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Addressing the topic of smoking cessation in a dental setting.

Globally, tobacco use is still a major contributor to ill health and is currently the most important preventable cause of death in the UK and worldwide. Although smoking trends are on the decrease, around 25% of men and 23%of women currently smoke in the UK (2). There are strong links between smoking and deprivation, with a higher prevalence of smokers in less affluent areas. These smokers are also the individuals who may find quitting more difficult (25). There is also increasing interest in tobacco use and young people, with one-fifth of Britain s 15-year-old individuals (18% of boys and 26% of girls) being regular smokers (2). While the general public are aware of the detrimental effects of smoking on general health, including the links with coronary heart disease, lung cancer and other cancers, their knowledge of the profound effect that tobacco can have on the mouth is less well developed. Cigarette smoking is a well-established risk factor for periodontitis, second only to bacterial plaque, and is the strongest of the modifiable risk factors (35). Smoking is associated with an increased prevalence and severity of periodontitis, and, depending on the definition of disease and the exposure to smoking, the risk represents a fiveto 20fold increase for a smoker compared with a never smoker (7). Cigarette smoking is associated with greater periodontal attachment loss, and smokers suffer from more tooth loss than nonsmokers (54). Tobacco use also exhibits a dose–response relationship with periodontal disease. Periodontal treatment (both surgical and nonsurgical) is compromised by tobacco use (29, 37). There is a wealth of literature outlining the role that cigarette smoking has on periodontal disease and treatment, and a number of reviews cover this topic in detail (29, 34, 35). Regarding oral cancer and potentially malignant lesions, the risk is higher amongst smokers compared with those who have never smoked. Patients who smoke have a sixfold increased risk of developing leukoplakia compared with nonsmokers (4). The overall risk of oral cancer among smokers is 7–10 times higher than for never smokers (65). Dental implants are also affected by tobacco use, with the majority of studies showing a failure rate in smokers that is at least twice as high as that in nonsmokers (34). Smoking also has an effect on the prevalence of complications after surgical and nonsurgical extractions (46). Tobacco control is the term used to describe a broad spectrum of strategies designed to deal with tobacco use, of which smoking cessation is one small part. Advertising restrictions, controlling cigarette prices through taxation, health warnings on packets of cigarettes and raising the age for the purchase of tobacco are all examples of elements that comprise the tobacco control agenda (67). One of the most important aspects of tobacco control is exposure to environmental tobacco smoke. All UK countries have now introduced bans on smoking in public places, and it is important that those smokers, whom these measures aim to encourage to quit smoking, have access to consistent and helpful advice from all sectors, including dental team members. In both primary and secondary care, there is increasing interest in the role that dental professionals can play in helping their patients quit the tobacco habit. Dental team members can be effective at communicating with their patients because in many cases they have established a rapport with their patients. Dentists may take the lead in assessing smoking status with their patients, with dental hygienists providing more detailed advice in helping patients to quit smoking. There may well also be a role for dental nurses. The main issue around the delivery of advice is that the team members are trained to a specified level and have undergone training that ideally is accredited. Helping patients to quit tobacco may be aiding them in a task that may be extremely difficult for them to achieve. Nicotine is highly addictive, and, in some