REVIEW PAPER
 
KEYWORDS
TOPICS
ABSTRACT
Smoking is considered as the major environmental risk factor for periodontal diseases. Smokers have a higher risk for severe periodontitis with more periodontal tissue destruction, more gingival recession, and more susceptibility for tooth loss. The aim of this narrative review is to provide up-to-date evidence on the clinical outcomes of periodontal treatment in smokers. Electronic databases were searched for studies that compare the clinical outcomes in smokers and nonsmokers following non-surgical and surgical periodontal treatment modalities and also during the supportive periodontal treatment. Clinical studies published before May 2021 were included in the review. Smokers have a higher risk for recurrence of periodontal disease and the response to non-surgical as well as surgical periodontal treatment is not as good as that of non-smokers. Moreover, there is a dose-response effect in the adverse effects of smoking on periodontal health. Compared to non-smokers, smoker patients with periodontitis tend to respond less favorably to non-surgical and surgical periodontal treatment, and exhibit recurrence more frequently during supportive periodontal treatment. Along with the periodontal treatment, smokers may be encouraged to quit. Long follow-up and the communication between the dentist and the patient give a great opportunity for such counseling.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
There was no source of funding for this study.
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval and informed consent were not required as this is a review of existing literature.
DATA AVAILABILITY
The data supporting this study are available from the authors on reasonable request.
AUTHORS' CONTRIBUTIONS
NB provided primary oversight to the organization of the review, as well as specific sections on periodontal treatment. MK and BK provided the content for the review.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
REFERENCES (58)
1.
Loos BG, Needleman I. Endpoints of active periodontal therapy. J Clin Periodontol. 2020;47(Suppl 22):61-71. doi:10.1111/jcpe.13253
 
2.
Papapanou PN, Sanz M, Buduneli N, et al. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol. 2018;89 Suppl 1:S173-S182. doi:10.1002/JPER.17-0721
 
3.
Montero E, La Rosa M, Montanya E, et al. Validation of self-reported measures of periodontitis in a Spanish Population. J Periodontal Res. 2020;55(3):400-409. doi:10.1111/jre.12724
 
4.
Vouros ID, Kalpidis CD, Chadjipantelis T, Konstantinidis AB. Cigarette smoking associated with advanced periodontal destruction in a Greek sample population of patients with periodontal disease. J Int Acad Periodontol. 2009;11(4):250-257. Accessed May 30, 2021. https://pubmed.ncbi.nlm.nih.go...
 
5.
Kanmaz B, Lamont G, Danacı G, Gogeneni H, Buduneli N, Scott DA. Microbiological and biochemical findings in relation to clinical periodontal status in active smokers, non-smokers and passive smokers. Tob Induc Dis. 2019;17(March). doi:10.18332/tid/104492
 
6.
Ah MK, Johnson GK, Kaldahl WB, Patil KD, Kalkwarf KL. The effect of smoking on the response to periodontal therapy. J Clin Periodontol. 1994;21(2):91-97. doi:10.1111/j.1600-051x.1994.tb00285.x
 
7.
Boström L, Linder LE, Bergström J. Influence of smoking on the outcome of periodontal surgery. A 5-year follow-up. J Clin Periodontol. 1998;25(3):194-201. doi:10.1111/j.1600-051x.1998.tb02428.x
 
8.
D'Aiuto F, Ready D, Parkar M, Tonetti MS. Relative contribution of patient-, tooth-, and site-associated variability on the clinical outcomes of subgingival debridement. I. Probing depths. J Periodontol. 2005;76(3):398-405. doi:10.1902/jop.2005.76.3.398
 
9.
Kaval B, Renaud DE, Scott DA, Buduneli N. The role of smoking and gingival crevicular fluid markers on coronally advanced flap outcomes. J Periodontol. 2014;85(3):395-405. doi:10.1902/jop.2013.120685
 
10.
Preshaw PM, Holliday R, Law H, Heasman PA. Outcomes of non-surgical periodontal treatment by dental hygienists in training: impact of site- and patient-level factors. Int J Dent Hyg. 2013;11(4):273-279. doi:10.1111/idh.12032
 
