External Validity of trials on Smoking Cessation in Dental Practice

Methods: This is a method study complementing a previously conducted systematic search of qualitative and quantitative studies on smoking cessation in dental practice. From the identified clinical trials in the review, there were six trials either focusing on smokers or users of smokeless tobacco (Nasser 2011). We evaluated the external validity of the six trials across the four dimensions “reach and representativeness”, “program on policy implementation and adaptation”, “outcomes for decision making” and “maintenance and institutionalization”.

Results: For “reach and representativeness”, most of the trials reported participant's rate among patients but not among setting and delivery staff. For “program or policy implementation and adaptation”, some data were reported on the quality of implementation but did not always cover all aspects of the intervention. The training program of dental practitioners to implement smoking cessation was reported but in some cases, it was not comprehensive. None of the studies reported adverse consequences of the program. This complement the results of the previous review which suggests that behavioural intervention is an effective method for reducing tobacco use. In addition to this, it demonstrated that lack of reimbursement, lack of training, fears over patient response.

Conclusion: “maintenance and institutionalization” and “outcomes for decision making” were less often transparently reported. More attention to external validity in trials is necessary. Most of the studies reporting training of the dental practitioners but it were not always comprehensively reported. Decision makers and practitioners should take this into consideration in implementing smoking cessation programs in dental practices.

Nasser M. Evidence summary: is smoking cessation an effective and cost-effective service to be introduced in NHS dentistry? Br Dent J. 2011 Feb 26;210(4):169-77.