Why Do Smoking and Glycaemic Control Change a Periodontal Treatment Plan?｜證據鏈

Smoking and glycaemic status are worth disclosing proactively before periodontal treatment because both are related to inflammatory presentation, treatment response, and long-term maintenance. The evidence for smoking is more direct: a meta-analysis of 17 studies found that smokers had smaller average reductions in pocket depth and gains in clinical attachment after non-surgical periodontal treatment. This supports incorporating smoking-cessation assistance, correction of cleaning technique, and closer reassessment into the plan, rather than ending care once instrumentation and debridement have been completed. The glycaemic evidence warrants greater caution. A newer systematic review found no significant difference in the short-term periodontal response to non-surgical periodontal treatment between groups with and without diabetes; a diabetes diagnosis itself therefore does not mean that treatment will be ineffective. On the other hand, the pooled difference in HbA1c associated with periodontal treatment in patients with type 2 diabetes was 0.29%, but the studies were highly heterogeneous and none of the 12 trials was rated at low risk of bias. Periodontal care can work in concert with diabetes care, but it cannot replace medical treatment, diet, exercise, or blood glucose monitoring.