Summary of Policy and Recommendations Regarding Tobacco
1964 – Present
1. The Association should continue to educate and inform its membership and the public about the many health hazards attributed to the use of tobacco products, particularly cigarettes, pipes, cigars and smokeless tobacco. (Initially adopted in 1964; revised in 1969, 1978, 1981, and 1988)
2. The Association is opposed to the advertising of cigarettes, pipes, cigar and smokeless tobacco products in both electronic and print media and supports national legislation to this effect. (Initially adopted in 1969; revised in 1988)
3. The Association prohibits smoking at all of its meetings and conferences. (Initially adopted in 1972; revised in 1973, 1976, 1988 and 1992)
4. The Association urges continued research into the adverse health effects of tobacco use. (Adopted in 1986)
5. The Association endorses the mandating of warning labels on tobacco products. (Adopted in 1988)
6. The Association urges its individual members, dental societies, dental schools and related dental organizations to adopt antismoking policies for their offices and meetings, where such policies are not already in place. (Adopted in 1988)
7. The Association urges its members to become fully informed about tobacco cessation intervention techniques to effectively educate their patients to overcome their addiction to tobacco. This information should include education on primary prevention of tobacco use. (Adopted in 1992)
8. The Association supports national and state legislation that would prohibit or limit the ways and places that tobacco advertising and promotion practices can be used, particularly that which appeals to children and teenagers. (Adopted in 1993)
9. The Association supports the enactment and enforcement of laws setting age restrictions for the sale of tobacco products in addition to bans on free sampling. (Initially adopted in 1986; revised in 1993)
10. The Association also supports licensing requirements for sellers of tobacco products and enforcement of bans on the sale of tobacco products through vending machines. (Adopted in 1993)
11. The Association supports the enactment of federal and/or state legislation to significantly increase taxes on tobacco products as a means to discourage the initiation and continuation of tobacco use. (Adopted in 1993)
12. The Association supports the enactment and enforcement of legislation and regulations to reduce the exposure of nonsmoking adults and children to environmental tobacco smoke (ETS), with emphasis on facilities and activities that expose the greatest number of people to ETS for the longest periods of time, such as work places, schools, daycare centers, and health care facilities. (Adopted in 1993)
13. The Association urges federal, state and local governments to strengthen and expand their roles in tobacco-use education, prevention, research and cessation efforts. (Adopted in 1993)
14. The Association supports legislation and/or regulation that acknowledges nicotine as an addictive drug and that authorizes the Food and Drug Administration to regulate tobacco products as nicotine delivery devices and/or drugs; and further, urges that such legislation be promptly enacted so that the use of nicotine is restricted. (Initially adopted in 1992, revised in 1995)
15. The American Dental Association urges that state tobacco settlement funds be targeted toward improving health and reducing the morbidity and mortality associated with tobacco-related diseases, especially oral diseases, in collaboration with health-related organizations and agencies. (Adopted in 1999)
16. The American Dental Association urges that state tobacco settlement funds be used to improve access to care for underserved populations by increasing funding to dental programs such as Medicaid and the State Child Health Insurance Program. (Adopted in 1999)
17. The American Dental Association urges that a portion of state tobacco settlement funds be targeted toward tobacco control programs that reduce tobacco use, particularly in children and adolescents. (Adopted in 1999)
18. The American Dental Association continue{s} to assist constituent dental societies in designing strategies to promote the use of state tobacco settlement funds in a manner consistent with Association policy. (Adopted in 1999)
19. National Action Plan for Tobacco Cessation
Resolved, that the American Dental Association supports the following proposals approved by the federal Interagency Committee on Smoking and Health in its 2003 national action plan for tobacco cessation:
1. establish a federally-funded National Tobacco Quitline network;
2. launch an ongoing, extensive paid media campaign to help Americans quit using tobacco;
3. include evidence-based counseling and medications for tobacco cessation in benefits provided to all federal beneficiaries and in all federally-funded healthcare programs;
4. invest in a new, broad and balanced research agenda (basic, clinical, public health, translational, dissemination) to achieve future improvements in the reach, effectiveness and adoption of tobacco dependence interventions across both individuals and populations;
5. invest in training and education to ensure that all clinicians in the United States have the knowledge, skills and support systems necessary to help their patients quit tobacco use; and
6. establish a Smokers' Health Fund by increasing the Federal Excise Tax on cigarettes by $2.00 per pack (from the current rate of $0.39 to $2.39) with a similar increase in the excise tax on other tobacco products. At least 50% of this new revenue generated by this tax increase (at least $14 billion of the estimated $28 billion generated) should be earmarked to pay for the components of this action plan. (Adopted in 2003)
20. Tobacco and Harm Reduction
Resolved, that the American Dental Association supports legislation that authorizes the Food and Drug Administration's regulation of all tobacco products, including tobacco products with risk reduction or exposure reduction claims, explicit or implicit, and any other products offered to the public to promote reduction in or cessation of tobacco use, and be it further
