Limited information on the effects of smoking cessation on clinical outcomes following periodontal therapy

Smoking is a known risk factor for periodontal disease. The aim of this study was to conduct an individual patient data meta-analysis to assess the effect of smoking cessation (SC) on clinical outcomes following the non-surgical periodontal treatment in patients with chronic periodontitis.

The Medline, Embase , CENTRAL and the OpenGray databases were searched for prospective cohort studies of at least 6 months duration. Reference lists of identified articles were also checked.

Articles were screened and data extracted independently and quality assessed using the Newcastle– Ottawa scale (NOS scale). The primary outcomes considered were clinical attachment level (CAL) and probing depth (PD). With plaque score, bleeding on probing, radiographic changes of the alveolar bone level, and number of teeth lost considered as secondary outcomes.

• Two studies with a total of 78 patients were included.  Both studies were considered to be of high quality
•  Smoking cessation seems to promote additional beneficial effects in reducing probing depths (PD) and improving attachment level following non-surgical periodontal treatment.

The authors concluded

….  only limited information on the effects of smoking cessation on clinical outcomes following periodontal therapy is available in the current base of evidence. Overall, it is reasonable to conclude that smoking cessation is an important component of periodontal therapy, and smokers should be encouraged to quit as part of their overall periodontal management.

Comment

A similar review has also just been published by  Fiorini et al, the aim of that review was to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy.  That review (only the abstract of which was available to the Dental Elf) also searched for prospective studies but only in the Medline and Embase databases. Fiorini  included 5 studies which were too heterogeneous to perform a meta-analysis. They also concluded, based on limited evidence that

smoking cessation seems to have a positive impact on periodontitis occurrence and periodontal healing.

A number of other reviews have also looked at smoking and periodontal outcomes and some of these are included in the links below.

Links

Chambrone L, Preshaw PM, Rosa EF, Heasman PA, Romito GA, Pannuti CM, Tu YK. Effects of smoking cessation on the outcomes of non-surgical periodontal therapy: a systematic review and individual patient data meta-analysis. J Clin Periodontol. 2013 Mar 27. doi: 10.1111/jcpe.12106. [Epub ahead of print] PubMed PMID: 23590649.

Fiorini T, Musskopf ML, Oppermann RV, Susin C. Is There a Positive Effect of Smoking Cessation on Periodontal Health? A Systematic Review. J Periodontol. 2013 Apr 19. [Epub ahead of print] PubMed PMID: 23600995.

Javed F, Al-Rasheed A, Almas K, Romanos GE, Al-Hezaimi K. Effect of cigarette  smoking on the clinical outcomes of periodontal surgical procedures. Am J Med Sci. 2012 Jan;343(1):78-84. doi: 10.1097/MAJ.0b013e318228283b. Review. PubMed PMID: 21804361.

Patel RA, Wilson RF, Palmer RM. The effect of smoking on periodontal bone regeneration: a systematic review and meta-analysis. J Periodontol. 2012 Feb;83(2):143-55. doi: 10.1902/jop.2011.110130. Epub 2011 May 31. Review. PubMed  PMID: 21627463.

Chambrone L, Chambrone D, Pustiglioni FE, Chambrone LA, Lima LA. The influence of tobacco smoking on the outcomes achieved by root-coverage procedures: a systematic review. J Am Dent Assoc. 2009 Mar;140(3):294-306. Review. PubMed PMID: 19255173.

Bergström J. Periodontitis and smoking: an evidence-based appraisal. J Evid Based Dent Pract. 2006 Mar;6(1):33-41. Review. PubMed PMID: 17138394.

Labriola A, Needleman I, Moles DR. Systematic review of the effect of smoking  on nonsurgical periodontal therapy. Periodontol 2000. 2005;37:124-37. Review. PubMed PMID: 15655029.