Resumen de Is There a Positive Effect of Smoking Cessation on Periodontal Health? A Systematic Review
Background: Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy.
Methods: Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole-paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking-cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow-up was required for inclusion.
Results: Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta-analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) =3 mm during a 6-year period was approximately three times higher among smokers than quitters (P <0.001). Two studies (10 and 20 years of follow-up) observed a decrease in radiographic bone loss of �30% among quitters when compared with smokers. Among individuals receiving non-surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P <0.05) than non-quitters/oscillators. No differences in AL were observed.
Conclusion: Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.
Tobacco use is an important risk factor for several diseases, including different types of cancer, respiratory infections, and cardiovascular diseases.1 According to the World Health Organization, tobacco is associated with �6 million deaths each year,2 and the cost related to its use approaches $200 billion per year in the United States alone.3 The detrimental effects of tobacco on oral health have also been investigated extensively. Smokers have higher risk for precancerous lesions and oral cancer,4,5 periodontal disease,6 tooth loss,7,8 and oral implant failure.9,10 Smoking is a well-established independent risk factor for periodontitis.11,12 There is also recent evidence that smoking may interact with other factors, including genetics13 and diabetes,14 to potentiate periodontal breakdown.15,16 Smoking not only increases disease occurrence, but it also impairs periodontal treatment.17,18 There is a wealth of evidence showing that tobacco smoking favors the establishment of a pathogenic microflora, decreases immune host response, and increases the release of proinflammatory mediators.19,20 Nevertheless, these mechanisms have not been fully explored.21,22 Smoking-cessation initiatives have reduced smoking-related morbidity and mortality, representing a cost-effective health promotion initiative.23,24 In this context, it has been suggested that smoking-cessation programs could help prevent a large proportion of new cases of periodontitis in several populations. Estimates suggest that smoking could be responsible for approximately half of the cases of periodontitis in the United States25,26 and one-third in Australia.27 Susin et al.28 projected that smoking cessation could prevent up to 90,000 cases of severe periodontitis in an urban population in southern Brazil. Hujoel et al.29 estimated that severe periodontitis incidence decreased 31% from 1955 to 2000, attributable to a decrease in the number of smokers in the United States population. These estimates underscore the great positive effect that smoking cessation might have on periodontal health. Indirect evidence supports this contention because epidemiologic studies25,26 have observed a lower likelihood of periodontitis among former versus current smokers.
Despite the strong evidence supporting the detrimental effect of smoking on periodontal health and the potential benefit of smoking cessation on periodontitis incidence, few studies have evaluated the effect of smoking cessation on periodontal health. The aim of the present systematic review is to assess the effect of smoking cessation on periodontitis incidence, progression, and response to treatment.
