Periodontal treatment ineffective for heavy smokers with severe periodontitis, study finds

The study was conducted at Aarhus University and involved 80 smokers with periodontitis who were offered an individualised voluntary smoking cessation programme and underwent periodontal therapy. According to their smoking patterns, the participants were categorised as light smokers or quitters (i.e. those who quit during the study), moderate smokers and heavy smokers. The researchers then observed their periodontal healing for 12 months with regard to clinical periodontal parameters such as clinical attachment level, periodontal pocket depth and bleeding on probing, and they provided supportive periodontal care every three months.

The researchers noted that heavy smokers began the study with a higher average clinical attachment level of 1.1 mm and ten more sites with severe periodontitis compared with light smokers or quitters. They stated that light smokers or quitters and moderate smokers obtained an average reduction of 0.6 mm in periodontal pocket depths and an average gain of 0.7 mm in clinical attachment levels, respectively, whereas heavy smokers experienced a 0.5 mm attachment loss.

The findings show that heavy smokers with the most severe forms of inflammation did not benefit from the treatment and that the periodontal parameters of heavy smokers with moderate periodontitis only improved by 50% compared with those who smoked less.

“To our surprise, we could see that the disease had actually grown worse in some parameters in the hardest-hit group, despite the fact that this particular group had received the most extensive, individually designed treatment,” co-author Julie Pajaniaye, a dental hygienist and teaching assistant professor in the Department of Dentistry and Oral Health at the university, said in a press release.

Severe periodontal disease is estimated to affect around 19% of the global adult population, representing more than one billion cases, the World Health Organization reports. According to the Danish Health Authority, around 18% of Danes smoked tobacco daily or occasionally in 2020.

Dentists and dental hygienists may or may not refer patients to smoking cessation programmes as part of periodontitis treatment. In light of the study findings, Pajaniaye believes that taking steps towards smoking cessation is essential for improving patients’ response to periodontal treatment and thus such counselling must form part of therapy.

“This is completely new knowledge for the country’s dental clinics, and it should be taken into account when treatment is being planned for the individual patients,” she commented. “As a heavy smoker with periodontitis, it is very important to understand that working towards stopping smoking is a crucial step in the effective treatment of the disease,” she concluded.

The study, titled “Effect of smoking exposure on nonsurgical periodontal therapy: 1-year follow-up”, was published online on 4 November 2022 in the Journal of Dental Research ahead of inclusion in an issue.