11.
van der Weijden GA, de Slegte C, Timmerman MF, van der Velden U. Periodontitis in smokers and non-smokers: intra-oral distribution of pockets. J Clin Periodontol. 2001;28(10):955-960. doi:10.1034/j.1600-051x.2001.028010955.x
 
12.
Ardais R, Mário Tde G, Boligon J, Kantorski KZ, Moreira CH. The effect of smoking on bleeding on probing after nonsurgical periodontal therapy: a quasi-experimental study. Braz Oral Res. 2014;28:1-7. doi:10.1590/1807-3107bor-2014.vol28.0058
 
13.
Eltas A, Orbak R. Clinical effects of Nd:YAG laser applications during nonsurgical periodontal treatment in smoking and nonsmoking patients with chronic periodontitis. Photomed Laser Surg. 2012;30(7):360-366. doi:10.1089/pho.2011.3184
 
14.
Jin L, Wong KY, Leung WK, Corbet EF. Comparison of treatment response patterns following scaling and root planing in smokers and non-smokers with untreated adult periodontitis. J Clin Dent. 2000;11(2):35-41. Accessed May 30, 2021. https://pubmed.ncbi.nlm.nih.go...
 
15.
Türkoğlu O, Eren G, Emingil G, Azarsız E, Kutukculer N, Atilla G. Does smoking affect gingival crevicular fluid LL-37 levels following non-surgical periodontal treatment in chronic periodontitis? Arch Oral Biol. 2016;61:98-105. doi:10.1016/j.archoralbio.2015.10.018
 
16.
Kanmaz B, Lappin DF, Nile CJ, Buduneli N. Effects of smoking on non-surgical periodontal therapy in patients with periodontitis Stage III or IV, and Grade C. J Periodontol. 2020;91(4):442-453. doi:10.1002/JPER.19-0141
 
17.
AlAhmari F, Ahmed HB, Al-Kheraif AA, Javed F, Akram Z. Effectiveness of scaling and root planning with and without adjunct antimicrobial photodynamic therapy in the treatment of chronic periodontitis among cigarette-smokers and never-smokers: A randomized controlled clinical trial. Photodiagnosis Photodyn Ther. 2019;25:247-252. doi:10.1016/j.pdpdt.2019.01.006
 
18.
ALHarthi SS, BinShabaib M, Akram Z, Rahman I, Romanos GE, Javed F. Impact of cigarette smoking and vaping on the outcome of full-mouth ultrasonic scaling among patients with gingival inflammation: a prospective study. Clin Oral Investig. 2019;23(6):2751-2758. doi:10.1007/s00784-018-2725-2
 
19.
Kwok V, Caton JG. Commentary: prognosis revisited: a system for assigning periodontal prognosis. J Periodontol. 2007;78(11):2063-2071. doi:10.1902/jop.2007.070210
 
20.
Yamamoto Y, Nishida N, Tanaka M, et al. Association between passive and active smoking evaluated by salivary cotinine and periodontitis. J Clin Periodontol. 2005;32(10):1041-1046. doi:10.1111/j.1600-051X.2005.00819.x
 
21.
Etzel RA. A review of the use of saliva cotinine as a marker of tobacco smoke exposure. Prev Med. 1990;19(2):190-197. doi:10.1016/0091-7435(90)90020-k
 
22.
Graziani F, Karapetsa D, Alonso B, Herrera D. Nonsurgical and surgical treatment of periodontitis: how many options for one disease? Periodontol 2000. 2017;75(1):152-188. doi:10.1111/prd.12201
 
23.
Hong DGK, Oh JH. Recent advances in dental implants. Maxillofac Plast Reconstr Surg. 2017;39(1):33. doi:10.1186/s40902-017-0132-2
 
24.
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;343(1):78-84. doi:10.1097/MAJ.0b013e318228283b
 
25.
Kotsakis GA, Javed F, Hinrichs JE, Karoussis IK, Romanos GE. Impact of cigarette smoking on clinical outcomes of periodontal flap surgical procedures: a systematic review and meta-analysis. J Periodontol. 2015;86(2):254-263. doi:10.1902/jop.2014.140452
 
