A Cochrane review [Abstract] 1 included 20 clinical trials assessing the efficacy of interventions in the dental office or a school community setting. Five studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users. All studies employed behavioural interventions and included an oral examination component. Four studies offered pharmacotherapy as an interventional component. Interventions conducted by oral health professionals increased tobacco abstinence rates (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) at 6 months or longer.
A study 2 examined the association between dentists' advice, use of cessation medications and quitting behaviours in the general population of adult smokers (n=2714) in Canada. Those who received dentists' advice were more addicted to tobacco than those who did not receive advice (self-perceived addiction to tobacco: 96% vs. 89%, p < 0.001). Dentists' advice alone was not effective. Dentists' advice in conjunction with cessation medications was associated with a higher likelihood of quit attempts (adjusted odds ratio [aOR] 9.85, 95% CI 7.77 to 12.47) and short-term quitting (aOR 3.19, 95% CI 2.20 to 4.62), compared with not receiving dentists' advice and not using cessation medications.
A review and meta-analysis 3 included 19488 smoking subjects. The combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet. The combination of a clinician's brief advice to quit and assistance to obtain tobacco cessation treatment is effective when routinely administered to tobacco users in virtually all health care settings.
A cost-effectiveness RCT and analysis 4 of a high-intensity (HIT) and a low-intensity (LIT) smoking cessation treatment programme using long-term follow-up effectiveness data included 294 smokers. Behaviour therapy, coaching and pharmacological advice (HIT) was compared with 1 counselling session introducing a conventional self-help programme (LIT).The more costly HIT led to higher number of 6-month continuous abstinent participants after 1 year and higher number of sustained abstinent participants after 5-8 years. The incremental cost/QALY of HIT compared with LIT amounted to €918 and €3786 using short-term and long-term effectiveness, respectively, which is considered very cost-effective.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment, lack of blinding).
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