Precontemplation Stage

Approximately 40% of tobacco users are in the precontemplation stage. In this stage individuals deny having a problem and they have no intention of quitting.

The following is an example of a typical dialog between a dental healthcare provider (DHP) and a smoker (Pt) in the precontemplation stage of change. The patient's responses provide a valuable insight into their feelings about their use of tobacco.

DHP: "Hi Mike, I noticed from your medical/dental questionnaire you smoke two packs of cigarettes a day. How do you feel about your smoking?"

Pt: "I get a lot of pleasure and relaxation from it. In fact, cigarettes are probably the best friends I have.

DHP: "Have you ever had any interest in quitting or tried to quit in the past?"

Pt: "Nah, I love to smoke and I've never wanted to quit. I don't understand why this is any of your concern as a dentist."

DHP: "Well, you told me during your first visit that you wanted to improve the appearance of your teeth. I also want to make sure you understand that smoking is one of the major reasons why you have gum disease and have lost some of your teeth. I am also concerned that smoking will be a factor in continual loss of bone around your remaining teeth."

Pt: "Hmm....I didn't know smoking causes gum disease too, along with everything else."

DHP: "Well it does. The treatment we have planned to reduce your periodontal infection will not be as effective if you continue to smoke. However, in addition to your oral health, I am also concerned about your general health. These are the reasons I asked if you had any interest in quitting.
By the way, if you would like more information about smoking and periodontal disease, you may want to take this pamphlet home and read through it."

Pt: "No one I know has been able to quit. I just don't think quitting works. For me, smoking is just too enjoyable."

DHP:
"I can appreciate that, but you should know today's methods of treatment and the new stop-smoking products and combinations of these aids have improved long-term quit rates. People who couldn't quit in the past have been able to do so now with the help of these newer products and methods.

If you do change your mind about quitting later on, we would be happy to help you or refer you to some quit smoking programs and "help lines." Just let us know.

If it is OK with you, we will ask during your next recall appointment if you have changed your mind."

Pt: "Well, maybe some day, but I doubt it. Right now I just don't want to quit."

This example of a brief intervention with a patient in the precontemplation stage of change emphasizes the importance of a low key, nonjudgmental approach. This is especially important with those individuals who are not interested in quitting. Precontemplators are in denial and may be very defensive. The intervention should try to raise their awareness of the effects of tobacco use on their oral health, but not nag or rush them into action. Raising their awareness may help them to think about the benefits of stopping and help to move them to the next stage. You should let them know that you would be willing to help them if they do change their mind. This leaves the door open for intervention later on.

DHP:	"Hi Mike, I noticed from your medical/dental questionnaire you smoke two packs of cigarettes a day. How do you feel about your smoking?"
Pt:	"I get a lot of pleasure and relaxation from it. In fact, cigarettes are probably the best friends I have.
DHP:	"Have you ever had any interest in quitting or tried to quit in the past?"
Pt:	"Nah, I love to smoke and I've never wanted to quit. I don't understand why this is any of your concern as a dentist."
DHP:	"Well, you told me during your first visit that you wanted to improve the appearance of your teeth. I also want to make sure you understand that smoking is one of the major reasons why you have gum disease and have lost some of your teeth. I am also concerned that smoking will be a factor in continual loss of bone around your remaining teeth."
Pt:	"Hmm....I didn't know smoking causes gum disease too, along with everything else."
DHP:	"Well it does. The treatment we have planned to reduce your periodontal infection will not be as effective if you continue to smoke. However, in addition to your oral health, I am also concerned about your general health. These are the reasons I asked if you had any interest in quitting. By the way, if you would like more information about smoking and periodontal disease, you may want to take this pamphlet home and read through it."
Pt:	"No one I know has been able to quit. I just don't think quitting works. For me, smoking is just too enjoyable."
DHP:	"I can appreciate that, but you should know today's methods of treatment and the new stop-smoking products and combinations of these aids have improved long-term quit rates. People who couldn't quit in the past have been able to do so now with the help of these newer products and methods. If you do change your mind about quitting later on, we would be happy to help you or refer you to some quit smoking programs and "help lines." Just let us know. If it is OK with you, we will ask during your next recall appointment if you have changed your mind."
Pt:	"Well, maybe some day, but I doubt it. Right now I just don't want to quit."