Table 1.

The Five A’s Approach to Tobacco Cessation

Approach	Suggested Actions or Patient Dialog
ASK Tobacco use:  Include current and former use  Include non-cigarette products  Document in patient chart	“Do you ever smoke or use any other type of tobacco, including smokeless tobacco and cigars?” “I take the time to ask all of our patients about tobacco use, because it is important.”
ADVISE Give clear, strong, non-judgmental, and personalized advice to quit Connect advice with oral findings	“There have been some tissue changes in your mouth and gums since your last visit. Tobacco use is affecting your health.” “The best thing that I can do for your current and future health is to advise you to stop smoking.”
ASSESS How willing is the patient to make a quit attempt?  If motivated: Help the patient create a quit plan  If not motivated: Enhance the patient’s motivation to quit	“Would you like to try to quit tobacco in the next month (or year)? If so, we can help.”
ASSIST Help create a quit plan, involving:  Set a quit date within two weeks  Review past quit attempts  Avoid other tobacco users  Tell family and friends  Remove tobacco from home, work, and car  Avoid alcohol Recommend or prescribe pharmacotherapy Enhance motivation to quit using the 5 R’s (Table 2)	For patients who are ready to quit: “Would you like to create a quit plan with me today?” For patients who are not ready to quit: Provide a brief intervention or a motivational interview using the 5 R’s approach (Table 2).
ARRANGE For patients not ready to quit:  Document in chart  Follow-up at the next appointment For patients ready to quit:  Refer to toll-free quit line, tobacco counselor, or local community-based tobacco cessation programs  Document in chart  Coordinate with other providers (e.g. patient’s physician) to re-enforce the quit plan  Schedule a follow-up appointment to review progress and provide additional counseling	For patients not ready to quit: “If it is okay with you, I’d like to check in with you at your next appointment to see where you are in your decision making.” For patients who are ready to quit: “If it’s okay with you, I’d like to schedule a follow-up appointment or phone call to discuss your progress”

^*Modified from American Dental Association reference card for dental professionals. Available at http://www.ada.org/en/member-center/oral-health-topics/smoking-and-tobacco-cessation