Resolved, that the Association supports regulation of all tobacco products in order to ensure meaningful access to a science base for evaluation of the effects of all tobacco products, and be it further
Resolved, that the Association supports regulation of all tobacco products in order to ensure that assessment, including extensive premarket testing, and surveillance are completed, to secure data to serve as a basis for developing and implementing appropriate public health measures, and be it further
Resolved, that if legislation is passed to authorize the FDA to regulate all tobacco products, the Association urges the FDA to authorize the use of harm reduction strategies only as a component of a comprehensive national tobacco control program that emphasizes abstinence-oriented prevention and treatment. (Adopted in 2003)
21. Sources of Tobacco Use Prevention and Cessation Materials
Resolved, that the American Dental Association urge dentists and health organizations to provide information or materials on tobacco use prevention or cessation to patients and consumers developed by credible and trustworthy sources with expertise in tobacco control, and be it further
Resolved, that the ADA urge dentists and health organizations to avoid providing patients and consumers information or materials on tobacco use prevention or cessation developed by tobacco companies or other groups aligned with the tobacco industry, and be it further
Resolved, that the Association not accept advertisements from tobacco companies or groups aligned with the tobacco industry concerning tobacco use prevention or cessation in any of its official publications, including, but not limited to, The Journal of the American Dental Association and ADA News.
Tobacco Use and Vaping
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Ad Interim Policy on E-Cigarettes and Vaping
(2019)
Resolved, that the ADA Board of Trustees adopts the following statement, which mirrors a recent action from the American Medical Association, as ad Interim ADA Policy to address the public health crisis related to e-cigarettes and vaping:
That the American Dental Association (1) urgently advocate for regulatory, legislative, and/or legal action at the federal and/or state levels to ban the sale and distribution of all e-cigarette and vaping products, with the exception of those approved by the FDA for tobacco cessation purposes and made available by prescription only; and (2) advocate for research funding to study the safety and effectiveness of e-cigarettes and vaping products for tobacco cessation purposes and their effects on the oral cavity.
American Dental Association
Board of Trustees
December 2019
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Policies and Recommendations on Tobacco Use
(2016)
Dentist’s Role in Preventing Tobacco Use
Resolved, that the ADA supports professional education related to the importance of primary prevention of tobacco use, and be it further
Resolved, that the ADA urges its members to become fully informed about tobacco cessation intervention techniques to effectively educate their patients to overcome their addiction to tobacco, and be it further
Resolved, that the ADA supports training and education for dental professionals to ensure that all clinicians in the United States have the knowledge, skills and support systems necessary to inform the public about the health hazards of tobacco products and to provide effective tobacco cessation strategies, and be it further
Resolved, that the ADA urges dentists and health organizations to provide educational materials on tobacco use prevention or cessation to patients and consumers developed by credible and trustworthy sources with no ties to the tobacco industry or its affiliates, and be it further
Access and Prevention
Resolved, that the ADA continue to educate and inform its membership and the public about the many health hazards attributed to the use of traditional and non-traditional tobacco products, including e-cigarettes, e-cigarette cartridges, snus, dissolvable tobacco, tobacco gels, and other products made or derived from tobacco, and be it further
Resolved, that the ADA encourages its members and dental societies to collaborate with students, parents, school officials, and members of the community to establish tobacco-free schools, and be it further
Resolved, that the ADA does not consider marketing some tobacco products as safer or less harmful to an individual’s health than others to be a viable public health strategy to reduce the death and disease associated with tobacco use, and be it further
Government Affairs
Resolved, that the ADA should give priority to the following when advancing public policies to prevent tobacco use:
- Protecting and enhancing state and federal regulatory authority to ban or otherwise prevent the use of traditional and non-traditional tobacco products;
- Banning the sale of traditional and non-traditional tobacco products in all venues, including through vending machines and the internet;
- Levying significant excise taxes on traditional and non-traditional tobacco products;
- Setting age restrictions for purchasers of traditional and non-traditional tobacco products;
- Requiring oral health warning statements and graphic images on traditional and non-traditional tobacco products;
- Barring companies from marketing some traditional and non-traditional tobacco products as being less harmful to the oral health than others;
- Regulating exposure to environmental tobacco smoke (ETS);
- Banning all forms of traditional and non-traditional tobacco product advertising and marketing (including bans on free sampling);
- Imposing licensure requirements for traditional and non-traditional tobacco product retailers;
- Prohibiting the use of traditional and non-traditional tobacco products on public and private property, including government buildings and school campuses;
- Requiring third-party payers to cover professionally administered tobacco cessation services (e.g., cessation counseling, prescription medications, etc.) as an essential plan benefit.
