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NATIONAL DENTAL TOBACCO-FREE STEERING COMMITTEE MEETING REPORT FOR January 25-26, 1999 SUPPLEMENTAL REPORTS DEPARTMENT OF HEALTH & HUMAN SERVICES U.S. PUBLIC HEALTH SERVICE NATIONAL INSTrFUTES OF HEALTH NATIONAL CANCER INSTITUTE

NATIONAL DENTAL TOBACCO'FREE STEERING COMMITTEE MEETINGREPORT~ J ry~_25~26, 1999 .anua SUPPLEMENTAL REPORTS DEPARTMENT OF HEALTH & HUMAN SERVICES U.S. PUBLIC HEALTH SERVICE NATIONAL INSTITUTES OF HEALTH NATIONAL CANCER INStlt'~T~

SUPPLEMENTAL REPORTS NATIONAL DENTAL TOBACCO-FREE STEERING COMMITTEE Committee Reports January 25-26, 1999 Pace(s) 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Chairman's report ....................................... Academy of General Dentistry report ....................... American Academy of 0ral Medicine report .................. | American Association for Dental Research report .............. American Association of Community Dental Programs report .... American Association of Dental Schools report ............... American Association of Public Health Dentistry report ......... American Association of Women Dentists report ................. American Dental Assistants Association report ................... American Dental Association reports - Part A Council on Access, Prevention and Professional Relations ....... - Part B Council on Dental Practice ............................. - National Board Dental Examination letter ..................... - Foundation for Dental Health Education order form .............. American Dental Hygienists' Association report .................. American Public Health Association report ...................... Association of State and Territorial Dental Directors report ......... • National Dental Association report ............................ Oral Health America, National Spit Tobacco Education Program.report ... .. .10 .. .11 .. .13 .. .14 .. .15 ...... 16 ........ 19 ........ 21 ........ 23 ....... 25 ....... 27 ....... 29 ....... 39 ....... 40 ....... 41 16. 17. 18. 19. 20. 21. 22. 23. 24. 25." 26. 27. 28. Secondhand Smoke Facts - Repaee Associates ...................... Adolescent Smoking Cessation Dental Practices., ................... Division of Oral Health, CDC report and ~ on Oral and Pharyngeal Cancer .................................. Center for Tobacco Preventioia, Karolinska Institute, Sweden .......... Indiana University Nicot'me Dependence Program report .............. Oregon Health Sciences University drug dependence intervention program ........................................ University of Southern California report ........................... Military Health Care Provider position statement .................... Tobacco Free Delaware Coalition report .......................... Tucson, Arizona: Full Court Press Coalition report .................. New Zealand Dental Association Smoke Free Promotion report ......... Section of World Dentistry Against Tobacco, FDI meeting report ....... 11t~ World Conference on Tobacco OR Health, August 6-10, 2000 - Announcement and ~n information ......... 45 ......... 47 ......... 49 ......... 53 ......... 59 ......... 61 ......... 65 ......... 66 ......... 67 ......... 71 ......... 75

Supplement 1: Chairman's Report CHAIRMAN'S REPORT NATIONAL DENTAL TOBACCO-FREE STEERING COMMITTEE January 25, 1999 This fifteenth meeting of the National Dental Tobacco-Free SteeringCommittee occurs at the dawn of a new phase of the "tobacco wars." In 1998, the industry mounted strong re~sistance against litigation that would hold it accountable for misdeeds hnd against legislation that would promote corporate responsibility. Public health objectives to prevent nicotine addiction and tobacco-related diseases and adverse conditions are diametricullyopposed to the tobacco industrfs objectives of developing markets and increasing profits. Strategies applied by public health forces constantly meet with tobacco industry efforts tO preempt individual, community, and State laws, exempt itself from justice, and weaken social controls and accountability. The first part of this meet~g will address current status of the National Cancer Iustitu~te (NcI) with respect to tobacco control. On October 6, 1998, the Tobacco Control Research Branch was established, giving increasedvi.