The dental profession has recognized tobacco cessation as an important part of comprehensive dental care, yet implementation of the Public Health Service clinical practice guideline on "Treating Tobacco Use and Dependence" remains a challenge. This is especially the case for patients presenting in dental clinics for whom smoking represents a large financial burden. Many of these smoking-addicted patients also present with multiple risk factors: dental, medical, and psychiatric. Innovative approaches are necessary to reduce barriers to providing smoking cessation services to underserved and high-risk smokers. A tobacco cessation clinic in a dental school setting provides an opportunity for dental students to learn about the management of difficult-to-treat cases and to bring their enhanced intervention skills back into the primary care dental setting. This paper describes a multidisciplinary approach to tobacco cessation in a dental school clinic within an academic medical center.