and be it further
Resolved, that the ADA should encourage federal research agencies to develop the body of credible, peer-reviewed scientific literature examining, among other things:
- The immediate and long-term effects of traditional and non-traditional tobacco product use on oral health;
- The viability of new cessation products and strategies;
- The validity of claims that some traditional and non-traditional tobacco products are less harmful to the oral cavity than others.
American Dental Association
October 2016 (2016:323)
Diet and Nutrition
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Policies and Recommendations on Diet and Nutrition
(2016)
In General
Resolved, that oral health depends on proper nutrition and healthy eating habits, and necessarily includes avoiding a steady diet of foods containing natural and added sugars, processed starches and low pH-level acids, and be it further
Resolved, that the ADA acknowledges it is beneficial for consumers to avoid a steady diet of foods containing natural and added sugars, processed starches and low pH-level acids as way to help maintain optimal oral health, and be it further
Resolved, that the ADA supports the findings and recommendations in the Council on Access, Prevention and Interprofessional Relations Supplemental Report 3 to the 2012 House of Delegates: Formulation a Strategic Approach for Addressing the Complex Emerging Issues Related to Oral Health and Nutrition in the United States (2012:4114) (PDF)*, and be it further
Dentist's Role in Nutrition and Oral Health
Resolved, that the ADA encourages dentists to routinely counsel their patients about the oral health benefits of maintaining a well-balanced diet and limiting the number of between-meal snacks, and be it further
Resolved, that the ADA encourages dentists to stay abreast of the latest science-based nutrition recommendations and nutrition-related screening, counseling and referral techniques, and be it further
Resolved, that the ADA encourages dentists to serve on local school wellness planning boards to establish and maintain local school wellness policies that:
- Appropriately balance the nutritional benefits of consuming certain foodstuffs and the risk of tooth decay.
- Promote lifelong mouth healthy behaviors, such brushing twice a day, flossing once a day, limiting consumption of sugary snacks and beverages and seeing the dentist regularly.
- Reflect the inextricable link between oral health and overall health and well-being.
and be it further
Access and Prevention
Resolved, that the ADA supports its members by providing access to current information and educational materials, and cultivating learning opportunities (e.g., continuing education modules, etc.), for dentists to learn more about the relationship between diet, nutrition and oral health—including latest science-based nutrition recommendations and nutrition-related screening and counseling techniques, and be it further
Resolved, that the ADA encourages collaborations with dieticians and other nutrition experts to raise interprofessional awareness about the relationship between diet, nutrition and oral health, and be it further
Resolved, that the ADA supports projects, as appropriate and feasible, to educate the public about the oral health benefits of maintaining a healthy diet and to encourage consumers to adopt healthier diets and establish better eating habits, and be it further
Resolved, that the ADA supports public information campaigns to reduce the amount of added sugars consumed in American diets, and be it further
Resolved, that the ADA encourages constituent and component dental societies to work with state and local officials to ensure locally-administered nutrition and food assistance programs have an oral health component (e.g., WIC, SNAP, NSLP, etc.), and be it further
Resolved, that the ADA encourages constituent and component dental societies to work with state and local school officials to prohibit schools from entering into contractual arrangements, including school pouring rights contracts, that incentivize schools to sell and aggressively advertise foods and beverages with high added sugar content on school grounds (e.g., providing free samples, posting signage, branding school equipment, sponsoring events, etc.), and be it further
Resolved, that the ADA supports the World Health Organization’s 2015 Guideline on Sugar Intake for Adults and Children, and be it further
Government Affairs
Resolved, that the ADA should give priority to the following when advancing public policies on diet, nutrition and oral health:
- Ensuring government-supported nutrition education and food assistance programs (e.g., WIC, SNAP, NSLP, etc.) have an oral health component, such as and general guidelines that promote good oral health.
- Encouraging federal research agencies to develop the body of high-quality scientific literature examining, among other things, the extent to which dental caries rates fluctuate with changes in total added sugar consumption and over what period(s).
- Maintaining the separate line-item declaration of added sugars content on Nutrition Facts labels and listing the declared added sugars content in relatable terms (e.g., teaspoons, grams, etc.).