~ibility to the!sst~ewi~'thin NC!. In November, NCI's Board of Scientificcouusellors approved t.h.e Branch's nine-po~int research plan; a comprehensive agenda that promises to bring fresh understanding of .factors that' l~ad individu.'als to avoid, !nitiate, quit, or continue tobacco nse~ The second part of this meeting will review sever~ tobacco legislative, litigation, and public education activities Of 1998, and what these mean to public health practice in '1999 and beyond. Certainly, the sum- zero result of h~ving no Congressional legislation passed in 1998 was a victory for public health, even though new public health measures were not adopted, Congress did not legislat~ the special protection and a~antages that the tobacco industry had sought. YeL the industry did gain some~ advantages when it returned ~to state Attorneys General for a ne~ settlement. Now, ~the industry is quietly returning to a new Congress in. an attempt to secure special protection and adv ~a:ntages not secur.ed ~ it~ a~eement with the States. The President and others areintioduci~ng countermeasures. The best that can be saldab0nt the 1998 tobacco wars is that the public is much ~ore aware tha~ tobacco is a major hea!th i.ssee. Also, there is some hope that a portion of Stat~.tobacco settlement funds ~ill be allocated tO. financing effective public health measures, including patient tobacco cessation programs and public education campaigns. The worst that can be said is that, in spite of new evidence of tobacco industry untruthfulness and misdeeds, the sheer magnitude of its political effort, coupled .with its huge med~a campa!gn, has been s.h0wn to be.still .quite~ capable~of misleading the public and stopping sound legislation. ~.: ~ The third part Of the : ~ ~ " :" . meeting will address re~entadvances in the science.that forms the basis of our~ understanding of tobacco effec~ on the body and ~the pubfic. Risks associated with cigars, nicotine~ addiction, human behavior, and population trends will be reviewed. The balance of the meeting will be devoted to tobacco control activifie~within t~he denta~:~mmunity in the U~$~ end abroad. Other general and dental.-specifiC activities may be addre.ssed. A few are recognized below, : In 1998, Dr. Gro Harlem " ~ , Brundtland became the Direct0r,General of the World Health Organization (WHO). She immediately pl~aced tobacco control among her three top priorities and designated Dr. Derek Yach to lead the WHO initiative. Globally, WHO expects tobacco-related deaths to triple within the next two decades. This week in Geneva, Switzerland, WHO tobacco control proposals may be clarified during the World Health Assembly, Elsewhere, national governments are beginning to file suits against tobacco ~ompanies; their suits being patterned after those sucee~fully brought in the U.S. European dental schools and dental associations are increasingly active in tobacco control, both clinically and as professional organizations. The Taiwan Dental Association is defining its tobacco control role in order to address high oral cancer rates among individuals who use tobacco and chew betel quid. 1

Supplement 1: Chairman's Report Canadian, Hew Zealander, Mexican and other dental leaders are making progress in bringing the dental profession into the community of organizatioas that are dedicated to reducing the use of tobacco and its adverse health consequences. The FDI World Dental Federation has been highlighting tobacco and/or oral cancer issues in every Congress and in most of its publications. It is planning to present and publicize special programs on oral cancer and tobacco control during its 100th anniversary Congress scheduled for Paris, November 29 - December 2, 2000. I am privileged to be involved in many of these activities. Several multidisciplinary tobacco control conferences have been held since the April 1998 NDTFSC meeting. For example, on June 15 and 16, leading tobacco-research scientists and distinguished public health program leaders met at an American Cancer Society-sponsored conference, Cigar Smoking Health Risks: State-of, the-Science. On July 27-28, Vice-President AI Gore,. leading tobacco-research scientists from the U.S. and abroad, and several