Effect of Periodontal Maintenance Therapy on Tooth Loss in Regular and Irregular Compliant Smokers and Non-Smokers: A Cohort Retrospective Analysis With a Follow-up Up to 40 Years

Periodontal diseases are infections cause by dental plaque (Socransky, 1970). Risk factors are present which modify the course of disease progression. One of these risk factors is tobacco smoking, which was first evaluated by Pindborg in 1947 and later by Grossi et al. in 1995. They found that tobacco smoking was strongly associated with attachment loss, bone loss, and lastly, tooth loss. Tooth loss in one of the most visible results of periodontal disease, which negatively affects physiological and psychological patient's life. The effects of cigarette smoking on periodontal status are independent of the plaque index and oral hygiene of the patient, due to the direct influence of tobacco on periodontal tissues.

Several studies have demonstrated the effectiveness of periodontal therapy in reducing the rate of tooth loss as well as the importance of patient compliance with periodontal maintenance therapy and adequate oral hygiene practice in achieving this reduction. Compliance is the main problem faced in periodontal maintenance therapy. Low rates of compliance and patient adherence to a maintenance program was reported in the literature. Periodontal maintenance therapy can be considered a critical factor for success in controlling periodontitis and in the long-term maintenance of teeth. In addition, neglecting a regular periodontal maintenance therapy program has been associated with increased risk of reinfection and progression of periodontitis, as well as increased tooth loss. The establishment of a criteria for time interval between different supportive periodontal maintenance visits, is still controversial.

Smokers are associated with low level of compliance to prevent being constantly reminded of quitting smoking as well as the health complications associated with the habit. There is a void in the literature addressing the direct influence of compliance and adherence in periodontal maintenance therapy and its contribution to arrest periodontitis progression, minimizing tooth loss, specifically in tobacco smoking patients, whether they are regular or irregular compliant with a long term follow-up up to 40 years. On the other hand, there is moderate scientific evidence that the independent effect of smoking is associated with the occurrence of tooth loss in individuals undergoing periodontal maintenance therapy. Lastly, only very few studies reported the specific outcome of periodontal maintenance therapy on tooth loss in regular and irregular compliant smokers compared to regular and irregular compliant non-smokers.

The focused question in this study is "Does periodontal maintenance therapy affect annual tooth loss rates differently in regular and irregular compliant smokers and non-smokers?".