- Supporting legislative and regulatory actions, as appropriate and feasible, to increase consumer awareness about the role dietary sugar consumption may play in maintaining optimal oral health and the potential benefits of limiting added sugar consumption in relation to general and oral health.
- Requiring third-party payers to cover nutrition counseling in dental offices as an essential plan benefit.
American Dental Association
Adopted 2016 (2016:330)
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* The findings and recommendations in the Council on Access, Prevention and Interprofessional Relations Supplemental Report 3 to the 2012 House of Delegates: Formulation a Strategic Approach for Addressing the Complex Emerging Issues Related to Oral Health and Nutrition in the United States (2012:4114) (PDF) are:
FINDINGS
- Oral health is dependent on proper nutrition (eating a well-balanced diet).
- Oral health is dependent on good eating habits (limiting snacking and eating in between meals [frequency of intake]).
- It is not practical to classify some foods and beverages as being more or less harmful to oral health than others.
- The best way to get people to adopt healthier diets and establish better eating habits is through a strong program of nutritional education that begins prenatally and continues throughout the life span.
RECOMMENDATIONS
- Determine how lower level evidence based research, the best science that is currently available, can inform policy.
- Support pilot programs that produce outcomes that could inform further research, legislative strategies and policies.
- Focus on education to change behavior.
- Develop materials to facilitate nutritional education as it relates to oral health (i.e., talking points, brochures, specific oral health information in DGA).
- Start nutrition education early, preferably prenatally, and continue educational efforts throughout the lifespan.
- Collaborate with non-dental providers both on a one-to-one basis and organizationally to increase their knowledge on the importance of oral health and how efforts to provide nutritional education can improve both oral and general health.
- Collaborate with ADEA/dental schools to ensure dentists receive nutritional training that prepares them to discuss nutrition related issues with patients.
- Encourage states to develop a state oral health plan that includes nutrition related initiatives.
- Develop defined parameters that would encourage reimbursement for nutritional counseling.
- Pilot test nutritional counseling for measurable outcomes.
Substance Use Disorders (Opioid Crisis)
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Policy on Opioid Prescribing
(2018)
Resolved, that the ADA supports mandatory continuing education (CE) in prescribing opioids and other controlled substances, with an emphasis on preventing drug overdoses, chemical dependency, and diversion. Any such mandatory CE requirements should:
- Provide for continuing education credit that will be acceptable for both DEA registration and state dental board requirements,
- Provide for coursework tailored to the specific needs of dentists and dental practice,
- Include a phase-in period to allow affected dentists a reasonable period of time to reach compliance,
and be it further
Resolved, that the ADA supports statutory limits on opioid dosage and duration of no more than seven days for the treatment of acute pain, consistent with Centers for Disease Control and Prevention (CDC) evidence-based guidelines, and be it further
Resolved, that the ADA supports improving the quality, integrity, and interoperability of state prescription drug monitoring programs.
American Dental Association
October 2018
(2018:XXX)
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Insurance Coverage for Chemical Dependency Treatment
(2017)
Resolved, that the ADA believes that any ADA or constituent-sponsored or endorsed medical and disability insurance coverage should include coverage for the treatment of chemical dependency (including alcoholism). constituent and component societies of the Association be urged to review current sponsored or endorsed medical and disability insurance coverage for chemical dependency (including alcoholism).
American Dental Association
October 2017
(1986:519; 2012:442; 2017:40)
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Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients
(2017)
Resolved, that the following ADA Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients be adopted.
Statement on Alcohol and Other Substance Use by Pregnant and Postpartum Patients
- Dentists are encouraged to inquire about pregnant or postpartum patients' history of alcohol and other drug use, including nicotine.
- As healthcare professionals, dentists are encouraged to advise these patients to avoid the use of these substances and to urge them to disclose any such use to their primary care providers.
- Dentists who become aware of postpartum patients' resumption of tobacco or illegal drug use, or excessive alcohol intake, are encouraged to recommend that the patient stop these behaviors. The dentist is encouraged to be prepared to inform the woman of treatment resources, if indicated.
American Dental Association
October 2017
(2005:330; 2017:40)
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Statement on Alcoholism and Other Substance Use Disorders
(2017)
Resolved, that the following ADA Statement on Alcoholism and Other Substance Use Disorders be adopted.
Statement on Alcoholism and Other Substance Use Disorders
- The ADA recognizes that alcoholism and other substance use disorders are primary, chronic, and often progressive diseases that ultimately affect every aspect of health, including oral health.
