When you have patients who smoke or use any form of tobacco, ask them if they have an interest in quitting, and if so, would they like some help. Have those who are interested fill out a Tobacco Use Assessment Form.

The discussion with your patients can be brief but should include raising their awareness of the effects of tobacco use on cancer and periodontal disease and the benefits of a smoke-free lifestyle.

On the back of the Tobacco Use Assessment Form are the Brief Tobacco Cessation Intervention protocols. Follow the outline so that you Ask, Advise, Assess, Assist, and Arrange for follow-up to encourage and support your patients in their attempts to quit.

Write brief notes on this intervention form so that we have information about the patient to refer to!!!!

Ask your patients if they would like some self- help pamphlets.

Refer them to our tobacco cessation clinic if they are interested in individual counseling and long- term follow-up. Give them the pamphlets explaining our program.

Ask your patients if they are willing to have a Quitline tobacco cessation coach call them to discuss quit strategies and help them with a quit plan. If they are interested, have them fill out the Minnesota Tobacco Quitlines Fax Form. We will fax the form to the Quitline and then get the results of the coaching back to you for documentation in the progress notes.

If they are interested in other quit smoking support programs give them the sheet that lists these programs.

If your patient is interested in nicotine replacement therapy, Zyban, or Chantix, contact me for some suggestions. I would be happy to help you discuss this with the patient.

Be sure to follow-up with your tobacco using patients who are interested in quitting. Your continued encouragement and support are important.

In the progress notes record ‘tobacco cessation discussed’ and list any pharmacotherapy recommended or prescribed (and add the wording ‘for the control & prevention of oral diseases’).

All of the forms and pamphlets are in the 8th and 9th floor clinics.

Dental students and the senior dental hygiene students are required to discuss with Dr. Stafne at least one tobacco cessation intervention before graduation.

In order to get credit: Please bring me the Tobacco Use Assessment Form and the filled out Brief Intervention form to Room 7-369 so you and I can discuss your intervention. Please do not leave the form on my desk without talking with me.