key individualsrepresenting tobacco control programs, met in Bethesda, Maryland for a special conference, Addicted to Nicotine. The conference, sponsored by- the Robert' Wood Johnson Foundation and the National Institute on Drug Abuse (NIDA), identified the current state Of the science and presented a comprehensive research agenda. Program summaries, presenters' biographies, and the meeting agenda are available on NIDA's home page on the World Wide Web at" www.nida.nih.gov. The conference provided the latest information about how nicotine acts in the body, especially in the central ncrvoussystem. This knowledge is expected to lead to more" effective means Of preventing and treating nicotifie addiction. I am optimistic about allthat the health professions, i~cluding the dental profession, can and will be doing in a few more years to reduce tobacco use-a major underlying cause of many oral diseases and conditions. (Incidentally, recentlyit has been learned that the tobacco industry has for years Worked ha~'dt0 prohibit tobacco from being identified in medical and death registries as~n underlying cause Of disease and mortality.) " ~ : .... ~ ..... ~ On Sep.temberJ0~ 1998, ,the Ageney for Health care Policy and Research (AHCPR) awarded a co~.tract the Unlversity:of Wisc0fisin tO reactivate th~ exper~ panel that developed CliniCal Pr~ctic~e Guideline N~. 18: Smoking Ce~idion. Release of~the Updated Gulde~ine is pl~anned for the fall6fihis year. I represent the dentalprofession on this panel. Upon its rel~ase in 1996,the Guideline was quickly adop~ted ~s the "gold standard" for clinical practice within numerous bealthcare systems ~n the U.S: and abroad. It is helping stimulate the adoption of clinical tobacco use intervention serv.i.'ces in managed care systems and as a practice standard.~ New Clinical intervention materials and upgrades, based on the Guideline are under development for dental iextb00ks: tbeADA Guide toDental 2~er~apeutics, the NCI dental manu'al, and other dental publichtions. ~ " ~ ' Since our last meeting,, I have had several opportunities to speakabout th~ AHCPR Guideline tO non- dental clinicians. ~Thi~has helped stimulate discussions of the topic in terms0f a variety of practice settings, and conversely has increased my appreciation that the ability and opportunity to help patients in dental practices are as good, if not better, than in other clinical settings. Of course, I continue to lecture and teach .dental clinicians about tobacco intervention and welcome opportunities to do so, but willnot present a litany Of. such. , past and future-, ~ evehts,.. •:. ! ~ i . . .~ :. ' " ~ ' . .' " ' TheNational~Iustitute of Delta| ahd Cr~iniofacial Research's Office of the Director has arranged for me to monitor, assess, and advise on-tobacco issues.~ A series of familiarization meetings are in progress. In due course, the role of all drugs of dependency and abuse on oral health should be considered. Substantial documentation on the effect of tobacco on oral health has been submitted for consideration for the forthcoming Surgeon General's Report on Oral Health. It is exciting to nole how firmly tobacco preventi6n and control issues have become established in dental organizati0ns~ The stream of tobacco and tobacco-control-related journal articles, meeting agendas, featured programs, and association policies, the activity of special interest groups in various national dental organizations, and dental representation in broad coalitions are evidence of the growing engagement of the profession in controlling a serious underlying cause of numerous oral diseases and adverse condition-s. Examples have been cited in every NDTFSC member's report. I am confident that we all look forward to hearing about many more accomplishments during this meeting. Thank you for your continuing heIp and commitment. 2

