Background and challenges to implementation:
In India, smokeless tobacco is more prevelant, specially in lower socio-economic strata, including women, and this fact is often underemphasized by the dental community.
The prime reason for visiting a dental practitioner is tooth pain; many times the patient is counseled to the specific cause of the pain. For example, an endodontist focuses on the root canal therapy.

Intervention or response:
This is a study undertaken by an endodontist, in which a sample of 150 female patients reporting with toothpain were questioned not just about the pain, but also about the usage of smokeless tobacco. It was revealed that 64 were using smokeless tobacco (mishri, khaini, mawa etc.)
These users were administered a questionnaire which included several key factors like personal information, details of tobacco use, family history of tobacco use, physical health problems. Behavioral counselling was done by the endodontist. This was done, as female patients showed reluctance to approach cessation clinics.

Results and lessons learnt:
The Fagerstrom test was used for scoring the levels of nicotine dependence. Followup was taken at regular intervals of two weeks, one month, three months and six months.
The findings revealed that 67% of the patients did not report back even for the first followup. Only 4 patients of the patients followed up right upto six month and were successful in substantial reduction or cessation of tobacco.

Conclusions and key recommendations:
Dental practitioners should make it a regular practice to counsel patients at their individual levels taking the consideration the paucity of cessation clinics in India. Women are reluctant and fear the stigma of approaching cessation clinics. Proactive measures must be used to motivate women to go through the cessation follow up.