3. Tobacco, alcohol and knowing when to stop talking

Tobacco

Ask. Record. If they smoke or vape nicotine, a short “the best thing you can do for your mouth and healing is to stop, and I can point you to free support” is enough for many visits. Do not argue about willpower. Offer the local stop-smoking service or national helpline your practice uses. Oral cancer risk belongs with the Oral Cancer course — you can mention it without a lecture.

Alcohol

You are not diagnosing dependence in a 90-second chat. You can ask, flag high intake as a mouth and general-health issue, and signpost NHS or local alcohol support. Combine with tobacco and the risk conversation is more honest. If they are intoxicated in the chair, that is a capacity and safety issue (Legal and Ethical 1), not a prevention leaflet moment.

Very brief intervention

For some patients, the win is “I noticed, I offered help, I recorded it.” Repeated nagging every six minutes of a scale and polish is not better medicine.

Children and safeguarding

Severe decay in a very young child is a clinical and sometimes a safeguarding question (Safeguarding Level 1). Prevention advice to the carer still matters. Do not confuse a missed toothpaste message with a referral decision — use both systems.

Always follow the current official prevention guidance and your local referral pathways.