Smoking out the facts: how to effectively discuss quitting with patients
The scope of Australia’s Oral Health Professionals is changing. Increasingly, Oral Health Professionals are addressing general health issues with their patients, because those issues may also impact a patient’s oral health.
While this is an important change to the way patients are cared for, it does mean that many Oral Health Professionals are on a steep learning curve. With this increased scope, it may be difficult for staff to feel confident enough to discuss issues like sleep apnoea, smoking, and chronic diseases such as diabetes, and to effectively assist with, or refer these issues on.
Smoking is one of the more common issues that Oral Health Professionals address with their patients. The fact is that most smokers don’t want to keep smoking and intend to stop at some point. There is evidence that even a brief conversation about quitting with a medical professional can help someone to successfully quit.  If this is done tactfully, at the right time for the patient, and with the right level of support and/or referral offered, an Oral Health Professional has a good chance of influencing a patient to try to quit.
So, why is an Oral Health Professional well placed to discuss quitting with a patient? How can you respectfully raise the issue with a perhaps reluctant patient? And importantly, how can you tell if the individual is ready to change their smoking behaviour?
First, let’s look at why it is so important for Oral Health Professionals to have these conversations with patients.
There are around 7,000 chemicals in tobacco smoke, and they can affect your patient’s oral health in a number of ways. From unpleasant results like stained teeth, bad breath and a decrease in sense of taste, to more serious issues like periodontal disease and tooth loss, all the way through to oral cancers. All are associated with smoking.
Many of the side-effects of smoking have an impact on the oral cavity, which is one reason why Oral Health Professionals are well-placed to talk about smoking cessation with patients.
The question is, are Australia’s Oral Health Professionals talking about smoking enough?
A study released in 2015 looked at the attitudes, behaviours and interest of Oral Health Professionals toward talking about quitting smoking with patients. While it found that the majority (around 90%) of Oral Health Practitioners frequently screened for smoking behaviour, only 51% assisted the patient to quit. The study showed that the primary barriers identified were a lack of knowledge of pharmacological treatments (almost 46%) and a lack of access to smoking cessation resources (44%). Of those who did provide assistance, almost 46% referred to a Quitline and around 44% to a GP, which is an effective strategy for assisting the patient to quit.
There are some smoking cessation resources that might be a useful starting point for Oral Health Professionals. These include:
- Smoking and Oral Health – The University of Adelaide
- Smokefree Smiles – Dental Health Services Victoria
- Smoking Cessation – SA Health
So, how does an Oral Health Professional start a conversation about smoking with a patient? There is increasing evidence that using techniques like Motivational Interviewing and Brief Interventions at the chair side are highly effective in helping smokers to try to quit.
Motivational Interviewing is widely used in smoking cessation. It is a counselling style which helps people to explore and resolve their uncertainties about changing their behaviour. In this instance the Oral Health Professional asks the questions, assisting the patient to explore the reasoning behind their current behaviour.
Brief Intervention practices are aimed at investigating a potential problem in a short interaction and motivating an individual to begin to do something about it. Brief interventions for quitting smoking focus on enhancing the smokers’ motivation to change and connecting them with evidence-based resources, such as the Quitline, to help make the next quit attempt a success. The 5 A’s is a brief intervention technique used to discuss cessation in a short fact-based way. The 5 A’s should only take a few minutes, and involves:
- Asking your patient about smoking at every appointment
- Advising them to quit
- Assessing their readiness to quit
- Assisting with a referral or information to help their efforts
- Arranging to follow-up with the patient in person or by phone.
Each technique takes time to master, but the keys to success are leaving the door open for the patient to talk more at another time if and when they are ready, and when they do, to be able to refer the patient to appropriate resources like Quitlines across Australia.
There are many apps available to help with smoking cessation and for some people, an app may be a useful tool. However, not all apps are equally effective. A recent study highlighted six apps that are available in Australia and considered to be of a ‘high-quality’. These include:
- HPB I Quit
- My Quit Buddy
- Quit Start
- Smart Quit
- Smoke-Free Baby.
Lecturing someone about quitting will rarely achieve the desired result. However, having a two-way conversation about smoking and how it impacts a patient’s oral health could be the catalyst to real change and long-term health benefits.
The Oral Health Advisory Panel (OHAP), is a group of independent healthcare professionals with the aim of raising awareness of the importance of good oral health and its impact on general wellness. The Panel aims to take oral health beyond the dental clinic.
Follow the Oral Health Advisory Panel via twitter @OHAPanel to stay up to date with practical advice on good oral health habits.
 Australian Institute of Health and Welfare: Australian burden of disease study. Impact and causes of illness and death in Australia 2011. Australian Burden of Disease series no 3. Bod4. Canberra. AIHW 2016.
 Australian Institute of Health and Welfare: National Drug Strategy Household Survey 2016. Key findings tables. Canberra. AIHW 2017.
 P Ford, P Tran, B Keen, C Gartner. Survey of Australian oral health practitioners and their smoking cessation practices. Australian Dental Journal 2015; 60: 43–51 https://onlinelibrary.wiley.com/doi/pdf/10.1111/adj.12270 Accessed 4 June 2018
 Thornton, L; Quinn, C; Birrell, L; Guillaumier, A; Shaw, B; Forbes, E; Deady, M; Lambkin, F. Free Smoking Cessation Mobile Apps Available in Australia: A quality review and content analysis. Australian and New Zealand Journal of Public Health, Volume 41, No 6. July 2017. https://onlinelibrary.wiley.com/doi/full/10.1111/1753-6405.12688