Cigarette smoking and periodontal diseases: etiology and management of disease.
Cigarette smoking and periodontal diseases: etiology and management of disease.
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DOI：
10.1902/annals.1998.3.1.88
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发表时间：
1998-07
期刊：
影响因子：
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通讯作者：
M. Tonetti
中科院分区：
文献类型：
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作者：
M. Tonetti
长期以来，吸烟一直被怀疑与包括牙周病在内的多种口腔疾病有关。过去20年积累的实验证据表明，吸烟可能是牙周炎的真正危险因素。这种环境暴露与发生临床可检测的牙周炎的几率增加2- 3倍有关。与不吸烟者相比，吸烟者的牙周病患病率更高，程度更严重，牙齿脱落和蛀牙的患病率也更高。据报道，牙周病进展率的增加可能部分解释了牙周病破坏的更严重程度。吸烟的有害影响已被证明是剂量依赖的，在年轻人身上尤其明显；在这些受试者中，高达51%的观察到的牙周炎风险与吸烟有关。许多文献也表明，吸烟者患牙周炎对非手术、手术和再生牙周治疗的反应都不太好。在吸烟者中，种植牙的成功率也会受到影响。此外，长期研究指出，吸烟与牙周炎在牙周维护期间的复发有关；这种影响似乎是剂量依赖性的，重度吸烟者（每天吸烟10支左右）表现出更高水平的疾病进展。与现在的吸烟者相比，以前的吸烟者患牙周炎的风险水平较低，这一迹象被认为是最有力的证据，证明戒烟将改善牙周健康，戒烟咨询应成为牙周治疗和预防的一个组成部分。然而，到目前为止，尚无随机对照临床试验证实戒烟和/或减少吸烟对牙周结果的影响。鉴于目前对牙周益处的不确定性，但鉴于戒烟计划对患者的总体健康益处，从业人员正在将戒烟咨询作为牙周治疗的一个组成部分。此外，吸烟状况是评估个体受试者牙周风险的关键参数，因此可以做出基于证据的临床决策。
Cigarette smoking has long been suspected to be associated with a variety of oral conditions including periodontal diseases. Experimental evidence accumulated over the last 2 decades has indicated that cigarette smoking is probably a true risk factor for periodontitis. This environmental exposure has been associated with 2- to 3-fold increases in the odds of developing clinically detectable periodontitis. Smokers have both increased prevalence and more severe extent of periodontal disease, as well as higher prevalence of tooth loss and edentulism, compared to non-smokers. The greater severity of periodontal destruction may be partly accounted for by the reported increases in the rate of periodontal disease progression. The noxious effect of smoking has been shown to be dose dependent and to be particularly marked in younger individuals; in these subjects, up to 51% of the observed risk of periodontitis was associated with smoking. Much of the literature has also indicated that smokers affected with periodontitis respond less favorably to both non-surgical, surgical, and regenerative periodontal treatments. The success rate of dental implants has also been shown to be compromised in smokers. Furthermore, longterm studies have pointed out that smoking was associated with recurrence of periodontitis during periodontal maintenance; the effect appeared to be dose dependent, with heavy smokers (> 10 cigarettes/day) presenting with higher levels of disease progression. The indication that previous smokers have lower levels of risk for periodontitis compared to current smokers is considered to be the strongest available evidence that smoking cessation will result in improved periodontal health and that smoking cessation counseling should be an integral part of periodontal therapy and prevention. So far, however, no randomized controlled clinical trial establishing the effect of smoking cessation and/or reduction on the periodontal outcomes has been reported. Given the present state of uncertainty about the periodontal benefits, but in light of the established general health gains for the patient that could be derived from a smoking cessation program, practitioners are incorporating smoking cessation counseling as an integral part of periodontal therapy. Furthermore, smoking status represents a key parameter to assess the periodontal risk of an individual subject and therefore to make evidence-based clinical decisions.