20 |
SANZ et al .
Balance of benefit and harm In addition to periodontal benefits, all the tested interventions rep - resent a relevant beneficial health impact. Economic considerations The various studies do not indicate a cost–benefit evaluation. However, it cannot be discarded an additional cost related to the psychologi - cal intervention. However, the systemic health benefits that can be obtained from these interventions, if they are successful, would rep - resent reduced cost of healthcare services in different comorbidities. Patient preferences Interventions are heterogeneous, but the potential systemic health benefits may favour preference for them. Applicability Demonstrated with studies testing large groups from the general population; the practicality of routine use is still to be demonstrated. R1.6 | What is the efficacy of tobacco smoking cessation interventions in periodontitis therapy? Evidence-based recommendation (1.6) We recommend tobacco smoking cessation interventions to be implemented in patients undergoing periodontitis therapy. Supporting literature Ramseier et al. (2020) Quality of evidence Six prospective studies with, at least, 6-month follow-up Grade of recommendation Grade A—↑↑ Strength of consensus Unanimous consensus (1.2% of the group abstained due to potential CoI)
it has been established that retentive factors may increase the risk of worsening the periodontal condition (Broadbent, Williams, Thomson, & Williams, 2006; Demarco et al., 2013; Lang, Kiel, & Anderhalden, 1983).
5.4 | Intervention: Risk factor control
R1.5 | What is the efficacy of risk factor control in periodontitis therapy? Evidence-based recommendation (1.5) We recommend risk factor control interventions in periodontitis
patients, as part of the first step of therapy. Supporting literature Ramseier et al. (2020)
Quality of evidence 25 clinical studies Grade of recommendation Grade A—↑↑ Strength of consensus Strong consensus (1.3% of the group abstained due to potential CoI)
Background
Intervention Smoking and diabetes are two proven risk factors in the etiopatho - genesis of periodontitis (Papapanou et al., 2018), and therefore, their control should be an integral component in the treatment of these patients. Interventions for risk factor control have aimed to educate and advice patients for behavioural change aimed to reduce them and in specific cases to refer them for adequate medical therapy. Other relevant factors associated with healthy lifestyles (stress reduction, dietary counselling, weight loss or increased physical activities) may also be part of the overall strategy for reducing patient's risk factors. Available evidence In the systematic review (Ramseier et al., 2020), the authors have identified 13 relevant guidelines for interventions for tobacco smok - ing cessation, promotion of diabetes control, physical exercise (activ - ity), change of diet, carbohydrate (dietary sugar reduction) and weight loss. In addition, 25 clinical studies were found that assess the impact of (some of) these interventions in gingivitis/periodontitis patients.
Background
Intervention Periodontitis patients may benefit from smoking cessation in - terventions to improve periodontal treatment outcomes and the maintenance of periodontal stability. Interventions consist of brief counselling and may include patient referral for advanced counsel - ling and pharmacotherapy. Available evidence In the systematic review (Ramseier et al., 2020), six prospective studies of 6- to 24-month duration and performed at university setting were identified. Different interventions were tested (smoking cessation counselling, 5 A's [ask, advise, assess, assist, and arrange], cognitive behavioural therapy [CBT], motivational interview, brief interventions, nicotine replacement therapies). In three of the studies, the interven - tion was programmed in parallel with non-surgical periodontal therapy (NSPT) and followed by SPC, in one study SPC patients were included and, in another, patients in NSPT and in SPC were compared; in one
Risk of bias It is explained specifically for each intervention.
Consistency The heterogeneity in study design precludes more consistent find - ings, but adequate consistency may be found for studies on smoking cessation and diabetes control. Clinical relevance and effect size No meta-analysis was performed; effect sizes can be found in the individual studies.
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