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STAGES OF THE PROCESS OF TOBACCO CESSATION IN THE DENTAL PRACTICE

Collaborators

14 Nov 2016

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.
4.2. Choose an exact day in which they will stop smoking.

4.3. Use Nicotine Replacement Therapy (NRT) for three months.

4.4. Where necessary, use varenicline, an α4β2 nicotinic acetylcholine receptor partial agonist. This is an anxiolytic. Treatment begins one week before cessation of smoking.

  • During the first three days: one 0.5 mg pill once a day.
  • During the following four days: one 0.5 mg pill twice a day.
  • On the day smoking will cease and over the following 11 weeks: 1 mg twice a day.

5. REFLECTION

All the previous stages must be reflected upon. Patients should be asked to know how they feel as we move forward in the process. Each patient will be classified as follows depending on their response:

5.1. Resistant. The patient is unwilling to speak to us. In this case, the visit should end and we should try again at the following one. We will thus get the patient to begin to think about it and, if there is a change of attitude, we should give positive reinforcement.

5.2. Ambivalent. The patient proves willing to begin the change, but at the moment of truth there are no changes in attitude.

5.3. Ready. The patient trusts us and proves confident on beginning the change.

5.4. Self-sufficient. The patient initiates the change by him/herself. 

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Data controller DENTAID, S.L. LABORATORIOS DE PREVENCIÓN E HIGIENE BUCAL, SLU (“PHB”).
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Recipients of disclosure or transfer Data is not disclosed or transferred internationally.
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