Is secondhand smoke exposure associated with poor periodontal status in children and adolescents? A systematic review and meta-analysis

Abstract

Purpose: We aimed to systematically evaluate whether SHS exposure is associated with poor periodontal status in individuals up to 15 years.

Methods: Seven databases were searched by two independent reviewers according to pre-specified eligibility criteria up to November 2021. The methodological quality of included studies was appraised using The Newcastle-Ottawa Scale and GRADE was used for assessing the certainty of evidence. Random-effects pairwise meta-analyses compared the periodontal status of those exposed and unexposed to SHS through standardized mean differences (SMDs) and associated confidence intervals (95% CI).

Results: Eight cross-sectional studies were eligible for inclusion and two present high methodological quality. All studies contributed to the meta-analysis for gingival index scores (GI) and four for probing pocket depth (PPD). Those exposed exhibited significantly higher levels of GI compared to unexposed (SMD = 1.03, 95% CI 0.17-1.89), but no difference was observed for PPD (SMD = 0.34, 95% CI - 0.14-0.82), with overall very low certainty on evidence.

Conclusion: Therefore, very low certainty evidence supports that children and adolescents exposed to SHS possibly present poorer periodontal status due to higher levels of GI.

Keywords: Adolescence; Child health; Cotinine; Gingivitis; Meta-analysis; Tobacco smoke pollution.