Helping your patients give up smoking

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Following on our story last week about nicotine replacement gum improving tooth staining my colleague  the Lifestyle Elf has highlighted the latest evidence from the Cochrane Collaboration on  interventions for tobacco cessation in dental settings.

Tobacco use has signification negative effects on the oral environment and dentists have a unique opportunity to help their patients achieve abstinence. The review notes that while wide spread acceptance of  tobacco use interventions in the dental setting has been slow for a range of reasons dentists are good at accurately estimating patients tobacco use. They are however less consistent with and supportive of intervention, less likely to report having strong knowledge or skill levels regarding tobacco cessation, and more likely to perceive barriers to tobacco intervention.

The usual robust Cochrane review processes identified 14 randomised controlled trials and they found:-

  • Interventions conducted by oral health professionals can increase quit rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer
  • The findings are similar for smokeless tobacco users and smokers
  • The additional evidence found for this update, providing eight studies of cigarette smokers rather than just one, shows a significant increase in demonstrated benefit compared to earlier findings of this review
  • There is some evidence that adult smokers may be particularly responsive to the effect of an intervention in a dental setting
  • Big differences between the studies mean clear recommendations about which components of the interventions work best can’t be made
  • Self-reported abstinence from smoking was verified by biochemical tests in only two studies

The authors concluded:

“Interventions for tobacco users delivered by oral health professionals, either in the dental office or in the school community, increase the odds of quitting tobacco. Insufficient evidence exists to make conclusions about the effectiveness of specific intervention components, but behavioural counselling (typically brief) is a consistent component.”

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.

 

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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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