Carr Alan B, Ebbert Jon
Department of Dental Specialities, Mayo Clinic, Rochester,
Cochrane Database Syst Rev. 2012 Jun 13;2012(6):CD005084. doi: 10.1002/14651858.CD005084.pub3.
Tobacco use has significant adverse effects on oral health. Oral health professionals in the dental office or community setting have a unique opportunity to increase tobacco abstinence rates among tobacco users.
This review assesses the effectiveness of interventions for tobacco cessation delivered by oral health professionals and offered to cigarette smokers and smokeless tobacco users in the dental office or community setting.
We searched the Cochrane Tobacco Addiction Group Specialized Register (CENTRAL), MEDLINE (1966-November 2011), EMBASE (1988-November 2011), CINAHL (1982-November 2011), Healthstar (1975-November 2011), ERIC (1967-November 2011), PsycINFO (1984-November 2011), National Technical Information Service database (NTIS, 1964-November 2011), Dissertation Abstracts Online (1861-November 2011), Database of Abstract of Reviews of Effectiveness (DARE, 1995-November 2011), and Web of Science (1993-November 2011).
We included randomized and pseudo-randomized clinical trials assessing tobacco cessation interventions conducted by oral health professionals in the dental office or community setting with at least six months of follow-up.
Two authors independently reviewed abstracts for potential inclusion and abstracted data from included trials. Disagreements were resolved by consensus. The primary outcome was abstinence from smoking or all tobacco use (for users of smokeless tobacco) at the longest follow-up, using the strictest definition of abstinence reported. The effect was summarised as an odds ratio, with correction for clustering where appropriate. Heterogeneity was assessed using the I² statistic and where appropriate a pooled effect was estimated using an inverse variance fixed-effect model.
Fourteen clinical trials met the criteria for inclusion in this review. Included studies assessed the efficacy of interventions in the dental office or in a community school or college setting. Six studies evaluated the effectiveness of interventions among smokeless tobacco (ST) users, and eight studies evaluated interventions among cigarette smokers, six of which involved adult smokers in dental practice settings. All studies employed behavioral interventions and only one required pharmacotherapy as an interventional component. All studies included an oral examination component. Pooling all 14 studies suggested that interventions conducted by oral health professionals can increase tobacco abstinence rates (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.44 to 2.03) at six months or longer, but there was evidence of heterogeneity (I² = 61%). Within the subgroup of interventions for smokers, heterogeneity was smaller (I² = 51%), but was largely attributable to a large study showing no evidence of benefit. Within this subgroup there were five studies which involved adult smokers in dental practice settings. Pooling these showed clear evidence of benefit and minimal heterogeneity (OR 2.38, 95% CI 1.70 to 3.35, 5 studies, I² = 3%) but this was a posthoc subgroup analysis. Amongst the studies in smokeless tobacco users the heterogeneity was also attributable to a large study showing no sign of benefit, possibly due to intervention spillover to control colleges; the other five studies indicated that interventions for ST users were effective (OR 1.70; 95% CI 1.36 to 2.11).
AUTHORS' CONCLUSIONS: Available evidence suggests that behavioral interventions for tobacco cessation conducted by oral health professionals incorporating an oral examination component in the dental office or community setting may increase tobacco abstinence rates among both cigarette smokers and smokeless tobacco users. Differences between the studies limit the ability to make conclusive recommendations regarding the intervention components that should be incorporated into clinical practice, however, behavioral counselling (typically brief) in conjunction with an oral examination was a consistent intervention component that was also provided in some control groups.
烟草使用对口腔健康有显著的不利影响。牙科诊所或社区环境中的口腔健康专业人员有独特的机会提高烟草使用者的戒烟率。
本综述评估口腔健康专业人员在牙科诊所或社区环境中为吸烟者和无烟烟草使用者提供的戒烟干预措施的有效性。
我们检索了Cochrane烟草成瘾小组专业注册库（CENTRAL）、医学期刊数据库（MEDLINE，1966年至2011年11月）、荷兰医学文摘数据库（EMBASE，1988年至2011年11月）、护理学与健康领域数据库（CINAHL，1982年至2011年11月）、健康之星数据库（Healthstar，1975年至2011年11月）、教育资源信息中心数据库（ERIC，1967年至2011年11月）、心理学文摘数据库（PsycINFO，1984年至2011年11月）、国家技术信息服务数据库（NTIS，1964年至2011年11月）、在线学位论文摘要数据库（1861年至2011年11月）、循证医学数据库（DARE，1995年至2011年11月）以及科学引文索引数据库（Web of Science，1993年至2011年11月）。
我们纳入了随机和半随机临床试验，这些试验评估了口腔健康专业人员在牙科诊所或社区环境中进行的戒烟干预措施，且随访期至少为六个月。
两位作者独立审查摘要以确定是否可能纳入，并从纳入的试验中提取数据。分歧通过协商解决。主要结局是在最长随访期时戒烟或戒用所有烟草（对于无烟烟草使用者而言），采用所报告的最严格的戒烟定义。效应以比值比进行汇总，并在适当情况下对聚类进行校正。使用I²统计量评估异质性，并在适当情况下使用逆方差固定效应模型估计合并效应。
14项临床试验符合本综述的纳入标准。纳入的研究评估了在牙科诊所或社区学校或学院环境中干预措施的疗效。6项研究评估了对无烟烟草使用者干预措施的有效性，8项研究评估了对吸烟者干预措施的有效性，其中6项涉及牙科诊疗环境中的成年吸烟者。所有研究均采用行为干预，只有一项研究要求将药物治疗作为干预组成部分。所有研究均包括口腔检查部分。汇总所有14项研究表明，口腔健康专业人员进行的干预措施可在六个月或更长时间内提高戒烟率（比值比[OR]为1.71，95%置信区间[CI]为1.44至2.03），但有证据表明存在异质性（I² = 61%）。在吸烟者干预措施的亚组中，异质性较小（I² = 51%），但主要归因于一项大型研究，该研究未显示出有益效果。在该亚组中有5项研究涉及牙科诊疗环境中的成年吸烟者。汇总这些研究显示出明显的有益证据且异质性最小（OR为2.38，95%CI为1.70至3.35，5项研究，I² = 3%），但这是一项事后亚组分析。在无烟烟草使用者的研究中，异质性也归因于一项大型研究未显示出有益迹象，可能是由于干预措施蔓延到了对照学院；其他5项研究表明对无烟烟草使用者的干预措施是有效的（OR为1.70；95%CI为1.36至2.11）。
现有证据表明，口腔健康专业人员在牙科诊所或社区环境中进行的结合口腔检查部分的戒烟行为干预措施，可能会提高吸烟者和无烟烟草使用者的戒烟率。然而，研究之间的差异限制了就应纳入临床实践的干预组成部分做出确定性推荐的能力，不过，行为咨询（通常为简短咨询）结合口腔检查是一个一致的干预组成部分，在一些对照组中也有提供。