Supplement 2: Academy of General Dentistry report Academy of General Dentistry ' 211 East Chicago Avenue, Suite 1200, Chicago, Illinois 60611-2670 (312) 440-4300 888-AGD-DENT Fax (312) 440-0559 Report to the National Tobacco-Free Steering Committee January 25 & 26, 1998 The Academy of General Dentistry encourages its members and all general practice dentists and members of the dental health team to promote tobacco cessation and abstinence through patient education. The Academy continues to educate the public about the adverse impact tobacco has on oral and general health through internal and external communications. AGD Impact A cover story on oral cancer was featured in the November t998 AGD Impact, and an editorial letter from Bob Krause, Oral Health America president, comments on AGD l!npact "s oral cancer cover story will appear in the March 1999 issue. Every month, the newsmagazine messages reach more than 35,000 general dentists. A Dental Health-Fact Sheet on Smoking and Periodontal Disease is scheduled for the 1999 AGD Impact editorial calendar. See attached articles. General Dentist~_ The 1999 July/August General Dentistry journal will feature tobacco and oral health studies from Drs. Karen Crews and Nancy Williams. Each hi-monthly journal mails to more than 65,000 general dentists. Public Information This year, the Academy has reached an audience of more than 223 million consumers with positive dental health messages, including anti-tobacco stories, that cite the Academy of General Dentistry in print and broadcast media. Two Dental Health Fact Sheets entitled "'Oral Cancer" and "Spit Tobacco" appeared in AGD Impact. Dentists are able to copy these fact sheets an distribute them to their patients. Both fact sheets were added to our fact sheet packet that is available to the dentist to help educate their patients. See attached articles. The Academy of General Dentistry is dedicated to this health care topic which broadens dentistry's role in comprehensive health care, and also encourages all dental offices to serve as model tobacco-free environments and to work actively within the community to promote tobacco cessation and abstinence and to educate school-age children on the hazards of tobacco use. 3

Supplement 2: Academy of General Dentistry report Fact Sheet Academy of General- Dentistry Spit Tobacco Spit tobacco affects your dental health as well a.,;the rest of your body. If you use smokeless to- bacco and have thmu.:ht about quitting, your dentist can help. In the meantime, here are a few facts that may help you decide to join the 200 million Ameri- cans who are tobacco-tree. What is spit tobacco? Spit tobacco includes snuff, a finely ground version of processed tobacco, and chewing tobacco in the form of shredded or pressed bricks and cakes. called plugs, or rope-like strands called twisls. Users "pinch" or "dip" tobacco and place a wad in their check or between their low- er tip and gums. In the United Kingdom. users often snort snuff, Isn't it safer " ' than smoking? Absolutely not. Some wrongly believe that spit Iobacco is safer than smoking cigarettes. But spit tobacco is more addictive be- cause it contains higher levels of addictive nicotine than cigarettes and can be harder to quit than cig- arettes, One can of snuff delivers as much nicotine as 6{) cigarettes. About 8.000 people die every. year from tobacco use. About 70 percent of those deaths are from oral cancer. Other cancers caused by tobacco include cancer of the pancreas, nasal cavil): urinal,. tract, esophagus, pharynx, laryn, x. intestincs and the stomach. Kids who use spit tobacco products arc 4 to 6 times more likely to devel- op oral cancer than non-users and tobacco juice-related cancers can form within five year of regular use. Among high ~hool seniors who have ever used spit tol:ratx:o. • ,2most lhr~.fourtlx~ began by lhe ninth gr,~3e, How do.es snuff and chewing tobacco harm my dental health? It causes bad breath, discolors teeth and promotes tooth decay that leads to tooth loss. Spit to- bacco users have a decreased sense of smell and taste, and they arc at. greater risk of devel- oping cavities. The grit in snuff eats away at gums. exposing IOOth roots which are sensitive to hot and cold temperatures and can be painful. Sugar in spit to- bacco causes decay. Spit tobac- co users also have a hard time getting their teeth clean. What about mouth sores? The most common sign of possi- ble ~mcer in smokeless tobacco users is leukopl',&ia. (Ioo-ko-play- key-ah) a white scaly patch or le- sion inside the mouth or lips. com- mon among many spit tobacco users. Red sore.,; are'dso a warn- ing sign of cancer. Often. signs