Smoking gums

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The Middle East is home to one of the highest number of smokers in the world.

As hygienists, statistics show that an estimated one out of every four adult patients you treat is a smoker and the evidence is clear in their mouths. These patients are at increased risk for oral cancer, periodontal disease, root caries and jaw bone loss, among other conditions. Most hygienists are aware of the importance of offering smoking cessation counselling to these patients. But finding the time to slot it in around the demands of a routine appointment can prove difficult. According to past American Dental Hygienist Association president, Helena Gallant Tripp, however, it's well worth the added effort.

"Dental hygienists are uniquely positioned to educate their patients or clients who smoke about the benefits of quitting as well as how to seek help," she explains. So how should hygienists approach this health issue with their patients?

No ifs or butts

Tobacco cessation advice is as essential as basic oral health advice for patients who smoke. Studies have shown that spending just three minutes or less on counselling is effective in motivating patients to quit smoking.

Interventions should be designed to fit comfortably within the usual routine of a dental hygiene visit. The first step is to systematically ask all patients, at every visit, about tobacco use and record their answer in their patient record. Adding reminder stickers to charts or, if the practice has electronic medical records, setting alerts, can help prompt staff to ask. Next, ask patients if they want to quit. Their response will group them into one of two categories: patients who smoke and are willing to stop, and those who smoke but are not ready to kick the habit.

Ready and willing...

A simple formula for patients who use tobacco and are willing to quit is the five A's; ask, advise, assess, assist, and arrange.

• Ask

Ask patients to confirm their smoking status, and to explain what kind of tobacco is used and how often.

• Advise

All smokers should be advised to quit, clearly and strongly. Hygienists can tailor this advice to the patient, for example, saying: "I can see you have signs of periodontal disease. Smoking can worsen this condition, so it is particularly important for you to stop now. Have you considered quitting?"

This recommendation should be supported with educational leaflets that outline current health risks, the economic costs of smoking, and the impact of secondhand smoke on children and others in the family. Highlight any precancerous changes to oral tissues that are visible in the mouth, but steer clear of scare tactics and reprimands, as these techniques tend to make patients defensive.

• Assess

Is the patient ready to commit to a cessation programme? What is their level of addiction? Are there complicating factors, such as depression? On the basis of these answers, assess the individual's willingness to quit and tailor your counselling accordingly.

• Assist

Work with the patient to formulate and agree a cessation plan. Creating a partnership approach can help ensure compliance with the quit programme, maximising its chance of success.

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