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Meta-Analysis
. 2021 Feb 19;2(2):CD005084.
doi: 10.1002/14651858.CD005084.pub4.

Interventions for tobacco cessation delivered by dental professionals

Richard Holliday  1 , Bosun Hong  2 , Elaine McColl  3 , Jonathan Livingstone-Banks  4 , Philip M Preshaw  1
Affiliations
Meta-Analysis

Interventions for tobacco cessation delivered by dental professionals

Richard Holliday et al. Cochrane Database Syst Rev. .

Abstract

Background: Dental professionals are well placed to help their patients stop using tobacco products. Large proportions of the population visit the dentist regularly. In addition, the adverse effects of tobacco use on oral health provide a context that dental professionals can use to motivate a quit attempt.

Objectives: To assess the effectiveness, adverse events and oral health effects of tobacco cessation interventions offered by dental professionals.

Search methods: We searched the Cochrane Tobacco Addiction Group's Specialised Register up to February 2020.

Selection criteria: We included randomised and quasi-randomised clinical trials assessing tobacco cessation interventions conducted by dental professionals in the dental practice or community setting, with at least six months of follow-up.

Data collection and analysis: Two review authors independently reviewed abstracts for potential inclusion and extracted data from included trials. We resolved disagreements by consensus. The primary outcome was abstinence from all tobacco use (e.g. cigarettes, smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. Individual study effects and pooled effects were summarised as risk ratios (RR) and 95% confidence intervals (CI), using Mantel-Haenszel random-effects models to combine studies where appropriate. We assessed statistical heterogeneity with the I2 statistic. We summarised secondary outcomes narratively.

Main results: Twenty clinical trials involving 14,897 participants met the criteria for inclusion in this review. Sixteen studies assessed the effectiveness of interventions for tobacco-use cessation in dental clinics and four assessed this in community (school or college) settings. Five studies included only smokeless tobacco users, and 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 four offering nicotine treatment (nicotine replacement therapy (NRT) or e-cigarettes) as part of the intervention. We judged three studies to be at low risk of bias, one to be at unclear risk of bias, and the remaining 16 studies to be at high risk of bias. 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, comprising either one session (RR 1.86, 95% CI 1.01 to 3.41; I2 = 66%; four studies, n = 6328), or more than one session (RR 1.90, 95% CI 1.17 to 3.11; I2 = 61%; seven studies, n = 2639), on abstinence from tobacco use at least six months from baseline. We found 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; I2 = 0%; four studies, n = 1221). We did not detect a benefit from multiple-session behavioural support provided by dental professionals delivered in a high school or college, instead of a dental setting (RR 1.51, 95% CI 0.86 to 2.65; I2 = 83%; three studies, n = 1020; very low-certainty evidence). Only one study reported adverse events or oral health outcomes, making it difficult to draw any conclusions.

Authors' conclusions: 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.

Trial registration: ClinicalTrials.gov NCT00273156 NCT00384254 NCT00683839 NCT02347124 NCT00670514 NCT00627185 NCT00297700 NCT00907309 NCT01275391 NCT02188563 NCT02570646 NCT02737176 NCT03276819 NCT03579355 NCT03656874 NCT01108432 NCT01584882 NCT00591175 NCT02582008.

PubMed Disclaimer

Conflict of interest statement

RH, EM, PP are authors of one of the studies included in the review (Holliday 2019).

BH declares no competing interests.

