Effect of smoking cessation on periodontal parameters. A systematic review and meta-analysis
Al Jasser, Reham N.
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Objectives: To systematically review the effect of smoking cessation on periodontal parameters. Methods: PubMed, Medline, Embase, and Cochrane CENTRAL databases were searched without language limitation in language and publication status (date of most recent search 30 August 2014). References of relevant articles were also hand searched. Clinical trials and cohort studies with any length of follow-up were included. Primary outcome was clinical attachment level. Secondary outcomes were probing depth, bleeding on probing, alveolar bone loss, tooth loss, pain, microbiome, and biomarkers relevant to periodontal health. Study selection and data extraction were performed independently by two reviewers (RAJ) and (MT). Data synthesis was qualitative due to significant heterogeneity in methods and results of the included studies except for 2 clinical trials, which assessed the effect of smoking cessation as an adjunct to non-surgical periodontal treatment. We performed a meta-analysis of these two trials using a random-effects model. Results: The initial search identified 394 studies. Of those, 20 potentially relevant studies were selected by screening titles and abstracts (κ=0.81 for inter-examiner agreement). After full-text review, 12 studies (7 clinical trials and 5 cohort studies), involving a total of 1,319 subjects (566 quitters and 753 non-quitters) met the inclusion criteria and were included in the systematic review. Sample sizes ranged from 19 to 810 and the follow-up time ranged from 3 weeks to 36 years. In long-term studies (1-36 years), smoking cessation seemed to: 1) slow clinical attachment, alveolar bone, and tooth loss; and 2) contribute to additional reductions in probing depth and putative periodontal pathogens in subjects receiving nonsurgical periodontal treatment. In short- term studies (3 weeks-6 weeks), smoking cessation seemed to increase inflammatory biomarkers and associated signs and symptoms such as bleeding on probing and pain. Meta-analysis revealed that smoking cessation had no significant effects on dental plaque, BOP, PD reduction, and CAL gain at 3, 6, and 12 months. Quitters had, on average, 0.12 mm more PD reduction but gained 0.12 mm less attachment than non- quitters at 12 months. In subgroup analysis restricted to diseased sites (PD ≥ 4mm), the difference in PD reduction between quitters and non-quitters increased to 0.31 mm, but did not reach statistical significance. Conclusion: The current available evidence on the effect of smoking cessation on periodontal health is limited. Considering their limitations, long-term studies suggest that smoking cessation decreases periodontal destruction, while short-term studies suggest an increase in inflammatory markers. Larger and well-designed clinical trials or cohort studies are required to determine the strength of association between smoking cessation and periodontal parameters.