of precancerous lesions are unde- tectahle. Demise,; can diagnose and treal SLlch cases belbre the conditiou develops into oral cancer. If a white or red sore appears and doesn't he'd. see your dentist inunediately for a ..... lnc~ous test to see I1 It sprec, . Spit tobacco users 'also should see their dentist every ~ee months, to make sure a prob- lem doesn't develop. Studies have found that 61) to 78 percenl of spit tobacco users have oral lesions. ' What are double dippers? Double dippers, who mix snuff and chewing tobacco, are more likely to develop precancerous lesions than those who use only one type of spit tobacco. Long- Icrm snuff users have a 5{} per- cent greater risk of developing troll cancer dlan non-users, imd spit lobncco users are more like- 13' to become cigarette smokers. How do you kick the habit? Your dentist can help you kick yourspit tobacco habit. Inaddi- lion to cleaning teeth and treating bad breath and pule},, swollen gums associated with tobacco use. your dentist may pres~,xibe a variety nf nicoline replacement therapies, such as the transdermai . nicotine patch or chewing gum that helps to wean addicted snuff dippers or tobacco chewers. Nicotine patches are worn for 24 hours over several week,;. supplying a steady flow of nico- tine. The four brands nf patches are Habitrol. Nicoderm. @Tl'=s =r~ormat)on wa'~ c~rnDded 1or you by the Academv ot General Den- II tistry.. Your dentist cares about long-term dental he~h fur you and .vour ~ fam~ and demonstrat~ that concern by below_ mg 1o the Academy ~ General Oenttstry. As one ot the, 35.000 general dentt~s =n the Umted Slates and Canada who ate meml:~rs c~ the Academy. ~ den~t D&'lwJgales m an ongoing pccx3r, am ol t:~es,s~o~;.I devetolxnera and congnum'g_ educat=on (o remain curren~ w~th advances ~nthe peoless=on and to ~'owde ~:luahty I:mt=enl treatrneat. V~s=t the AGD's wel:mte at w~w..a.aa.o~. You ha~e perm~s~on to photocow th~ I~ .age and ~lnl~qe ~t 1~ ~ur p al~ec~ls. Ni¢otrol aud Pmstep. Over the course of treaunent the amount of nicotine in the patch decreas- es. The nicotine patch has a 25 percent success rate. Or you may try nicotine gum therapy on your quit day. One piece of gum is slowly chewed every 1-2 hours. Each piece should be dis- carded after 20-30 minutes. Make goals Make the following go',tls to quit and never resume chewing or dip- ping: • Pick a date and taper use as the date nears. Instead of using spit tobacco, carry subFtitutes like gum. hard candy and sunflower seeds. • Cut back on when and where you dip and chew. Let friends and family know that you're quitting and solicit their support. It" they dip and chew, ask them not to do it around you. • Make a list of three situations you" re most likely to dip and they,; and make every, effort to avoid using lObtV.:co at those times. • Switch to a lower nicotine bnmd to help cut down your dose. &)ttrces: Campa~qn far Tobacco.Free Kids. Oral ltealth America. Beat the Smokeles.r Ilabit: Game Plan for Surress. Nathmal l~ti~ttes of Health and National Cancer Institute. June 1o03: llealth hnplicationx of Smo~lesx ~barro [I.~': National la~lilule.t Ilealth ~flsen.~t.¢ Development Co~nre Statement. 1986: Smo~le~¢ Tobacco: Think Befo~ You American Dental A.~rociation. 19~: ~e theman Cost o[Tobacco ~ by Carl Banerd~i. M.D. et al.. ~ New England J, mmal of Medicine. Ma¢h 31. 1~: Morb[dity and MonaliEv Wee~y Report. Cente~ for Contud and P~.ention. Ma~h 25. 1~: Nirotine ~t~ Succ¢~ Rate Set at Drily 25~. by ~n Van. Chica~ T~bune. Fehma~ 24. I~: and Ce~atmn A~g ~ Bo~r. by Fe~¢aq" 1~: ~ 173-1~. March 19~ 4

Supplement 2: Academy of General Dentistry report Fact Sheet .Academy of General Dentistry. Oral cancer How common and how serious is oral cancer? Oral cancer, the sixth most com- mon cancer, accoums for about 3.6 percent of all cance~s diag- nosed, with roughly 40.000 new cases of oral cancer reported an- nually in the United States. The vast majority of 0ral cancers oc- cur in people older than 45 years, with men being twice as likely as women to develop the disease. 