Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil.
Int Endod J. 2020 Aug;53(8):1068-1083. doi: 10.1111/iej.13316. Epub 2020 Jun 1.
Controversial findings exist in the literature regarding the association between tobacco smoking and development of apical periodontitis or need for root canal treatment, with some studies reporting an increase in the prevalence of these outcomes in smokers, whilst others reporting no association.
To evaluate if there is scientific evidence to support an association between tobacco smoking and a greater prevalence of apical periodontitis and/or root canal treatments.
A systematic search was performed using MeSH terms and free terms in the PubMed, Scopus, Virtual Health Library (VHL), Cochrane library and Open Gray databases.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS: Observational studies that evaluated the association between smoking and the development or healing of periapical lesion and/or the prevalence of root canal treatment in humans were included.
A quality assessment of included studies was performed, and the relevant information and findings were evaluated. A meta-analysis using nine included studies was performed through RevMan software, and the certainty of evidence was evaluated through GRADE.
Fifteen studies were included, of which 10 were classified as low risk of bias, 4 were considered as moderate risk of bias and 1 as high risk of bias. Ten studies reported that smoking was associated with a greater prevalence of periapical periodontitis and/or root canal treatment. Five studies reported no association. Nine studies were included in the pooled meta-analysis, comprising two subgroups: apical periodontitis and root canal treatment. From these nine studies, eight studies were included in the apical periodontitis subgroup meta-analysis and demonstrated that this condition was significantly more prevalent in smokers when compared to the nonsmokers (odds ratio = 2.78[CI: 1.60, 4.85], P < 0.001; I = 79%; no adjusted odds ratio). Three studies were included in the root canal treatment subgroup meta-analysis and demonstrated an increased prevalence in smokers when compared to the nonsmokers (odds ratio = 2.73 [CI: 1.06, 2.83], P < 0.001; I = 72%; no adjusted odds ratio). The pooled meta-analysis demonstrated that smokers had twice the chance of having apical periodontitis and/or root canal treatment when compared to nonsmokers (odds ratio of 2.42 [CI: 1.59, 3.68], P < 0.01; I = 85%). The GRADE analysis demonstrated moderate certainty of evidence.
Several confounding factors were identified such as misinformation regarding the period of time subjects had smoked, as well as the frequency of smoking and the number of cigarettes consumed. No adjustment in odds ratio data for confounding was performed.
This systematic review and meta-analysis indicate that tobacco smokers have an increased prevalence of periapical periodontitis and root canal treatments with moderate certainty of evidence.
关于吸烟与根尖周炎或根管治疗需求之间的关联，文献中存在争议的发现，一些研究报告吸烟者中这些结果的患病率增加，而其他研究则没有报告关联。
评估是否有科学证据支持吸烟与根尖周炎和/或根管治疗患病率增加之间存在关联。
使用 MeSH 术语和 PubMed、Scopus、虚拟健康图书馆 (VHL)、考科蓝图书馆和 Open Gray 数据库中的自由词进行了系统搜索。
研究入选标准、参与者和干预措施：纳入评估吸烟与人类根尖周病变和/或根管治疗发展或愈合之间关联的观察性研究。
对纳入的研究进行了质量评估，并评估了相关信息和发现。使用 RevMan 软件对 9 项纳入研究进行了荟萃分析，并通过 GRADE 评估证据确定性。
纳入了 15 项研究，其中 10 项被归类为低偏倚风险，4 项被认为是中度偏倚风险，1 项为高偏倚风险。10 项研究报告吸烟与根尖周炎和/或根管治疗的患病率增加有关。5 项研究报告没有关联。9 项研究纳入了荟萃分析，包括 2 个亚组：根尖周炎和根管治疗。这 9 项研究中，有 8 项纳入了根尖周炎亚组荟萃分析，结果表明吸烟者的根尖周炎患病率明显高于非吸烟者（比值比=2.78[95%CI：1.60，4.85]，P<0.001；I²=79%；未调整比值比）。3 项研究纳入了根管治疗亚组荟萃分析，结果表明吸烟者的患病率高于非吸烟者（比值比=2.73[95%CI：1.06，2.83]，P<0.001；I²=72%；未调整比值比）。荟萃分析表明，吸烟者发生根尖周炎和/或根管治疗的可能性是不吸烟者的两倍（比值比为 2.42[95%CI：1.59，3.68]，P<0.01；I²=85%）。GRADE 分析表明证据确定性为中等。
确定了几个混杂因素，例如关于受试者吸烟时间、吸烟频率和吸烟量的信息有误。未对混杂因素进行比值比数据调整。
本系统评价和荟萃分析表明，吸烟者根尖周炎和根管治疗的患病率增加，证据确定性为中等。