JLB: none known

Figures

1
1
Study flow diagram for most recent update.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Single‐session behavioural support (1 session) versus control: subgrouped by comparator, Outcome 1: Abstinence at 6+ months
2.1
2.1. Analysis
Comparison 2: Multi‐session behavioural support (> 1 session) versus control: subgrouped by comparator, Outcome 1: Abstinence at 6+ months
3.1
3.1. Analysis
Comparison 3: Behavioural intervention + NRT/e‐cigarette versus control: subgrouped by comparator, Outcome 1: Abstinence at 6+ months
3.2
3.2. Analysis
Comparison 3: Behavioural intervention + NRT/e‐cigarette versus control: subgrouped by comparator, Outcome 2: Adverse events
3.3
3.3. Analysis
Comparison 3: Behavioural intervention + NRT/e‐cigarette versus control: subgrouped by comparator, Outcome 3: Oral health outcomes
3.4
3.4. Analysis
Comparison 3: Behavioural intervention + NRT/e‐cigarette versus control: subgrouped by comparator, Outcome 4: OHQoL‐UK
4.1
4.1. Analysis
Comparison 4: Behavioural support from dental professional at high school/college versus usual care/no intervention, Outcome 1: Abstinence at 6+ months
5.1
5.1. Analysis
Comparison 5: Single‐session behavioural support (1 session) versus control: subgrouped by tobacco‐use type, Outcome 1: Abstinence at 6+ months
6.1
6.1. Analysis
Comparison 6: Multi‐session behavioural support (> 1 session) versus control: subgrouped by tobacco‐use type, Outcome 1: Abstinence at 6+ months
7.1
7.1. Analysis
Comparison 7: Multi‐session behavioural support (> 1 session) versus control: subgrouped by motivation, Outcome 1: Abstinence at 6+ months
8.1
8.1. Analysis
Comparison 8: Behavioural intervention + NRT/e‐cigarette versus control: subgrouped by motivation, Outcome 1: Abstinence at 6+ months
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NCT00907309 {published data only}
    1. NCT00907309. Dental and Medical Office iMET to Reduce Teen Tobacco, Alcohol, and Drug Use. clinicaltrials.gov/ct2/show/NCT00907309 (first received 22 May 2009). [NCT00907309]
NCT01275391 {published data only}
    1. NCT01275391. cSBIRT to reduce teen tobacco, alcohol and drug use. clinicaltrials.gov/ct2/show/NCT01275391 (first received 12 January 2011).
NCT02188563 {published data only}
    1. NCT02188563. A comprehensive smoking cessation intervention duration radiation for upper aerodigestive cancers. ClinicalTrials.gov/show/NCT02188563 (first received 11 July 2014). [NCT02188563]
NCT02570646 {published data only}
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NCT02737176 {published data only}
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NCT03276819 {published data only}
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NCT03579355 {published data only}
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NCT03656874 {published data only}
    1. NCT03656874. Engaging patients in tobacco cessation resources in dental settings. clinicaltrials.gov/ct2/show/NCT03656874 (first received September 2018). [NCT03656874]
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    1. Kottke TE, Brad Rindal D, Rush WA, Asche SE, Enstad CJ. Persistence of smoking-cessation decision support use in a dental practice. American Journal of Preventive Medicine 2015;48(6):722-8. [CENTRAL: 1077092] [EMBASE: 2015785386] [PMID: ] - PubMed
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Williams 2002 {published data only}
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References to ongoing studies

CTRI/2018/02/011846 {published data only}
    1. CTRI/2018/02/011846. Tobacco Cessation Program Conducted At Government Dental College, Kottayam, Kerala. http://www.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2018/02/011846 2018 (first received 12 February 2018). [CTRI/2018/02/011846]
CTRI/2018/03/012867 {published data only}
    1. CTRI/2018/03/012867. Effectiveness of Behavioral Counselling with Nicotine Gum versus Behavioral Counselling alone for quitting tobacco usage among patients at a Tobacco Cessation Clinic in Delhi. http://www.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2018/03/012867 2018 (first received 26 March 2018). [CTRI/2018/03/012867]
La Torre 2013 {published data only}
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NCT00591175 {published data only}
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NCT01846910 {published data only}
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NCT02582008 {published data only}
    1. NCT02582008. Bupropion Hydrochloride or Patient's Choice for Smoking Cessation in Patients With Squamous Cell Head and Neck Cancer Undergoing Radiation Therapy With or Without Chemotherapy. clinicaltrials.gov/ct2/show/NCT02582008 (first received 21 October 2015). [NCT02582008]

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References to other published versions of this review

Carr 2006
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Carr 2012
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