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Smokeless tobacco users should be offered behavioural support. There is limited evidence for pharmacotherapy.



Behavioural interventions that include an oral examination and feedback about the specific risks of oral tobacco use have been shown to assist quitting. Trials of bupropion and NRT have not detected significant long-term effects. One trial of varenicline showed a significant long term effect.



West R, McNeill A, Raw M. Smokeless tobacco cessation guidelines for health professionals in England. Br Dent J. 2004; 196: 611-618.

Ebbert J, Montori VM, Erwin PJ, Stead LF. Interventions for smokeless tobacco use cessation. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD004306. DOI: 10.1002/14651858.CD004306.pub4.

Fagerström K, Gilljam H, Metcalfe M, Tonstad S, Messig M. Stopping smokeless tobacco with varenicline: randomised double blind placebo controlled trial. BMJ. 2010; 341: c6549.

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