Effect of Smoking Exposure on Nonsurgical Periodontal Therapy: 1-Year Follow-up

Abstract

This study investigated the influence of different levels of exposure to smoking on periodontal healing for 12 mo after nonsurgical periodontal therapy and supportive periodontal care every third month. Eighty smokers willing to quit smoking and with periodontitis were included. Participants were offered an individualized voluntary smoking cessation program. Data collection included questionnaires and a full-mouth periodontal examination. Group-based trajectory modeling was used to model smoking trajectories over the follow-up. The effect of smoking trajectory on periodontal parameters over time was estimated with mixed effects modeling. Three smoking patterns were identified: light smokers/quitters ( n = 46), moderate smokers ( n = 17), and heavy smokers ( n = 17). For the periodontal data, the first factor, moderate periodontitis, included the number of sites with clinical attachment levels (CALs) of 4, 5, 6, and 7 mm; periodontal pocket depths (PPDs) of 4, 5, and 6 mm; and bleeding on probing. The second factor, severe periodontitis, consisted of the number of sites with a CAL ≥8 mm and PPD ≥7 mm. Heavy smokers commenced with a higher average CAL of 1.1 mm and 10 more sites with severe periodontitis than light smokers/quitters. While light smokers/quitters and moderate smokers obtained an average improvement of 0.6-mm PPD and 0.7-mm CAL, respectively, heavy smokers experienced 0.5-mm attachment loss. Heavy smokers had only a 50% reduction in the number of sites with moderate periodontitis when compared with light smokers/quitters and moderate smokers. While most participants benefited from nonsurgical periodontal therapy with results affected in a dose-response manner, the therapy had no effect on severe periodontitis among heavy smokers. Smoking cessation should be part of periodontal therapy; otherwise, limited benefits would be observed among heavy smokers, hindering the effect of treatment.

Salivary cytokine expression after non‐surgical periodontal therapy in smokers: 12‐month follow‐up

“…Therefore, exploring potential factors related to periodontal causation and finding markers of disease progression are relevant 2,23 . Given the role of smoking in periodontitis development and deficient healing, 7,8 we investigated cytokine expression patterns among smokers.…”

“…Therefore, exploring potential factors related to periodontal causation and finding markers of disease progression are relevant. 2,23 Given the role of smoking in periodontitis development and deficient healing, 7,8 we investigated cytokine expression patterns among smokers. The association of periodontitis in smokers with the major proinflammatory cytokines, IL-1β, IL-6, and TNFα, was not unanticipated.…”

“…More details about the study are available elsewhere. 8 The screening aimed to assess the presence of periodontitis and attendance to eligibility criteria. Current smoking was evaluated via exhaled carbon monoxide (CO, in parts per million) at every visit * for immediate counseling.…”

“…6,7 We have demonstrated that non-surgical periodontal therapy had no effect on heavy smokers with severe periodontitis. 8 Fortunately, the risk for periodontitis returns to the same level as a never-smoker after smoking cessation, 9 emphasizing the role of tobacco in the mesenchymal compartment. Different mechanisms explain the augmentation of periodontitis risk and worsening of therapy outcomes in smokers: decrease in capillaries proportion, further restriction of nutrients and oxygen supply, waste products accumulation, extra alterations in the mesenchymal-inflammatory axis, altered gene expression, and biofilm dysbiosis.…”

Confounding in observational studies evaluating the association between Alzheimer's disease and periodontal disease: A systematic review

“…Smoking, for instance, is a variable with several dimensions, including type, frequency, duration, metabolization, and damage susceptibility. However, observational studies usually categorize smoking as current, former, or never-smoking, thus, neglecting the several dimensions of such a confounder [ 22 ]. Lack of proper measure refers to the use of information that may not be valid to accurately assess the potential confounder, such as self-reported information on health conditions.…”