At the last annual conference of the Spanish Society for Periodontology and Osseointegration (SEPA), Dr. Christoph Ramseier of the Department of Periodontology a the University of Bern gave a talk on how to help dental patients give up smoking. In this article we summarise the chief points of the lecture.

If we want to help patients in the process of giving up smoking, we have to go through several distinct stages (C.I.M.A.R.).

1. CONNECTION

This is the stage that will take longest. We will have to gradually build up a relationship of trust with patients.

2. INFORMATION

Once we have built up trust with patients, we must inform them all about periodontal disease (aetiology, risk factors, treatment options) and smoking, with special emphasis on the benefits of giving it up.

They need to understand all the information we give them and know what their opinion is.

3. MOTIVATION

Once we have established a relationship of trust, and patients have understood all the information, we must motivate them to change. There is a multitude of methods in the literature that help to motivate patients to give up a harmful habit.

Miller and Rollnick [Office2] developed the concept of motivational interviewing as therapy for problem drinkers in 1991. This consists of a style of direct counselling whose main objective is to avoid ambivalence (a mood in which two opposing feelings coexist). This concept is based on the following points:

• Motivation for change is provoked from within the patient, and not imposed from outside.
  
• It is the patient’s task, and not the counsellor’s, to resolve their ambivalence.
  
• Direct persuasion is not an effective method for solving ambivalence.
  
• Patients should be addressed in a calm and slow manner, trying to provoke their reaction.
  
• The willingness to change is not a trait of the patient, but a fluctuating product of interpersonal interaction.
  
• The therapeutic relationship must resemble a relationship of companionship rather than one of expert/client.
  

At this stage it may also be useful to use tables that show the advantages/disadvantages of giving up the habit or continuing to smoke, with particular emphasis on the benefits of quitting and the disadvantages of not quitting.

In the “Consensus report of group 1 of the 11th European Workshop on Periodontology on effective prevention of periodontal and peri-implant diseases”, oral health professionals are advised to routinely have at least one brief conversation with all patients, using the AAR approach in relation to smoking:

• Ask all patients about their smoking habit.
  
• Advise patients to stop smoking. Information should be given on the effects of smoking on oral health, the benefits of giving up, and the methods available for quitting.
  
• Refer: offer the patient the possibility of referral to a specialist.

4. ACTION

Below is a detailed, step-by-step description of the tobacco cessation process.

4.1. Work on the patient's history of smoking:

• Assess how many cigarettes the patient smokes per day.
  
• Reduce the number of unneeded cigarettes.
  
• Let them know about the substitutes available.