Sir,- We share the concern of C. Stillman-Lowe (BDJ 2003, 195: 482) who drew attention to the dental team lacking the skills needed to encourage patients to quit smoking, but we believe a more fundamental problem prevents the pursuit of smoking cessation: motivation of dentists.

To put it bluntly, what is in it for the dentist? He/she will need to take time out from clinical work to discuss smoking. We believe such discussions have been discouraged by the NHS 'treadmill' because it has focused on clinical work at the expense of patient education. This belief is reinforced by the recent study by John et al1 which showed that, compared to dentists in mixed and private practice, NHS dentists are less likely to record a patients smoking status and less likely to counsel them.

Furthermore, it appears that only a minority of dentists actually believe that the dental profession is effective in helping patients to stop smoking.1 In fact dentists' scepticism is entirely consistent with a paper published recently which concluded that more rigorous research was needed to establish the efficacy of smoking cessation advice when delivered by dentists.1 Smoking is the biggest cause of preventable death in the western world: it kills more than 120,000 in the UK every year. How can we refocus our profession to help prevent these deaths?

Two developments give primary care trusts (PCTs) the opportunity, and indeed responsibility, to address this problem. Firstly, the Health Development Agency has clearly stated that PCTs will take the lead in commissioning and providing smoking cessation services.1

Secondly, in April 2005, PCTs will take over control of the budget for general practice dentistry. What specific action should PCTs take? We suggest three things are needed:

  • PCTs should use their smoking cessation staff to offer training to dentists and their team. This could be done with the section 63 postgraduate scheme and would alleviate the problem identified by C. Stillman-Lowe.

  • PCTs should offer incentives to motivate dentists to spend time on smoking cessation. If they need inspiration, PCTs could look at the incentive schemes used to encourage doctors to give vaccinations.

  • PCTs should promote research to establish the efficacy of smoking advice when delivered by the dental team.

This research should be conducted in field settings, so that dentists can see what can be achieved in field conditions. By pursuing these three activities PCTs could equip and motivate dentists to play a major role in smoking cessation. We urge your readers who are involved with PCTs (and this may include many more of us by April 2005) to press for this action.