Impact of smoking on cost-effectiveness of 10-48 years of periodontal care

Abstract

The study aims were (1) to explore whether "periodontal treatment" consisting of surgical therapy (flap, resective, or regenerative) or scaling and root planing treatment with long-term periodontal maintenance treatment, is cost-effective in terms of preventing periodontitis-attributable tooth extraction and replacement by implant-supported crowns ("extraction/replacement"); (2) to assess the effect of cigarette smoking on this cost-effectiveness. Data for this observational retrospective study were collected from dental charts of patients who had received periodontal therapy and at least annual follow-up visits for >10 years were analyzed by linear regression generalized estimating equations and generalized linear models. Among 399 adults (199 males, 200 females), those with the least mean annual treatment cost experienced the greatest mean annual costs for extraction/replacement, indicating general cost-effectiveness. Cigarette smoking adversely impacted this cost-effectiveness, with current heavy smokers experiencing no cost-effectiveness. Former smokers with Grade C periodontitis benefitted most, whereas smoking did not influence cost-effectiveness for Grade B periodontitis. Assessed by mean annual costs of "extraction/replacement," periodontal treatment was cost-effective, which decreased in a dose-response manner by former and current smoking intensity. Cigarette smoking should be factored into treatment planning and cost-effective analyses of periodontal treatment. Smoking cessation should be encouraged.

Keywords: cigarette smoking; dental; dental implants; direct service costs; fees; periodontal maintenance therapy; prostheses and implants; tooth extraction.

FIGURE 1

Distribution of study participants by smoking habits at the baseline intervention visit (T0), during the study (T0 – T1), and at the last visit (T1) (N = 399). cigs, cigarettes; N or n, number of patients; T0, baseline visit; T1, last study visit.

FIGURE 2

Associations between the MEC of tooth extractions attributed to periodontitis and replacement with ISC (extraction/replacement) and the MEC of periodontal treatment (SRP, ST, PMT) among all participants stratified by smoking status at the last study visit (T1) (Panel A) (N = 399); and among former smokers stratified by duration since smoking cessation (Panel B, Table S2) (N = 100). ex‐smoker, former smoker; ISC, implant‐supported crown; MEC, mean economic annual cost; PMT, periodontal maintenance treatment; smoker, current smoker; SRP, scaling and root planing; ST, surgical periodontal treatment; USD, United States 2022 dollars.

FIGURE 3

Associations between the MEC of tooth extractions attributed to periodontitis and replacement with ISC (extraction/replacement) and the MEC of periodontal treatment (SRP, ST, and PMT) among all participants stratified by periodontitis Stage (Panel A, Table S1) (N = 399); for Stage III patients only (Panel B, Table S1) (N = 196); and for Stage IV patients only (Panel C, Table S1) (N = 37). ex‐smoker, former smoker; ISC, implant‐supported crown; MEC, mean economic annual cost; PMT, periodontal maintenance treatment; smoker, current smoker; SRP, scaling and root planing; ST, surgical periodontal treatment; USD, United States 2022 dollars.

FIGURE 4

Associations between the MEC of tooth extractions attributed to periodontitis and replacement with ISC (extraction/replacement) and the MEC of periodontal treatment (SRP, ST, PMT) among all participants stratified by periodontitis Grade (Panel A, Table S1) (N = 399); for Grade B patients only (Panel B, Table S1) (N = 259); and for Grade C patients only (Panel C, Table S1) (N = 99). ex‐smoker, former smoker; ISC, implant‐supported crown; MEC, mean economic annual cost; PMT, periodontal maintenance treatment; smoker, current smoker; ST, surgical periodontal treatment; SRP, scaling and root planing; USD, United States 2022 dollars.