Cumulative smoking exposure and cessation associated with the recurrence of periodontitis in periodontal maintenance therapy: A 6‐year follow‐up

Abstract

Background This study followed individuals in periodontal maintenance therapy (PMT) over 6 years and longitudinally evaluated the effects of cumulative smoking exposure and duration of smoking cessation on the recurrence of periodontitis. Methods From a 6‐year follow‐up cohort study with 212 individuals in PMT, 142 patients who attended at least one PMT visit within 12 months were determined to be elegible. According to smoking habits they were categorized into three groups: non‐smokers (NS; n = 95), former smokers (FS; n = 22), and current smokers (CS; n = 25). Complete periodontal examination and smoking habits were evaluated at two instances: T1 (first time, after active periodontal therapy) and T2 (second time, 6 years). Associations between the recurrence of periodontitis (RP; probing depth ≥4 mm and clinical attachment loss ≥3 mm, together with the presence of bleeding on probing and/or suppuration), smoking status, and potential risk variables were analyzed by univariate and multivariate analysis, when appropriate. Results The RP in NS, FS, and CS groups was 44.2%, 68.2%, and 80.0%, respectively. After adjusting for confounders, odds ratios (95% confidence interval) for the RP in T2 was 2.80 (2.11 to 5.14) for FS and 5.97 (3.58 to 9.88) for CS. There was a significant dose‐response relationship between pack‐years of smoking and the RP, as well as a significant decrease in the risk for the RP as the years of smoking cessation increased. Conclusion During 6 years of PMT, cumulative smoking exposure and shorter time since smoking cessation were significantly associated with the RP.

The impact of smoking on non‐surgical periodontal therapy: A systematic review and meta‐analysis

“…ES: effect size The current systematic review did not evaluate treatment outcomes in former smokers. Studies have showed that smoking cessation can significantly improve clinical outcomes of both non-surgical and surgical periodontal treatments (Costa & Cota, 2019;Haber & Kent, 1992;Preshaw et al, 2005). Smoking intensity and duration can also affect clinical outcomes of periodontal therapies (Baljoon et al, 2005;Bergström et al, 2000;Kaldahl et al, 1996).…”

Tooth loss in complying and non-complying periodontitis patients with different periodontal risk levels during supportive periodontal care

“…When considering that high-risk patients are also those showing less adherence to the SPC program in the long term [25,[33][34][35], the adoption of a SPC program based on a more stringent (i.e., < 3-month) interval between sessions might represent a weak option to enhance SPC efficacy over time. Considering that patients with PerioRisk level 5 are significantly different in terms of smoking and disease-associated markers (Table 8), a more efficient treat-to-target approach based on smoking cessation program [36][37][38] as well as a more intense treatment of pockets and periodontal inflammation may be recommended prior to SPC enrollment in individuals at the highest risk level, particularly if not complying with the suggested SPC recall interval. This recommendation is also supported by previous data showing that high (≥ 30%) BoP score [8] and increasing proportions of bleeding pockets [4] at re-evaluation following active therapy were positively associated with greater tooth loss during SPC.…”

Supportive periodontal therapy in moderate‐to‐severe periodontitis patients: A two‐year randomized clinical trial

“…It is well known that smokers have a worse clinical response to non‐surgical periodontal treatment compared to non‐smokers (González et al., ; Heasman et al., ; Wan et al., ). A recent study investigating the effect of smoking during 6 years of periodontal maintenance showed that cumulative smoking exposure was significantly associated with the recurrence of periodontitis (Costa & Cota, ). This phenomenon appeared to be present also in the 2‐year SPT period, since the analysis showed that at sites PPD ≥ 4 mm and ≥5 mm at baseline, smokers were more likely to develop PPD increase and attachment loss overtime compared to non‐smokers in both groups.…”