26.
Preber H, Bergström J. Effect of cigarette smoking on periodontal healing following surgical therapy. J Clin Periodontol. 1990;17(5):324-328. doi:10.1111/j.1600-051x.1990.tb01098.x
 
27.
Kaldahl WB, Johnson GK, Patil KD, Kalkwarf KL. Levels of cigarette consumption and response to periodontal therapy. J Periodontol. 1996;67(7):675-681. doi:10.1902/jop.1996.67.7.675
 
28.
Scabbia A, Cho KS, Sigurdsson TJ, Kim CK, Trombelli L. Cigarette smoking negatively affects healing response following flap debridement surgery. J Periodontol. 2001;72(1):43-49. doi:10.1902/jop.2001.72.1.43
 
29.
Trombelli L, Cho KS, Kim CK, Scapoli C, Scabbia A. Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers. A controlled clinical trial. J Clin Periodontol. 2003;30(1):81-87. doi:10.1034/j.1600-051x.2003.10182.x
 
30.
Orbak R, Erciyas K, Kaya H. Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in smokers and non-smokers with chronic periodontitis. Int Dent J. 2003;53(3):159-164. doi:10.1111/j.1875-595x.2003.tb00741.x
 
31.
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;140(3):294-306. doi:10.14219/jada.archive.2009.0158
 
32.
Silva CO, Ribeiro Edel P, Sallum AW, Tatakis DN. Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers. J Periodontol. 2010;81(5):692-701. doi:10.1902/jop.2010.090381
 
33.
Tawfik Diab AY, El-Destawy MT, Mandour HM. Efficacy of free gingival graft in treatment of localized gingival recession in smokers and non-smokers: Donor site healing, graft shrinkage and success. Al-Azhar Journal of Dental Science. 2020;23(4):401-407. doi:10.21608/ajdsm.2020.26633.1047
 
34.
Zucchelli G, Tavelli L, Ravidà A, Stefanini M, Suárez-López Del Amo F, Wang HL. Influence of tooth location on coronally advanced flap procedures for root coverage. J Periodontol. 2018;89(12):1428-1441. doi:10.1002/JPER.18-0201
 
35.
Yadav AP, Kulloli A, Shetty S, Ligade SS, Martande SS, Gholkar MJ. Sub-epithelial connective tissue graft for the management of Miller's class I and class II isolated gingival recession defect: A systematic review of the factors influencing the outcome. J Investig Clin Dent. 2018;9(3):e12325. doi:10.1111/jicd.12325
 
36.
Cortellini P, Tonetti MS. Clinical concepts for regenerative therapy in intrabony defects. Periodontol 2000. 2015;68(1):282-307. doi:10.1111/prd.12048
 
37.
Trombelli L, Kim CK, Zimmerman GJ, Wikesjö UM. Retrospective analysis of factors related to clinical outcome of guided tissue regeneration procedures in intrabony defects. J Clin Periodontol. 1997;24(6):366-371. doi:10.1111/j.1600-051x.1997.tb00199.x
 
38.
Luepke PG, Mellonig JT, Brunsvold MA. A clinical evaluation of a bioresorbable barrier with and without decalcified freeze-dried bone allograft in the treatment of molar furcations. J Clin Periodontol. 1997;24(6):440-446. doi:10.1111/j.1600-051x.1997.tb00209.x
 
39.
Trombelli L, Bottega S, Zucchelli G. Supracrestal soft tissue preservation with enamel matrix proteins in treatment of deep intrabony defects. J Clin Periodontol. 2002;29(5):433-439. doi:10.1034/j.1600-051x.2002.290508.x
 
40.
Loos BG, Louwerse PH, Van Winkelhoff AJ, et al. Use of barrier membranes and systemic antibiotics in the treatment of intraosseous defects. J Clin Periodontol. 2002;29(10):910-921. doi:10.1034/j.1600-051x.2002.291006.x
 
41.
Patel RA, Wilson RF, Palmer RM. The effect of smoking on periodontal bone regeneration: a systematic review and meta-analysis. J Periodontol. 2012;83(2):143-155. doi:10.1902/jop.2011.110130
 
