Table 3.

The 5 R’s Approach to Tobacco Cessation Counseling

Approach	Actions
Relevance	Encourage patient to indicate why quitting is personally relevant Disease status/risk, family or social situations (e.g. children/ grandchildren, stigma associated with tobacco use, etc.), health concerns, age, sex, and other patient characteristics may help motivate patients to change behavior
Risks	Ask the patient to identify potential negative consequences of tobacco use Example of risks are: dental treatment outcomes, increased risk of oral disease (e.g. periodontal disease, tooth loss, oral and pharyngeal cancer, etc.), cardiovascular disease, lung disease, cancer, osteoporosis, life-expectancy, etc.
Rewards	Ask the patient to identify potential benefits of stopping Examples of rewards are: improved treatment/health outcomes, financial savings, setting good example for children/grandchildren, healthier children/grandchildren (if a smoker), feeling physically better, improved relationships, etc.
Roadblocks	Ask the patient to identify barriers or impediments to quitting Examples of roadblocks are: withdrawal symptoms, fear of failure, weight gain, anxiety/depression, enjoyment of tobacco use, social benefits of use, limited knowledge of resources to help quit, etc.
Repetition	The motivational intervention should be repeated every time an unmotivated patient has an interaction with a clinician Tobacco users who have failed in previous quit attempts should be encouraged to continue trying to quit

Adapted from 2008 PHS Guideline Update Panel Liaisons and Staff. Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care. 2008;53(9):1217–1222.

World Health Organization. Toolkit for oral health professionals to deliver brief tobacco interventions in primary care. In. Geneva: Licence: CC BY-NC-SA 3.0 IGO; 2017.