Vieira Thais Ribeiral, Martins Carolina Castro, Cyrino Renata Magalhães, Azevedo Andrea Mara Oliveira, Cota Luís Otávio Miranda, Costa Fernando Oliveira
Faculdade de Odontologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brasil.
Cad Saude Publica. 2018 Sep 21;34(9):e00024918. doi: 10.1590/0102-311X00024918.
Dental mortality has been reported by longitudinal studies on periodontal maintenance therapy (PMT), but the independent effect of smoking on tooth loss (TL), adjusted for important confounding variables, has been poorly evaluated. This systematic review aimed to assess and analyze the isolated effect of smoking TL among individuals undergoing PMT. Electronic, manual, grey literature, and recent articles (from April 2018) were searched, with no restriction regarding language; respective dates of publication were included. Epidemiological clinical studies reporting TL data among smokers undergoing PMT in comparison to nonsmoker control groups were selected. Methodological quality was assessed using the Newcastle-Ottawa Scale. Meta-analysis was performed, as well as I2 heterogeneity and sensitivity tests. Evidence quality was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Eleven papers were included in the systematic review: four case-control and seven cohort studies. Ten out of the 11 studies concluded that smoking was an important risk factor for the occurrence of TL. Meta-analysis of four of the cohort studies found that smokers had 3.24 times the chance of occurrence of TL than nonsmokers undergoing PMT (95%CI: 1.33-7.90). Overall, studies' risk of bias was low. The quality of the scientific evidence moderately supports that smokers undergoing PMT have a greater chance of TL than nonsmokers.
纵向牙周维护治疗（PMT）研究报告了牙齿死亡率，但在对重要混杂变量进行校正后，吸烟对牙齿脱落（TL）的独立影响尚未得到充分评估。本系统评价旨在评估和分析接受PMT的个体中吸烟对TL的单独影响。检索了电子、手工、灰色文献和近期文章（自2018年4月起），无语言限制；纳入了各自的发表日期。选择了报告接受PMT的吸烟者与非吸烟者对照组之间TL数据的流行病学临床研究。使用纽卡斯尔-渥太华量表评估方法学质量。进行了荟萃分析以及I²异质性和敏感性检验。使用GRADE（推荐分级、评估、制定和评价）评估证据质量。系统评价纳入了11篇论文：4篇病例对照研究和7篇队列研究。11项研究中有10项得出结论，吸烟是TL发生的重要危险因素。对4项队列研究的荟萃分析发现，吸烟者发生TL的几率是接受PMT的非吸烟者的3.24倍（95%CI：1.33-7.90）。总体而言，研究的偏倚风险较低。科学证据的质量适度支持接受PMT的吸烟者比非吸烟者有更大的TL几率。
