Increasing smoking cessation implementation in dental primary care


In addition to its well-known harmful effects on the lungs and heart Smoking tobacco has serious adverse effects on oral health. Dental health professionals have an excellent opportunity to help reduce smoking and tobacco use.  The aim of this study was to evaluate two interventions intended to increase the implementation of tobacco use prevention and cessation (TUPAC) counselling in primary care oral health settings.

This cluster randomised study was conducted in Finland. There were three groups a control of 5 clusters (potential; 31 participants) and education arm (4 clusters; potential 27 participants) and an education and fee arm (4 clusters; potential 37 participants). The education consisted of training specifically designed to address the perceived barriers and enablers, such as self- efficacy, skills and knowledge needed to provide TUPAC.  While the education plus fee arm received an additional fee to provide the intervention in practice.

  • Of 95 providers, 73 participated (76.8%).
  • At 6-month follow-up counselling activity increased significantly in intervention groups.
  • On average, dental hygienists showed greater activity in tobacco prevention (F = 12.13; P = 0.001) and cessation counselling (F = 30.19; P < 0.001) than did dentists.
  • In addition, cessation counselling showed a statistically significant provider-by-group-by-time interaction (F = 5.95; P < 0.001), indicating that interventions to enhance cessation counselling were more effective among dental hygienists.
  • The education and education + fee-for-service groups showed no statistically significant group- by-time interaction at 1 month (F = 1.45; P = 0.24) or at any other time point assessed

The authors concluded

Educational intervention yielded positive short-term effects on cessation counselling, but not on preventive counselling. Adding a fee-for-service to education failed to significantly improve TUPAC counselling performance. Other approaches than monetary incentives may be needed to enhance the effectiveness of educational intervention. Further studies with focus on how to achieve long-term changes in TUPAC counselling activity among oral health professionals are needed.


The Cochrane review by Carr and Ebbert (2012)  shows that tobacco interventions delivered by dental health professionals do help they patients quit.  Increasingly dentists are asking the patients about their smoking habits but it seems that we need to put more research into getting them to take it to the next stage and getting them to encourage their patients to consider reducing or stopping the tobacco use and or attending smoking cessation clinics.


Amemori M, Virtanen J, Korhonen T, Kinnunen TH, Murtomaa H. Impact of educational intervention on implementation of tobacco counselling among oral health professionals: a cluster-randomized community trial. Community Dent Oral Epidemiol. 2012 Aug 30. doi: 10.1111/j.1600-0528.2012.00743.x. [Epub ahead of print] PubMed PMID: 22934678.

Carr AB, Ebbert J. Interventions for tobacco cessation in the dental setting. Cochrane Database of Systematic Reviews 2012, Issue 6. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub3.

Dental Elf 18th June



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Derek Richards

Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He has been involved with teaching EBD and a wide range of evidence-based initiatives both nationally and internationally since 1994.

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