Oral Health Professionals; A helping hand for tobacco cessation


    Tobacco use is the leading preventable cause of death in the world and it kills half of all lifetime users. Use of tobacco in the form of chewing tobacco, cigarettes or snuff is the leading cause of oral cancer in patients especially in developing countries like Nepal. The risk of developing oral cancer depends on the duration and frequency of tobacco use.

    Besides this it also has psychosocialand financial issues. Tobacco habit may create conflict in the family especially between the spouses. People with tobacco habit portray bad impression in the society. This in turn causes psychological trauma due to imposed inferiority complex to the tobacco users which in turn may increase the dose and frequency of intake.

    The financial loss to the person or the family is uncountable as we never take care of small amount of money that is wasted everyday which actually multiplies to huge amount when calculated in terms of days, weeks, months and years. All these contribute to poor quality of life

    Whatever may be the cause for beginning this deleterious habit, if you are determined, devoted and dedicated, you can definitely cease the habit. With this, you can be one of the most influencing role model to your family and community.

    Oral health professionals have several roles to play in comprehensive tobacco control efforts, including role model, clinician, educator and opinion-builder.

    All Oral health professionals should at least serves as:

    • Tobacco-free role models for the general public.
    • Address tobacco dependence as part of your standard of care practice.
    • Assess exposure to secondhand smoke and provide information about avoiding all exposure.

    Helping patients quit tobacco as part of Oral health care providers’ routine practice takes us only three to five minutes and is feasible, effective and efficient. The algorithm below will guide us to deliver the 5A’s and 5R’s brief tobacco interventions to patients in primary care.

    tobacco cessation

    The 5A model

    Summarizes all the activities that a primary care provider can do to help a tobacco user ready to quit, within 3−5 minutes in a primary setting.


    Ask all your patients in every visit about tobacco use in friendly way and document it. Keep it simple and confidential. Do not accuse the patient. Make it routine practice.


    Advise every tobacco user to quit. Make it clear that even occasional tobacco habit is not at all good. Convince strongly that quitting tobacco is most important thing to protect one’s health. Personalize tobacco habits to its ill effect in health, family, society and economy.


    Assess patients readiness to make an attempt to quit tobacco. Ask if he/ she would like to become non-user and he/she have chance of quitting successfully. Move ahead if patient gives positive response. If not, deliver 5R intervention.


    Assist patient in developing quit plan with STAR method.Set a quit date ideally within two weeks. Tell family, friends, and coworkers about quitting, and ask for support. Anticipate challenges to the upcoming quit attempt. Remove tobacco products from the patient’s environment and make the home smoke free.


    Arrange for follow-up visits and referral to specialist if needed. The first follow up should be arranged during first week. A second follow up, within one month after the quit date. Identify problems encountered, anticipate challenges.

    Remind patients of social support. Assess medication use and problems. Schedule next follow up contact. For patients who are abstinent congratulate them. For patients with relapse, remind them it’s a learning experience. Help them to give subsequent try.

    The 5 R model

    Areas that should be addressed in a motivational counseling intervention to help those who are not ready to quit.


    Encourage patient and indicate how quitting is personally relevant. Contextualize it to their daily life issues like health issues, social and family issues, financial issues etc.


    Help patients identify potential negative consequences of tobacco habit which imposes threat to their life. Discuss it in terms of short term, long term and environmental risks.


    Help patient identify potential positive consequences (benefits) of quitting tobacco relevant to their life. These may include improve health, financial benefits, good family and social relations and being role model to the community.


    Ask patient identify potential barriers to quitting like fear of withdrawal symptoms, failure, weight gain, depression etc. Provide them all necessary treatments possible. It may be non-pharmacological (counseling, motivation) or pharmacological (Nicotine replacement therapy).


    Repeat assessment of patient’s readiness to quit tobacco. Get back to assess stage of 5A, if ready to quit continue with 5A. If not try 5R at every visit unless you succeed motivating patient to quit. Always end conversation with positive note.

    (Ref: WHO toolkit for delivering 5A and 5R brief tobacco intervention in primary care. 2014.)

    Whatever may be the patient’s reason to begin tobacco habit, let us be the patient’s reason to quit the habit. Being Oral health professionals, it’s our utmost responsibility to enquire about tobacco habits in every patient who visits us and counsel them for cessation of habit if any.

    We fail to do so because we rarely enquire. We rarely enquire because we rarely give importance to oral soft tissue findings and their possible consequences. We rarely give importance to soft tissues because we are simply carried away by hard tissue findings. We rarely give importance to soft tissues because we actually tend to neglect them.

    Let’s be the change in ourselves in order to bring about change in the nation. Let’s devote 2-3 minutes out of our hectic schedule to help patient to actually quit tobacco or else at least motivate and counsel them so that they can think about it.

    “A journey of thousand miles begins with the single step”

    Dr Abhinaya Luitel
    Government Consultant,
    Department of Oral Medicine and Radiology
    BPKIHS, Dharan, Nepal


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