{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:19:11Z","timestamp":1788239951533,"version":"build-2803163510"},"reference-count":84,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Periodontology 2000"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Smoking tobacco is a critical modifiable risk factor for periodontal and peri\u2010implant diseases. This narrative review integrates established behavioral theories with communication\u2010based psychological processes to propose an evidence\u2010based model for smoking cessation support in periodontal care. While the model is developed around smoking cessation, its underlying principles are applicable to broader behavioral risk factor management in dental practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Evidence from systematic reviews, randomized controlled trials, and international guidelines was synthesized to determine effective strategies. Key concepts analyzed include the transtheoretical model (TTM), the COM\u2010B model and motivational interviewing (MI), and the impact of personalized risk communication and biofeedback on patient adherence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Structured behavioral interventions, particularly in combination with pharmacotherapy and personalized feedback (e.g., risk scores or biomarker testing), improve quit rates and, consequently, periodontal outcomes. The proposed four\u2010stage behavioral support staircase provides a clinical support structure comprising connection (rapport), information, motivation and action, with continuous evaluation. Complementing this is an \u201celemental\u201d metaphor to guide clinicians through patient resistance, ambivalence, and the emotional adaptation inherent in cessation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Smoking cessation serves as a model for how structured behavioral support can be integrated into periodontal therapy. The presented frameworks provide oral health professionals with guidance on the complex cognitive, emotional, and motivational transitions necessary for achieving long\u2010term periodontal stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance<\/jats:title>\n                    <jats:p>This educational model enables periodontal teams to systematically address modifiable behavioral risk factors. It offers a four\u2010stage approach to supporting cessation and managing relapse, shifting the focus from didactic instruction to a patient\u2010centered collaborative approach.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/prd.70040","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:15:47Z","timestamp":1775722547000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["An integrated behavioral change model for smoking cessation in periodontal care: The four\u2010stage behavioral support staircase"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5110-2539","authenticated-orcid":false,"given":"Christoph A.","family":"Ramseier","sequence":"first","affiliation":[{"name":"Department of Periodontology, School of Dental Medicine University of Bern  Bern Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"crossref","first-page":"1590","DOI":"10.1186\/s12903-025-07003-0","article-title":"Associations among smoking status, including the use of cigarettes, electronic cigarettes, and heated cigarettes, periodontal condition, and tooth loss in employed Japanese adults: a cross\u2010sectional study","volume":"25","author":"Hashimoto H","year":"2025","journal-title":"BMC Oral Health"},{"key":"e_1_2_14_3_1","doi-asserted-by":"crossref","first-page":"831","DOI":"10.1016\/j.amepre.2018.02.014","article-title":"Effect of smoking on periodontitis: a systematic review and meta\u2010regression","volume":"54","author":"Leite FRM","year":"2018","journal-title":"Am J Prev Med"},{"key":"e_1_2_14_4_1","first-page":"832","article-title":"Five\u2010year results following regenerative periodontal surgery with an enamel matrix 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