- The ADA recognizes the need for research on the oral health implications of chronic alcohol, tobacco and/or other drug use.
- The ADA recognizes the need for research on substance use disorders among dentists, dental and dental hygiene students, and dental team members.
American Dental Association
October 2017
(2005:328; 2017:40)
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Statement on the Use of Opioids in the Treatment of Dental Pain
(2016)
- When considering prescribing opioids, dentists should conduct a medical and dental history to determine current medications, potential drug interactions and history of substance abuse.
- Dentists should follow and continually review Centers for Disease Control and state licensing board recommendations for safe opioid prescribing.
- Dentists should register with and utilize prescription drug monitoring programs (PDMP) to promote the appropriate use of controlled substances for legitimate medical purposes, while deterring the misuse, abuse and diversion of these substances.
- Dentists should have a discussion with patients regarding their responsibilities for preventing misuse, abuse, storage and disposal of prescription opioids.
- Dentists should consider treatment options that utilize best practices to prevent exacerbation of or relapse of opioid misuse.
- Dentists should consider nonsteroidal anti-inflammatory analgesics as the first-line therapy for acute pain management.
- Dentists should recognize multimodal pain strategies for management for acute postoperative pain as a means for sparing the need for opioid analgesics.
- Dentists should consider coordination with other treating doctors, including pain specialists when prescribing opioids for management of chronic orofacial pain.
- Dentists who are practicing in good faith and who use professional judgment regarding the prescription of opioids for the treatment of pain should not be held responsible for the willful and deceptive behavior of patients who successfully obtain opioids for non-dental purposes.
- Dental students, residents and practicing dentists are encouraged to seek continuing education in addictive disease and pain management as related to opioid prescribing.
American Dental Association
October 2016
(2005:328; 2012:139; 2016:286)
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Guidelines Related to Alcohol, Nicotine, and/or Drug Use by Child or Adolescent Patients
(2013)
Resolved, that the following Guidelines Related to Alcohol, Nicotine, and/or Drug Use by Child or Adolescent Patients be adopted.
Guidelines Related to Alcohol, Nicotine, and/or Drug Use by Child or Adolescent Patients
- Dentists are urged to be knowledgeable about the oral manifestations of nicotine and drug use in adolescents.
- Dentists are encouraged to know their state laws related to confidentiality of health services for adolescents and to understand the circumstances that would allow, prevent or obligate the dentist to communicate information regarding substance use to a parent.
- Dentists are encouraged to take the opportunity to reinforce good health habits by complimenting young patients who refrain from using tobacco, drinking alcohol or using illegal drugs.
- A dentist who becomes aware of a young patient's tobacco use is encouraged to take the opportunity to ask about it, provide tobacco cessation counseling and to offer information on treatment resources.
- Dentists may want to consider having age- appropriate anti-tobacco literature available in their offices for their young patients.
- Dentists who become aware of a young patient's alcohol or illegal drug use (either directly or through a report to a team member), are encouraged to express concern about this behavior and encourage the patient to discontinue the drug or alcohol use.
- A dentist who becomes aware that a parent is supplying illegal substances to a young patient, may be subject to mandatory reporting under child abuse regulations.
American Dental Association
November 2013
(2005:330; 2013:64)
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Statement on Provision of Dental Treatment for Patients with Substance Use Disorders
(2005)
Resolved, that the following ADA Statement on Provision of Dental Treatment of Patients with Substance Use Disorders be adopted.
Statement on Provision of Dental Treatment for Patients with Substance Use Disorders
- Dentists are urged to be aware of each patient's substance use history, and to take this into consideration when planning treatment and prescribing medications.
- Dentists are encouraged to be knowledgeable about substance use disorders—both active and in remission—in order to safely prescribe controlled substances and other medications to patients with these disorders.
- Dentists should draw upon their professional judgment in advising patients who are heavy drinkers to cut back, or the users of illegal drugs to stop.
- Dentists may want to be familiar with their community's treatment resources for patients with substance use disorders and be able to make referrals when indicated.
- Dentists are encouraged to seek consultation with the patient's physician, when the patient has a history of alcoholism or other substance use disorder.
- Dentists are urged to be current in their knowledge of pharmacology, including content related to drugs of abuse; recognition of contraindications to the delivery of epinephrine-containing local anesthetics; safe prescribing practices for patients with substance use disorders—both active and in remission—and management of patient emergencies that may result from unforeseen drug interactions.
- Dentists are obliged to protect patient confidentiality of substances abuse treatment information, in accordance with applicable state and federal law.
American Dental Association
October 2005
(2005:329)