TY - JOUR
T1 - Interventions for tobacco cessation delivered by dental professionals
AU - Holliday, Richard
AU - Hong, Bosun
AU - McColl, Elaine
AU - Livingstone-Banks, Jonathan
AU - Preshaw, Philip M.
N1 - Funding Information:
This project was supported by the National Institute for Health Research (NIHR), via a Clinical Lectureship (RH), Academic Clinical Fellowship (BH) and a Cochrane Infrastructure and Cochrane Programme grant funding to the Cochrane Tobacco Addiction Group. The views and opinions expressed herein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health and Social Care.
Funding Information:
QUOTE: "Supported in part by grant #1 R01 HL48768 from the National Heart, Lung and Blood Institute."
Funding Information:
QUOTE: "VB has received funding from Pfizer for attending meetings, and has written articles on smoking cessation for GSK. None of the other authors have conflicting interests."
Funding Information:
QUOTE: "This research was supported by a grant from the National Cancer Institute, grant no. PHS 1 R01 CA38337."
Funding Information:
QUOTE: "This project was supported by the National Institute of Dental and Craniofacial Research grant DE16024-02."
Funding Information:
QUOTE: "This research was supported by the Tobacco Surtax Fund of the State of California (Grant 4RT-0068) through the Tobacco-Related Disease Research Program of the University of California."
Funding Information:
QUOTE: "This research was funded by grant R01 DA017972 from the National Institutes of Health, National Institute on Drug Abuse, to the Oregon Research Institute, Eugene."
Funding Information:
QUOTE: "This research was funded by grant from the National Institutes of Health, National Cancer Institute (grant R01-CA107442)."
Funding Information:
QUOTE: "This study was supported by a Fukuoka Dental College Grant and by Grant-in-Aids for Cancer Research from the Japanese Ministry of Health, Labor and Welfare (13–3, 17–1)."
Funding Information:
QUOTE: "Richard Holliday is funded by a National Institute for Health Research Doctoral Research Fellowship (DRF-2015-08-077)."
Funding Information:
QUOTE: "This research was supported by a grant from the National Institute of Dental and Craniofacial Research (Grant R01 DE12677)."
Funding Information:
QUOTE: "This research was supported by the National Institute for Dental and Craniofacial Research (NIDCR; grant U01DE024462)."
Funding Information:
QUOTE: "This work was supported by grants from the Västmanland County Council, Sweden."
Funding Information:
QUOTE: "This research was supported by grant 1 RO1 HL48768 from the National Heart, Lung, and Blood Institute."
Funding Information:
QUOTE: "This work was supported by grant P01 CA 44648 from the National Cancer Institute."
Funding Information:
QUOTE: "The work of Maria R Galanti, Suvi Virtanen and Izla Rohyo was supported by grant awarded by the National Board of Health and Welfare. The work of Zangin Zeebariwas due as part of his employment at the Centre for Epidemiology and Community Medicine, Stockholm County Council. The funding agencies had no role in study design; collection, analysis, and interpretation of data; writing the report; and the decision to submit the report for publication." QUOTE: "Authors declared that they have no conflicts of interest. No financial disclosures were reported by the authors of this paper."
Funding Information:
QUOTE: "This research was supported by the Tobacco Surtax Fund of the State of California through the Tobacco-Related Disease Research Program of the University of California."
Funding Information:
QUOTE: "This research was supported by the Tobacco Surtax Fund of the State of California (Grant No. 4RT-0068) through the Tobacco-Related Disease Research Program of the University California and by the National Cancer Institute (Grant No. CA 67654)."
Funding Information:
This research project was funded by the University of Malaya Postgraduate Research Fund (Reference Number: PG075-2013A)
Funding Information:
• National Institute for Health Research, UK * RH is funded by the National Institute for Health Research (NIHR) as a Clinical Lecturer. BS is funded by the NIHR as an Academic Clinical Fellow. JLB is funded via Cochrane Infrastructure and Cochrane Programme grant funding to the Cochrane Tobacco Addiction Group. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Publisher Copyright:
Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
PY - 2021/2/19
Y1 - 2021/2/19
N2 - 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.
AB - 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.
KW - Bias
KW - Counseling
KW - Dentists
KW - Oral Health
KW - Randomized Controlled Trials as Topic
KW - Schools
KW - Smoking Cessation
KW - Tobacco Use Cessation
KW - Tobacco, Smokeless
KW - Universities
UR - http://www.scopus.com/inward/record.url?scp=85101743471&partnerID=8YFLogxK
U2 - 10.1002/14651858.CD005084.pub4
DO - 10.1002/14651858.CD005084.pub4
M3 - Review article
C2 - 33605440
AN - SCOPUS:85101743471
SN - 1465-1858
VL - 2021
JO - Cochrane Database of Systematic Reviews
JF - Cochrane Database of Systematic Reviews
IS - 2
M1 - CD005084
ER -