42.
Reynolds MA, Kao RT, Camargo PM, et al. Periodontal regeneration - intrabony defects: a consensus report from the AAP Regeneration Workshop. J Periodontol. 2015;86(2 Suppl):S105-S107. doi:10.1902/jop.2015.140378
 
43.
Liaw K, Delfini RH, Abrahams JJ. Dental Implant Complications. Semin Ultrasound CT MR. 2015;36(5):427-433. doi:10.1053/j.sult.2015.09.007
 
44.
Strietzel FP, Reichart PA, Kale A, Kulkarni M, Wegner B, Küchler I. Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis. J Clin Periodontol. 2007;34(6):523-544. doi:10.1111/j.1600-051X.2007.01083.x
 
45.
Bahrami G, Vaeth M, Kirkevang LL, Wenzel A, Isidor F. The impact of smoking on marginal bone loss in a 10-year prospective longitudinal study. Community Dent Oral Epidemiol. 2017;45(1):59-65. doi:10.1111/cdoe.12260
 
46.
Nazeer J, Singh R, Suri P, et al. Evaluation of marginal bone loss around dental implants in cigarette smokers and nonsmokers. A comparative study. J Family Med Prim Care. 2020;9(2):729-734. doi:10.4103/jfmpc.jfmpc_1023_19
 
47.
Naseri R, Yaghini J, Feizi A. Levels of smoking and dental implants failure: A systematic review and meta-analysis. J Clin Periodontol. 2020;47(4):518-528. doi:10.1111/jcpe.13257
 
48.
Twito D, Sade P. The effect of cigarette smoking habits on the outcome of dental implant treatment. PeerJ. 2014;2:e546. doi:10.7717/peerj.546
 
49.
Javed F, Rahman I, Romanos GE. Tobacco-product usage as a risk factor for dental implants. Periodontol 2000. 2019;81(1):48-56. doi:10.1111/prd.12282
 
50.
Lindhe J, Nyman S. The effect of plaque control and surgical pocket elimination on the establishment and maintenance of periodontal health. A longitudinal study of periodontal therapy in cases of advanced disease. J Clin Periodontol. 1975;2(2):67-79. doi:10.1111/j.1600-051x.1975.tb01727.x
 
51.
Tan AE. Periodontal maintenance. Aust Dent J. 2009;54(s1):S110-S117. doi:10.1111/j.1834-7819.2009.01149.x
 
52.
Jansson L, Lavstedt S. Influence of smoking on marginal bone loss and tooth loss--a prospective study over 20 years. J Clin Periodontol. 2002;29(8):750-756. doi:10.1034/j.1600-051x.2002.290812.x
 
53.
Hanioka T, Ojima M, Tanaka K, Aoyama H. Relationship between smoking status and tooth loss: findings from national databases in Japan. J Epidemiol. 2007;17(4):125-132. doi:10.2188/jea.17.125
 
54.
Matuliene G, Pjetursson BE, Salvi GE, et al. Influence of residual pockets on progression of periodontitis and tooth loss: results after 11 years of maintenance. J Clin Periodontol. 2008;35(8):685-695. doi:10.1111/j.1600-051X.2008.01245.x
 
55.
Krall EA, Dietrich T, Nunn ME, Garcia RI. Risk of tooth loss after cigarette smoking cessation. Prev Chronic Dis. 2006;3(4). Accessed May 30, 2021. http://www.cdc.gov/pcd/issues/...
 
56.
Pretzl B, El Sayed S, Weber D, Eickholz P, Bäumer A. Tooth loss in periodontally compromised patients: Results 20 years after active periodontal therapy. J Clin Periodontol. 2018;45(11):1356-1364. doi:10.1111/jcpe.13010
 
57.
Helal O, Göstemeyer G, Krois J, et al. Predictors for tooth loss in periodontitis patients: Systematic review and meta-analysis. J Clin Periodontol. 2019;46(7):699-712. doi:10.1111/jcpe.13118
 
58.
Trombelli L, Simonelli A, Franceschetti G, Maietti E, Farina R. What periodontal recall interval is supported by evidence? Periodontol 2000. 2020;84(1):124-133. doi:10.1111/prd.12340
 
 
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