Interventions for tobacco cessation in the dental setting

Department of Dental Specialities, Mayo Clinic, Rochester, .
Cochrane database of systematic reviews (Online) (Impact Factor: 6.03). 06/2012; 6(6):CD005084. DOI: 10.1002/14651858.CD005084.pub3
Source: PubMed


Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users.
This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting.
We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011).
We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up.
Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I² statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model.
Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I² = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I² = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I² = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11).
Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.

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Available from: Alan B Carr, Jan 08, 2015
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    • "Also, the negative consequences of tobacco use for oral health, such as oral cancer and poor periodontal health in smokers and local lesions in snus users, give high legitimacy to dental professionals to provide tobacco cessation support to their patients (Cnattingius et al., 2005; Scientific Committee on Emerging and Newly Identified Health Risks, 2008; Swedish Council on Health Technology Assessment, 2002; U.S. Department of Health and Human Services, 2004). In fact, both a recent Cochrane review and a report by Swedish Council on Health Technology Assessment concluded that tobacco cessation interventions in dental care clinics are effective in increasing the abstinence rates among tobacco users (Carr and Ebbert, 2012; Swedish Council on Health Technology Assessment, 2002). "
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    ABSTRACT: The aim of this study is to assess the effectiveness of a very brief structured counseling for tobacco cessation in dentistry clinics. A cluster randomized trial was conducted in Sweden in 2012-2013. Twenty-seven dentistry clinics in two Swedish counties were randomized to provide either a structured brief advice based on the 5 A's model or usual care. Participants were 467 patients currently using tobacco daily (225 in the intervention group and 242 in usual care), of which 97% were retained at follow-up, six months after enrolment. Study outcomes were: 7-day abstinence (primary outcome); 3-month sustained abstinence; 50% reduction of the amount tobacco used; quit attempts lasting at least 24h. Compared to usual care, brief counseling was not associated to statistically significant increase in the proportion abstinent from tobacco use after 6months. However, there was a statistically significant association with reduction of tobacco consumption (OR=2.07 95% CI 1.28-3.35). Changes in the expected direction for all outcomes were more frequent in the intervention than in the usual care group, and larger among exclusive snus users than among smokers. Very brief and structured counseling in dentistry may achieve positive behavioral modifications among tobacco users, with significant reduction of tobacco consumption, particularly among smokeless tobacco users. Copyright © 2014 Elsevier Inc. All rights reserved.
    Full-text · Article · Nov 2014 · Preventive Medicine
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    • "Similar advice given as part of health checks and prevention activities seem to be less effective but still may have some impact.45 Dentists and other oral health professionals also have an ideal opportunity during dental health checks to ask about their patients’ smoking status and provide smoking cessation information and advice.46 While brief advice/interventions should be delivered by all professionals and therefore have a very wide reach, intensive support (individual, group, or telephone) is most effective when delivered by specialist advisors.26 "
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    ABSTRACT: Tobacco smoke is the leading cause of preventable premature death worldwide. While the majority of smokers would like to stop, the habitual and addictive nature of smoking makes cessation difficult. Clinical guidelines suggest that smoking cessation interventions should include both behavioural support and pharmacotherapy (e.g. nicotine replacement therapy). This commentary paper focuses on the important role of behavioural interventions in encouraging and supporting smoking cessation attempts. Recent developments in the field are discussed, including 'cut-down to quit', the behaviour change techniques taxonomy (BCTT) and very brief advice (VBA) on smoking. The paper concludes with a discussion of the important role that health professionals can and should play in the delivery of smoking cessation interventions.
    Full-text · Article · Aug 2013 · Health Services Insights
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    • "Interestingly , of the 6 studies included in a recent systematic review of tobacco-use cessation interventions in the dental setting, no biochemical confirmation was used to validate self-report in 3 studies. In the remaining 3 studies, biochemical confirmation was initially utilized and abandoned, or used to enhance self-report (i.e., "bogus pipeline") (Ebbert et al. 2006). It is also evident from the above that self-report measures of abstinence remain the primary outcome measure in cessation studies, whether or not augmented with biochemical measures. "
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    ABSTRACT: Tobacco use cessation (TUC) in dentistry is critical to reducing the effect of a major risk factor for both oral and systematic diseases. The effect of TUC interventions has been widely reported. The data show that the success of TUC without professional support is negligible but that behavioural and pharmacological interventions are effective. Furthermore, the greater the intensity of support, the greater the quit rate and success rates are similar comparing different health care professionals including dental professionals. Although few studies have been performed in dental practice, it is clear that TUC should be embedded in routine oral health care. In addition to evaluating the effect of TUC, several studies have investigated barriers to implementing TUC in dental settings. A large number of barriers have been reported. These studies highlight the importance of further training for dental professionals but also identify the need for major cultural and policy changes to facilitate the provision of TUC. Research on barriers to TUC in dental care could be facilitated by employing qualitative or mixed methods designs and studies that evaluate the impact of changing such barriers on TUC provision. Such an approach will help to close the gap between research findings and implementation. Regarding the measurement of outcomes from TUC, no gold standards exist currently. Therefore both self-reported and biochemical measures of tobacco use should be reported in evaluation studies. It is also clear that feedback from biochemical testing of tobacco use can increase success rates in tobacco use cessation.
    Full-text · Article · Feb 2006 · Oral health & preventive dentistry
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