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禁煙が歯周炎に与える影響．プロスペクティブな縦断的観察研究と介入研究のシステマティックレビューとメタアナリシス
Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies.
PMID: 30011036 DOI: 10.1093/ntr/nty147.
抄録
AIMS:
本システマティックレビューは、非喫煙者と比較して歯周炎リスクに対するタバコ禁煙の影響を推定し、非外科的歯周治療の臨床転帰に対するタバコ禁煙の影響を評価することを目的とした。
AIMS: This systematic review aimed to estimate the effect of tobacco smoking cessation on the risk for periodontitis compared to the risk among never-smokers and to evaluate the effect of tobacco smoking cessation on the clinical outcomes of nonsurgical periodontal treatment.
方法:
電子検索はPubMed、Scopus、Embaseで行った。検索戦略には MeSH と自由語を用いた：歯周炎、歯周病、喫煙、たばこ使用、たばこ、たばこ製品、たばこ、パイプ、葉巻。禁煙と歯周炎の発症または進行との関連を調査したプロスペクティブな縦断観察研究および介入研究の原著のみが含まれた。証拠を要約するためにメタアナリシスを実施した。
METHODS: Electronic searches were performed in PubMed, Scopus, and Embase. Search strategy included MeSH and free terms: periodontitis, periodontal diseases, smoking, tobacco use, tobacco, tobacco products, cigarette, pipe, and cigar. Only original prospective longitudinal observational and interventional studies that investigated the association between smoking cessation and periodontitis onset or progression were included. Meta-analyses were conducted to summarize the evidence.
結果:
電子検索では合計2743件の論文が同定されたが、そのうちメタ解析に含まれたのは6件のみであった。推定値をプールしたところ、禁煙者における歯周炎の発症または進行のリスクは、非喫煙者のリスクと有意差はなかった（リスク比[RR]=0.97；95％信頼区間[CI]=0.87％～1.08％）。喫煙者は、禁煙者（RR = 1.79；95％CI = 1.36％～2.35％）および非喫煙者（RR = 1.82；95％CI = 1.43％～2.31％）に比べて歯周炎のリスクが約80％高かった。歯周治療は、短期間（12-24ヵ月）の追跡調査の後、非喫煙者よりも禁煙者の方が最大0.2mm（95％ CI = -0.32％～-0.08％）高いアタッチメントレベルの増加とポケットの深さの0.32mm（95％ CI = 0.07％～0.52％）の余分な減少をもたらした。
RESULTS: A total of 2743 articles were identified in electronic searches; out of which only six were included in the meta-analysis. Pooled estimates showed that the risk of periodontitis incidence or progression among those who quit smoking was not significantly different from the risk for never-smokers (risk ratio [RR] = 0.97; 95% confidence interval [CI] = 0.87% to 1.08%). Smokers had approximately 80% higher risk of periodontitis than quitters (RR = 1.79; 95% CI = 1.36% to 2.35%) and never-smokers (RR = 1.82; 95% CI = 1.43% to 2.31%). Periodontal therapy resulted in up to 0.2 mm (95% CI = -0.32% to -0.08%) higher gain in attachment level and extra 0.32 mm (95% CI = 0.07% to 0.52%) reduction in pocket depth among quitters over nonquitters after short follow-up (12-24 months).
結論:
このトピックに関する研究はほとんどなかった。禁煙は歯周炎の発症と進行のリスクを減少させ、非外科的歯周治療の転帰を改善した。
CONCLUSIONS: Few studies on the topic were identified. Smoking cessation reduced the risk for periodontitis onset and progression, and improved the outcomes of nonsurgical periodontal therapy.
意義:
本レビューでは、歯周炎の発症・進行リスクに対する禁煙の影響を初めて定量的に示した。その結果、歯周炎のリスクは非喫煙者と同程度になり、非外科的歯周治療の転帰は禁煙後に改善することが示された。歯科専門家は歯周治療の関連要素として禁煙介入を検討すべきである。
IMPLICATIONS: This review provides the first quantitative evidence of the impact of smoking cessation on the risk for periodontitis onset and progression. The findings have demonstrated that the risk for periodontitis becomes comparable to that of never-smokers and that nonsurgical periodontal treatment outcomes improve after smoking cessation. Dental professionals ought to consider smoking cessation interventions as a relevant component of the periodontal therapy.
© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.