2"he most f~quent oral cancer sites are the tongue, the floor of the mouth, soft palate tissues in back of the tongue, lips. and gums. If not diagnosed and treated in its early stages, oral cancer can spread, leading to chronic prin, loss of function, ir- reparable facial and oral disfig- uroment following surgery, and even death. Your general dentist can perform a thorough screen- ing for oral cancer. What causes oral cancer? Scientists aren't sure of the exact cause of oral cancer. However, the carcinogens in tobacco prod- ucts, alcohol and certain foods. as well as excessive exposure to the sun have been found to in- crease the risk of developing oral cancer. Risk factors for oral cancer may also be genetically inherited. What are the warning signs to watch out for? Oral cancer--represented by" red. white or discolored lesions. patches or lumps in or around the mouth--is typically painless in its early stages. As the malig- nant career spreads and destroys healthy oral tissue, the lesions or lumps become more painful. However. oral cancer is some- times difficult to self-diagnose. so routine dental exams are rec- ommended. See your dentist immediately if you observe: any sore that persists longer than two weeks: a swelling, growth or lump any- where in or about the mouth or neck: white or red patches in the mouth or on the lips: repeated bleeding from the mouth or throat:, difficulty swallowing or persistent hoarseness. cheeks and oral cavity, and thor- oughly examines the soft tissues in your mouth, specifically looking for any sores or discol- ored tissues. How is oral cancer treated? If your dentist suspects oral can- cer. a biopsy of the lesion is re- quired to confirm the diagnosis. SurgeD' is required to remove the minors, which may cause disfiguration. Radiation therapy may be used as part of the treatment. How does a dentist screen for oral cancer? Your dentist should screen for oral cancer during routine checkups. He or she feels for lumps or irregular tissue O ° chan=es m your neck. head. What can I do to prevent oral cancer? Oral cancer accounts for roughly 9.000 deaths annually (about 3 percent of all cancer-cansed deaths). Of all major cancers. oral cancer has the worst five- This mtormat=on was compded for you by the Acaoerny o! General Dent=stry Your dentist cares about long-term Oental health for you ~ your lamdy and ¢~.strates that cor~cem 0y belong=ng to the Aeanq~my ol General Dentistry. As ¢a'~e ot the 35.000 general dentils =n the United States and Canaaa who are members o! the Aeaoemy, you~ ~entlst oamooales in an ongoing program OI i:~:)less~tal de- velol:~nt and continuing, eOucal~on to remain ounen! w~th aOvanees =n the omles- ss:m and to 0n:n,,~Se ~.~-u¢/oat*eric u'eacaent ~hstt me AGDs ~¢~te at v,'n'w.a~.o~2. year survival rate at about 54 ~ercent. Because oral cancer is usually not dia~osed in its early stages, less than half of all oral cancer patients are cured. You can help prevent oral cancer by not smoking, using spit to- bacco and drinking excessive al- cohol. When tobacco use and al- cohol use are combined, the risk of oral cancer increases 15 times more than non-users of tobacco and alcohol products. Research suggeststhat eating plenty of fruits and vegetables may safe- guard against oral cancer. Be- cause successful treatment and rehabilitation are dependent on early detection, it is extremely important to see your dentist for an oral cancer screening and re~lar checkup at least every six months. Survival rates great- -ly increase the earlier oral can- cer is discovered and treated. During your next dental visit. ask your dentist to do an oral cancer screening. Sources: American Cancer Society: Luke E Matranga, DOS, MAGD, CBGD. past pres- ident of the AGD: "The War on Oral Cavil." and Pharyngeal Cancer." by Dr. Harold Slarkh~. JADA, April 1996; "U.S. Adult Knonqedge of Risk Factors and Signs of Oral Cancers: 1990.'" b.v Dr. Alice Horowit:, et. aL. J/IDA, January 1995: "The Early Warning Signs of Oral Cancer." by Edmund Cataldo. Dental Hygienist News. Sprine 1994. AGD IMPACT Nmmbet 1998 5

