title: Assessment and prevention of behavioural and social risk factors associated with oral cancer: protocol for a systematic review of clinical guidelines and systematic reviews to inform Primary Care dental professionals.
abstract: BACKGROUND
  Tobacco and alcohol are recognised as the major risk factors for both oral cavity (mouth) and oropharyngeal (throat) cancers, with increasing acceptance of the role of human papillomavirus (HPV) in the aetiology of oropharyngeal cancers. In addition, there is a significant increased risk for oral cancer among lower socioeconomic groups, males and older age groups. There is a growing evidence for the potential role of primary care professionals in smoking cessation and reducing alcohol-related harm. However, there are uncertainties about the best approaches/strategies to assess risk factors associated with oral cancer, effective components of preventive interventions for behaviour change and implementation strategies in primary care dental settings. Thus, in order to contribute to the prevention of oral cancer effectively, dental professionals need to assess patients on the major risk factors (tobacco, alcohol and HPV/sexual behaviours) and deliver appropriate prevention, taking into account the patient's sociodemographic context.
  
  
  OBJECTIVE
  The study aims to synthesise evidence on the best practice for undertaking an assessment of major behavioural risk factors associated with oral cancer and delivering effective behaviour change preventive interventions (e.g. advice, counselling, patient recall, signposting/referral to preventive services) by dental professionals in primary care dental settings.
  
  
  METHODS
  The study involves a systematic review and evidence appraisal. We will search for clinical guidelines and systematic reviews from the following databases: Cochrane Library, Ovid MEDLINE, EMBASE, Web of Science, PsychINFO, PubMed, TRIP and Google Scholar. We will also search websites of professional organisations/agencies and bibliographies/reference lists of selected papers. Quality will be assessed with the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument for included clinical guidelines and the AMSTAR (A Measurement Tool to Assess Systematic Reviews) and ROBIS instruments for included systematic reviews. The best practice evidence will be assessed via a narrative synthesis of extracted data, considering publication quality.
  
  
  CONCLUSIONS
  This systematic review will synthesise evidence on the best practice for oral cancer risk factor assessment and prevention and evaluate the relationship between available clinical guidelines and the review evidence base. This collation of evidence will be useful for making recommendations for future intervention, research and guideline development.
  
  
  BACKGROUND
  PROSPERO CRD42015025289.
authors.affiliation: Institution: University of Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK. s.mathur.1@research.gla.ac.uk.
authors.forename: Sweta
authors.initials: S
authors.lastname: Mathur
authors.affiliation: Institution: University of Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK. David.Conway@glasgow.ac.uk.
authors.forename: David I
authors.initials: DI
authors.lastname: Conway
authors.affiliation: Institution: University of Glasgow Library, Glasgow, UK. Heather.Worlledge-Andrew@glasgow.ac.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Worlledge-Andrew
authors.affiliation: Institution: University of Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK. Lorna.Macpherson@glasgow.ac.uk.
authors.forename: Lorna M D
authors.initials: LM
authors.lastname: Macpherson
authors.affiliation: Institution: University of Glasgow Dental Hospital & School, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK. Alastair.Ross@glasgow.ac.uk.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Ross
mesh_terms: D000428:Alcohol Drinking / Q000517:prevention & control; D002985:Clinical Protocols; D003813:Dentistry; D000431:Ethanol / Q000009:adverse effects; D015438:Health Behavior; D006801:Humans; D009062:Mouth Neoplasms / Q000209:etiology*; D009959:Oropharyngeal Neoplasms / Q000209:etiology* / Q000821:virology; D027383:Papillomaviridae; D011320:Primary Health Care; D012107:Research Design; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012907:Smoking; D000074606:Smoking Prevention; D000078202:Systematic Reviews as Topic; D047568:Unsafe Sex / Q000517:prevention & control
chemical_list: D000431:Ethanol