Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome

Aims: The aim of this study was to investigate the effects of smoking on the response to non-surgical treatment for aggressive periodontitis. Methods: Seventy-nine patients with generalized aggressive periodontitis were included in the study; 20 were smokers. All patients received a course of non-surgical periodontal therapy and outcomes assessed 10 weeks post-operatively. Non-responding patients were designated if they had 30% or more non-responding deep sites. Results: At baseline, bleeding scores were lower in smokers. There was no difference in baseline plaque, pocket depth (PD), recession or clinical attachment levels (CALs); when sites were selected by equal levels of CAL, increased recession was seen in smokers. Outcomes were poorer in smokers (mean PD change 1.75 +/- 0.56 versus 2.23 +/- 0.87 mm). The odds ratio for 30% of sites not responding in smokers was 2.9; for 40% non-responding it was 5.9. Smoking altered the distribution of site-specific responses to increase specifically the number of non-responding sites. There was no significant difference in responses between ex-smokers and never-smokers. Conclusions: The results demonstrate that smoking is a major risk factor for poor response to initial treatment and emphasize the importance of smoking cessation in periodontal therapy.