Supplement 2: Academy of General Dentistry report March 1999 COVER STORY: Evidence based care BUSINESS BUILDER: Creating a good dental team FEATURE: Why you should look into ~ Fellowship/Mastership Awazds SPECIAL TECHNOLOGY: Extraoml cameras w/ fact sheet FACT SHEET: Dental implants Editorial Calendar July 1999 COVER STORY: Nutrition and oral health making the connection BUSINESS BUILDER: Old patient records--Keep them under control FEATURE: Working with pcriodontist FEATURE: Generic drug companies leave the market FACT SHEET: Nutrition and health April 1999 COVER STORY: Legislation affecting dentistD' BUSINESS BUILDER: Y2K-Effects on the dental practice FEATURE: What's new in pain management FEATURE: Anesthesia in the dental office SPECIAL TECHNOLOGY: Intraoral cameras w/ fact sheet FACT SHEET: Dental anesthesia August/September 1999 COVER STORY: Dentistry's relationship with insurance companies--good and bad BUSINESS BUILDER: Transition planning FEATURE: Dental noise is a work hazard FEATURE: Problem-based learning FACT SHEET: Diabetes and perio disease May 1999 COVER STORY: DentistD"s response to PEW BUSINESS BUILDER: Y2K--Carriers payment options, eligibili .ty issues FEATURE: The changing physician and dentist relationship FEATURE: Consolidation among dental suppliers SPECIAL TECHNOLOGY: Curing lights w/fact sheet FACT SHEET: Women's dental health October 1999 COVER STORY: Access to car~deliwring care to patients- BUSINESS BUILDER: Bomncrs dental needs growing FEATURE: Violence in the workplace FEATURE: Caries--not as insignificant as we thought FACT SHEET: Low-birth-weight babies and perio disease June 1999 COVER STORY: Is there room for expanded function auxiliaries? BUSINESS BUILDER: Keeping your patients happy FEATURE: Annual meeting previcxv or new dental research FEATURE: Tree or false: The year 2000 will have a shortage of dentists SPECIAL TECHNOLOGY: Panoramic x-rays w/ fact sheet FACT SHEET: Sealants November 1999 COVER STORY: Dentistry. and the Media BUSINESS BUILDER: How to choose an associate FEATURE: Latest latex allergy, statistics FEATURE( Working with pediatric dentists FACT SHEET: Heart disease and pcrio disease December 1999 COVER STORY: Wellness in dental care--what dentists are doing and what they can do BUSINESS BUILDER: Cosmetic dentist~, a practice staple FEATURE: AGD helping members FEATURE: Where dentistry stands on the fluoridation battle line FACT SHEET: Smoking and perio disease Updated Dec. 30. 1998 6

Supplement 3: American Academy of Oral Medicine report REPORT TO THE NATIONAL DENTAL TOBACCO-FREE STEERING COMMITTEE JANUARY 25-26, 1999 The American Academy of Oral Medicine (AAOM) had its annual meeting on 27 April-01 May 1998, and the board of directors agreed to reaffirm the commitment of the Academy to support the goals of the NDTFSC. Discussion were made on how the AAOM can continue to support of the important mission of the NDTFSC. The proposed American Academy of Oral Medicine organization statement, regarding the effects of tobacco on oral health and oral medicine related conditions, was presented to members during the general business meeting. The proposed statement, which indicates that there is no safe form of tobacco, and that all forms of tobacco including cigars, pose a significant risk to the oral health of users, was accepted by the general membership. The statement is to be published as a letter to the editor to the major English language peer- reviewed medical and dental journals. All dental health care providers were urged to become active in tobacco control. Additionally the Academy will continue support bfthe NDTFSC by: ' 1.) Including tobacco related topics such as tobacco control in the scientific program at future fiie~ings, as will be done at the May 1999 meeting. 2.) Having educational materials and information regarding tobacco use and intervention distributed at annual meetings. • ~. 3.) Publishing in the quarterly AAOM newsletter information for members regarding tobacco use and control, as was done with the most recent issue. 4.) Continuing to include in the Academy's official.publication, the Jbumal of Oral Surgery~ Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics, scientific papers regarding the pathophysiology of tobacco and strategies of cessation. 5.) Actively encouraging all members, many of whom are engaged in dental education, to include tobacco related issues in their dental curriculum. The American Academy of Oral Medicine looks forward to further defining its role and contributing to the mission of the NDTFSC. Respectfully submitted, Paul J. Vankevich, D.M.D. AAOM representative to the NDTFSC 7