;291(10):1238–1245 [cited 2009 June 16]. U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2004 [accessed 2010 February]. U.S. Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 1989 [accessed 2010 February]. Ockene IS, Miller NH. Cigarette Smoking, Cardiovascular Disease, and Stroke: A Statement for Healthcare Professionals from the American Heart Association. Circulation 1997;96(9):3243–3247 [cited 2009 May 5]. Fielding JE, Husten CG, Eriksen MP. Tobacco: Health Effects and Control. In: Maxcy KF, Rosenau MJ, Last JM, Wallace RB, Doebbling BN, editors. Public Health and Preventive Medicine. 14th ed. New York: McGraw-Hill, 1998:817–845 [cited 2009 May 5].

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U.S. Department of Health and Human Services. Women and Smoking: A Report of the Surgeon General. Rockville (MD): U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon General, 2001 [accessed 2010 February].

The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General, U.S. Department of Health and Human Services. U.S. Department of Health and Human Services, Office of the Surgeon General. Revised January 4, 2007.

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TOBACCO USE FOR THE DENTAL PROFESSIONAL

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