Worldwide tobacco smoking has been responsible for millions of deaths. As well as its harmful effects on respiratory and cardiovascular systems it is a major risk factors for oral cancer and periodontal diseases. Smoking is estimated to be responsible 75% of oral cancer cases so smoking cessation is important for prevention of oral diseases. Behavioural support in the dental setting usually involves brief or very brief advice interventions with referral for specialist support.
The aim of this Cochrane review was to assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.
Searches were conducted in the Cochrane Tobacco Addiction Group’s Specialised Register which incorporates searches from the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, PsycINFO, The US National Institutes of Health (NIH) trials registry at ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) databases.
Two reviewers independently selected studies extracted data and assessed risk of bias using specific guidance developed by the Cochrane Tobacco Addiction Group. Randomised controlled trials (RCTs), Cluster-randomised controlled trials(cluster-RCTs) or Quasi-randomised controlled trials(quasi-RCTs) with at least six months of follow-up assessing tobacco cessation interventions conducted by dental professionals in a dental practice or community setting were considered. The primary outcome was abstinence from all tobacco use which was summarised as risk ratios (RR) and associated 95% confidence interval (CI). A narrative summary of secondary outcomes was presented.
- 20 studies (10 RCTs, 10 cluster RCTs) involving 14,897 patients were included.
- 12 studies were conducted in dental clinics, 3 in hospital settings, one in a military dental clinic and 4 in non-dental settings.
- 5 studies included only smokeless tobacco users, the remaining studies included either smoked tobacco users only, or a combination of both smoked and smokeless tobacco users.
- All studies employed behavioural interventions, with 4 offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention.
- 3 studies were considered to be at low risk of bias, 1 at unclear risk and 16 at high risk.
- Compared with usual care, brief advice, very brief advice, or less active treatment, we found very low-certainty evidence of benefit from behavioural support provided by dental professionals on abstinence from tobacco use at least six months from baseline of
- either one session RR = 1.86 (95%CI; 1.01 to 3.41) [4 studies n = 6328] or
- more than one session RR = 1.90 (95%CI; 1.17 to 3.11) [7 studies n = 2639].
- There was moderate-certainty evidence of benefit from behavioural interventions provided by dental professionals combined with the provision of NRT or e-cigarettes, compared with no intervention, usual care, brief, or very brief advice only RR = 2.76 (95%CI; 1.58 to 4.82;) [4 studies, n = 1221].
- A benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting was not seen RR = 1.51 (95%CI; 0.86 to 2.65) [3 studies, n = 1020; very low-certainty evidence)]
- Only one study reported adverse events or oral health outcomes.
The authors concluded: –
There is very low-certainty evidence that quit rates increase when dental professionals offer behavioural support to promote tobacco cessation. There is moderate-certainty evidence that tobacco abstinence rates increase in cigarette smokers if dental professionals offer behavioural support combined with pharmacotherapy. Further evidence is required to be certain of the size of the benefit and whether adding pharmacological interventions is more effective than behavioural support alone. Future studies should use biochemical validation of abstinence so as to preclude the risk of detection bias. There is insufficient evidence on whether these interventions lead to adverse effects, but no reasons to suspect that these effects would be specific to interventions delivered by dental professionals. There was insufficient evidence that interventions affected oral health.
This review was conducted using the robust methodological approaches adopted by Cochrane. While identifying 20 trials a majority of these (16) were considered to be at high risk of bias the most common reason for this being the self-reporting of tobacco use status. As the authors highlight in their discussion the quit rates identified are similar to those seen when smoking cessation advice is delivered by physicians. It is also interesting to note that when behavioural support was combined with nicotine treatment a larger effect was seen an area highlighted for future research by the reviewers. As health care professionals the dental team are in a good position to encourage their tobacco using patients to quit.
Holliday R, Hong B, McColl E, Livingstone-Banks J, Preshaw PM. Interventions for tobacco cessation delivered by dental professionals. Cochrane Database of Systematic Reviews 2021, Issue 2. Art. No.: CD005084. DOI: 10.1002/14651858.CD005084.pub4.
Dental Elf – 15th Nov 2019