Department of Endodontics, Case School of Dental Medicine, Cleveland, OH, USA.
American Board of Endodontics, 2123 Abington Road, A 280, Cleveland, OH, 44106, USA.
Clin Oral Investig. 2020 Feb;24(2):533-545. doi: 10.1007/s00784-019-03094-6. Epub 2019 Nov 26.
The purpose of this systematic review was to examine if, in adult patients, the absence or presence of smoking influenced the prevalence of periapical periodontitis (PP).
Databases were searched, and original research manuscripts up to June 2019 were identified by two reviewers. The Newcastle-Ottawa Scale (NOS) was used for risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used for certainty in the evidence. A meta-analysis was performed using RevMan 5 software. Risk ratio (RR) was used for the cohort studies, and odds ratio (OR) was used for the case-control studies with 95% confidence interval (CI).
All the studies had many covariates and confounding variables. Three longitudinal cohort articles discussed radiographic findings as they related to the prevalence of PP in root-filled teeth. The RR of smoking and the prevalence of PP was 2.11 (95% CI 0.88-5.05, p = 0.09). Nine case-control studies focused on the prevalence of PP and smoking. There was a positive association between smoking and the prevalence of PP with an OR of 2.78 and a 95% confidence interval of 2.23-3.48, with p value < 0.05. The quality of the studies was fair per NOS, and the certainty of the literature assessment was moderate per GRADE.
The current best available evidence suggests that smoking was associated with the prevalence of PP but more studies are needed to report this association in the longitudinal cohort studies.
Smoking has a positive association with the prevalence of PP.
本系统评价旨在研究成年患者中，吸烟状况（存在或不存在）是否会影响根尖周炎（PP）的患病率。
通过两位评审员检索数据库，确定截至 2019 年 6 月的原始研究手稿。采用纽卡斯尔-渥太华量表（NOS）评估偏倚风险。使用推荐分级、评估、制定与评价（GRADE）系统评估证据的确定性。使用 RevMan 5 软件进行荟萃分析。队列研究采用风险比（RR），病例对照研究采用比值比（OR），置信区间（CI）为 95%。
所有研究均存在许多协变量和混杂变量。三篇纵向队列文章讨论了与根充牙 PP 患病率相关的影像学发现。吸烟与 PP 患病率的 RR 为 2.11（95% CI 0.88-5.05，p=0.09）。九项病例对照研究主要关注 PP 和吸烟的患病率。吸烟与 PP 患病率之间存在正相关，OR 为 2.78，95% CI 为 2.23-3.48，p 值<0.05。按照 NOS 评估，研究质量为中等，按照 GRADE 评估，文献评估的确定性为中等。
现有最佳证据表明，吸烟与 PP 患病率之间存在关联，但仍需要更多的纵向队列研究来报告这种关联。
吸烟与 PP 的患病率呈正相关。
