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. 2025 May:156:105665.
doi: 10.1016/j.jdent.2025.105665. Epub 2025 Mar 7.

A systematic review of oral health outcomes following smoking cessation in type 2 diabetes: Clinical and research implications

Giusy Rita Maria La Rosa  1 , Eugenio Pedullà  2 , Iain Chapple  3 , Jan Kowalski  4 , Magdalena Walicka  5 , Salvatore Piro  6 , Riccardo Polosa  6
Affiliations
Free article

A systematic review of oral health outcomes following smoking cessation in type 2 diabetes: Clinical and research implications

Giusy Rita Maria La Rosa et al. J Dent. 2025 May.
Free article

Abstract

Objective: This systematic review analyzes the effects of smoking cessation on oral health outcomes in individuals with type 2 diabetes.

Data: The review followed PRISMA guidelines, and the protocol was registered on PROSPERO (CRD42024604271). Risk of bias was assessed using the Joanna Briggs Institute's critical appraisal tools.

Sources: PubMed, Scopus, and Web of Science were searched on November 7, 2024, alongside references from highly cited journals and conference proceedings. No language or date restrictions were applied.

Study selection: Inclusion criteria were human clinical studies (randomized controlled trials, cohort, case-control, or cross-sectional studies) involving patients with type 2 diabetes, stratified by smoking status (former, current, never smokers), assessing oral health outcomes (e.g., periodontal disease, caries). Studies without detailed smoking status data were excluded.

Results: The search retrieved 549 studies, of which 4 (N = 926 participants) met the inclusion criteria. These studies examined smoking status in relation to periodontitis progression and response to periodontal therapy. Overall, the effects smoking cessation in improving periodontal outcomes in this population appears limited. However, methodological limitations were identified, and the studies may have been underpowered for the smoking status subgroup.

Conclusion: Evidence on the impact of smoking cessation on oral health in patients with type 2 diabetes remains inconclusive, as large prospective studies specifically designed for this purpose are lacking. While smoking cessation benefits oral health in the general population, its effects on oral outcomes in patients with diabetes remain unclear. Further research is needed to elucidate its impact on patients with type 2 diabetes.

Clinical significance: A multidisciplinary approach to managing diabetic patients is essential, where dentists not only address oral health but also support healthy behaviors, including smoking cessation, to improve overall diabetes-related complications.

Keywords: Former smokers; Oral health; Periodontal; Smoking cessation; Systematic review; Type 2 diabetes.

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Conflict of interest statement

Declaration of competing interest Giusy Rita Maria La Rosa is a research fellow at the Department of Clinical and Experimental Medicine of the University of Catania. She declares no conflict of interest. Eugenio Pedullà, Jan Kowalski and Salvatore Piro have nothing to disclose. Iain Chapple provides consulting advice to various oral healthcare companies, including Unilever, Philips, Haleon, P&G, Johnson & Johnson. Magdalena Walicka reports relationships with: Sanofi that includes speaking and lecture fees and travel reimbursement; AstraZeneca that includes speaking and lecture fees; Novo Nordisk that includes travel reimbursement; Berlin-Chemie that includes travel reimbursement. Riccardo Polosa is full tenured professor of Internal Medicine at the University of Catania (Italy) and Medical Director of the Institute for Internal Medicine and Clinical Immunology at the same University. He has received grants from U-BIOPRED and AIR-PROM, Integral Rheumatology & Immunology Specialists Network (IRIS), Foundation for a Smoke Free World, Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A/S, Sandoz, Merk Sharp & Dohme, Boehringer Ingelheim, Novartis, Arbi Group Srl., Duska Therapeutics, Forest Laboratories, Ministero dell Universita’ e della Ricerca (MUR) Bando PNRR 3277/2021 (CUP E63C22000900006) and 341/2022 (CUP E63C22002080006), funded by NextGenerationEU of the European Union (EU), and the ministerial grant PON REACT-EU 2021 GREEN- Bando 3411/2021 by Ministero dell Universita' e (MUR) – PNRR EU Community. He is founder of the Center for Tobacco Prevention and Treatment (CPCT) at the University of Catania and of the Center of Excellence for the Acceleration of Harm Reduction at the same university. He receives consultancy fees from Pfizer, Boehringer Ingelheim, Duska Therapeutics, Forest Laboratories, CV Therapeutics, Sermo Inc., GRG Health, Clarivate Analytics, Guidepoint Expert Network, and GLG Group. He receives textbooks royalties from Elsevier. He is also involved in a patent application for ECLAT Srl. He is a pro bono scientific advisor for Lega Italiana Anti Fumo (LIAF) and the International Network of Nicotine Consumers Organizations (INNCO); and he is Chair of the European Technical Committee for Standardization on “Requirements and test methods for emissions of electronic cigarettes” (CEN/TC 437; WG4).

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