19 July 2011

Q. I am a hygienist who has been asked to give smoking cessation advice to a patient who wants to have multiple implants. The patient smokes 20+ a day and has done so for 14 years. He has never expressed a wish to give up smoking during the time that I have been providing hygiene treatment for him (5 years) despite my best efforts to advise and encourage him. The new associate is keen to place the implants and the patient is very keen to have them placed but not to give up smoking. This patient has periodontal breakdown in all quadrants – this implant is highly likely to fail – do I tell the patient this? The clinician placing the implant wishes to go ahead with the treatment and ‘to encourage him to give up smoking’ – I am uncomfortable with this, please advise.

The diagnosis and treatment planning of a patient for restorative procedures currently remains the responsibility of the dentist, however, all dental care professionals are guided by the General Dental Council to work as a team in providing patients with treatment that is in the patient's best interests. Although the hygienist may have been requested to provide smoking cessation for a patient, in a treatment plan from the associate, that does not diminish the hygienist's responsibility. If the hygienist has any concerns then s/he should discuss those concerns with the referring dentist, who after all may not be fully aware of the previous history and attempts to provide smoking cessation before.

Ultimately the dentist carries the full responsibility for the restorative treatment and may well have considered the smoking factor before drawing up the treatment plan for the patient. If this is the case, then the hygienist is faced with an ethical dilemma as to how to proceed. Providing smoking cessation advice is however unlikely to harm the patient and therefore the hygienist may feel that proceeding with the dentists request is reasonable. The discussion and the views of the hygienist and dentist should be fully recorded in the records. If the patient insists that they will continue smoking then a full and contemporaneous record of any such comment should be made and brought to the attention of the dentist.

Further information on the management of smoking cessation is available here

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