Cigarette smoking and periodontitis: methodology to assess the strength of evidence in support of a causal association

Abstract

Identification of the cause of the development and progression of periodontitis has received extensive attention, with notable advances over the past decade in clinical, microbiological, immunological, biochemical, and behavioral knowledge. However, it is still largely unknown which factors lead to the conversion of non-destructive forms of periodontal disease into destructive forms and disease progression. Chronic adult periodontitis is believed to be influenced by an interaction of host defense and environmental factors. Although these variables have been studied extensively, no study has employed randomized controlled prospective human or randomized controlled community intervention designs, methodologies necessary to prove a variable to be a cause of periodontitis. Owing to the absence of literature employing rigorous experimental design, this article assesses systematically observational, cross-sectional and longitudinal studies to examine the potential causal association between cigarette smoking and periodontitis. The methodology of Sir Bradford Hill's criteria for causation was used as the framework. Results suggest that cigarette smoking is causally associated with periodontitis. That is, cigarette smoking is consistently associated with an increased prevalence/severity of periodontitis and is suspected on theoretical grounds of playing a causal role. Hill's criteria provide a useful methodology to better understand the pathogenesis of periodontal diseases and may be applied to study the pathogenesis of other dental diseases as well.

Prevalencia de enfermedades periodontales, factores de riesgo y necesidad de tratamiento en el personal de tropa masculino en Servicio Militar en Lima en el año 2000

“…Se ha reportado que a mayor núme-ro de cigarrillos mayor puntuación de IPCNT y pérdida de fijación, lo cual sugeriría que el hábito de fumar juegue un rol preponderante en la prevalencia e intensidad de las EEPP (2,6,8,(35)(36)(37)(38).…”

“…El consumo de cigarrillos se asocia fuertemente con el incremento de prevalencia y severidad de EEPP, se sospecha que juega un rol importante en la patogénesis de las EEPP (2,6,8,21,(33)(34)(35)(36)(37)(38), y puede afectar el resultado de las terapias quirúrgicas (39). El cepillo dental es el dispositivo más usado para la higiene oral con el propósito de remover la placa dental; cuando se utiliza correctamente y el paciente es instruido, se ha observado una reducción de aproximadamente el 30% de los niveles de placa comparada con la higiene oral ordinaria (40).…”

Sigara ve Periodontal Sağlık İlişkisi

“…Kronik periodontitis, konak yanıtı mekanizmalarından ve çevresel faktörlerden etkilenebilmektedir (38). Deneysel çalışmalar plağa bağlı gingivitis modelinde, gingival inflamasyon belirtilerinin sigara içmeyen bireylerde, içenlere nazaran baskın olduğunu göstermektedir (39).…”

Effects of Tobacco Smoking on Chronic Periodontitis and Periodontal Treatment

“…Gelskey (1999) stated that smoking meets most of the criteria for causation proposed by Hill (1965). This statement is based on the consistency and strength of association between smoking and periodontal disease severity demonstrated by multiple cross-sectional as well as longitudinal studies.…”