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Systematic overview of systematic reviews and clinical guidelines: assessment and prevention of behavioural risk factors associated with oral cancer to inform dental professionals in primary care dental practices

A Correction to this article was published on 24 June 2022

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Aims/objectives Tobacco and alcohol are recognised as the major modifiable risk factors for oral cancer, the incidence of which is rising globally and predicted to increase. This paper aimed to: 1) appraise and synthesise best practice evidence for assessing the major behavioural risk factors for oral cancer and delivering behaviour change interventions (for example, advice, counselling, signposting/referral to preventive services); and 2) assess appropriateness for implementation by dental professionals in primary care.

Methods A systematic overview was undertaken of systematic reviews and international clinical guidelines. This involved: systematically searching and collating the international literature on assessing oral cancer risk and delivering preventive interventions within primary care; quality appraising and assessing the risk of bias using validated tools; synthesising the evidence for best practice; and assessing application of key findings to the dental setting.

Results and conclusions There is clear evidence for the effectiveness of a 'brief', in-person, motivational intervention for sustained tobacco abstinence or reduced alcohol consumption, following risk factor assessment. Evidence for combined behavioural interventions is lacking. There is no firm conclusion with regards to optimal duration of brief interventions (range 5-20 minutes). For tobacco users, longer (10-20 minutes) and intensive (more than 20 minutes, with follow-up visits) interventions are more effective in increasing quit rates compared to no intervention; very brief (less than five minutes) interventions in a single session show comparable effectiveness to the longer/more intensive interventions. For alcohol users, 10-15-minute multi-contact interventions were most effective, compared to no intervention or very brief (less than five minutes) intervention or intensive intervention; brief interventions of five-minute duration were equally effective. There is limited direct evidence from the dental practice setting (one high-quality systematic review relating to tobacco prevention and none relating to alcohol). Thus, very brief, or brief advice of up to five minutes, should be trialled for tobacco and alcohol respectively in a dental practice setting, after risk assessment tailored to patient motivational status. Exploring delivery by the dental team is supported, as effectiveness was generally independent of primary care provider.

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The study is ethically approved by the University of Glasgow College of Medical, Veterinary & Life Sciences Ethics Committee. We gratefully acknowledge the input and feedback provided by John Gibson, Andrea Sherriff, Heather Worlledge-Andrew and Naeema Al-Balushi. The views expressed are those of the authors and not necessarily those of any of the funders or organisations they represent. Systematic review registration: PROSPERO CRD42015025289.


The project has received funding from NHS Education for Scotland and the Glasgow Dental Educational Trust.

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SM wrote the first draft of the manuscript, with feedback from other authors. SM, AJR, DIC and LMDM participated in the study design, development, refinement of the methodological approach, quality appraisal and synthesis. All authors contributed to revising the manuscript, and all authors read and approved the final manuscript.

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Correspondence to Sweta Mathur.

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The authors declare that they have no competing interests.

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Mathur, S., Conway, D., Macpherson, L. et al. Systematic overview of systematic reviews and clinical guidelines: assessment and prevention of behavioural risk factors associated with oral cancer to inform dental professionals in primary care dental practices. Evid Based Dent (2022).

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