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OBJECTIVES: Perform a systematic review to evaluate the influence of smoking on the effectiveness of tooth whitening (TW) and to analyze whether tooth sensitivity is different between smokers and non-smokers. MATERIALS AND METHODS: A systematic review modeled according to the PRISMA guidelines was conducted. PubMed, Embase, Web of Science, Cochrane, Scopus, and OpenGrey databases were searched for related clinical trials. The population, exposure, comparison, outcomes (PECO) was individuals who had TW performed, smoking individuals, non-smoking individuals, and effectiveness of TW, respectively. Risk of bias was assessed with the ROBINS-I tool, and data from included studies were extracted by two researchers independently. The certainty of the evidence was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. RESULTS: Five studies were selected for qualitative analysis. The ROBINS-I tool classified 3 studies as having a moderate risk of bias, one study as having a serious risk of bias, and one with a critical risk. GRADE performed only for color change results and showed a low certainty of evidence. Limited evidence suggests that effectiveness of TW between smokers and non-smokers is similar. The tooth sensitivity also does not seem to be influenced by smoking. Due to the heterogeneity of the data, a meta-analysis could not be performed. CONCLUSIONS: Effectiveness of TW between smokers and non-smokers is comparable. The tooth sensitivity also does not seem to be influenced by smoking. CLINICAL RELEVANCE: The effectiveness of bleaching among smokers and non-smokers appears to be similar. Tooth sensitivity during TW also appears not to be influenced by smoking.

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BACKGROUND: Patients with biomass exposure-related COPD (BE-COPD) is a prevalent disease in developing countries and requires a detailed study of its clinical and inflammatory characteristics, specifying interventions that may differ from tobacco exposure-related COPD (TE-COPD). The objective was to describe clinical characteristics, biomarkers of inflammation, T-helper cells, and microbiological agents during a COPD exacerbation in BE-COPD in comparison with TE-COPD. METHODS: A prospective observational study in patients with moderate or severe exacerbation was recruited either in the emergency room or the COPD clinic. At enrollment, nasopharyngeal swabs and sputum were collected to identify viral and bacterial pathogens. Blood samples were also collected to measure inflammatory biomarkers and T-helper cells levels. Days of hospitalization and mechanical ventilation requirement was evaluated. RESULTS: Clinical characteristics, vaccination history, hospitalization, history of exacerbations, and microbiological pattern between BE-COPD and TE-COPD were similar. The Th2 profile was higher in BE-COPD than in TE-COPD (2.10 [range 1.30-3.30] vs. 1.40 [range 1.20-1.80], p = 0.001). The Th2/Th1 ratio was higher in BE-COPD than TE-COPD (1.22 [range 0.58-2.57 ] vs. 0.71 [range 0.40-1.15], p = 0.004). The need of mechanical ventilation (MV) was higher in TE-COPD than BE-COPD (13% vs. 31.1%, p = 0.01). Nonvaccination history and high CRP levels were significantly associated with hospitalization [OR 1.48 (CI 95% 1.30-4.61, p = 0.005) and OR 1.17 (CI 95% 1.10-1.24, p = 0.001), respectively]. CONCLUSIONS: Clinical characteristics, inflammatory markers, and microbiological isolates were similar in both groups but BE-COPD show a tendency to present higher inflammatory Th2 cells and low requirement MV compared with TE-COPD.

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Although different trajectories in lung function decline have been identified in patients with COPD associated to tobacco exposure (TE-COPD), genetic, environmental, and infectious factors affecting lung function throughout life have not been fully elucidated in patients with COPD associated to biomass (BE-COPD). In this review, we present current epidemiological findings and notable advances in the natural history of lung decline in BE-COPD, as well as conditions modeling the FEV1 trajectory, such as health insults, during the first years of childhood. Evidence shows that women exposed to biomass smoke reach adult life with a lower FEV1 than expected. However, in contrast to the "horse racing effect" predicting an excessive lung-function decline in forthcoming years, as observed in smokers, this decline is slower in non-smokers, and no rapid decliners are observed. Accordingly, BE-COPD might be considered another phenotype of COPD based on assessments of lung function decline. Likewise, other functional and clinical aspects described in this review suggest that this condition might be similar to TE-COPD. More research is needed to fully characterize this subgroup of variants of COPD.

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Introdução: As doenças periodontais são infecções crônicas multifatoriais que acarretam a perda de inserção periodontal e dos tecidos de suporte. O tabagismo é considerado um dos principais fatores de risco associados à periodontite. O tratamento periodontal não cirúrgico possui seus efeitos clínicos bem estabelecidos e ao longo dos anos, pesquisadores buscaram avaliar as mudanças microbiológicas associadas a esta terapia, principalmente quando utilizada em pacientes fumantes. Objetivo: O objetivo da presente revisão sistemática de literatura foi avaliar se existem alterações microbiológicas em pacientes tabagistas portadores de periodontite, após o tratamento não cirúrgico, quando comparados a não tabagistas. Materiais e métodos: O trabalho está protocolado na plataforma PROSPERO sob o número de registro: CRD420191197. Foi realizado até janeiro de 2019 a busca eletrônica nas principais bases computadorizadas: Literatura Latino Americana em Ciências da Saúde (LILACS), Bibliografia Brasileira de Odontologia (BBO) e as bases de dados da área de Ciências da Saúde: Medline/PubMed e Dentistry & Oral Sciences Source (EBSCO), nas bases multidisciplinares SCOPUS (Elsevier) e Web of Science (Thompson Reuters), além da busca manual. A estratégia PICO foi utilizada para avaliar se pacientes tabagistas com periodontite (P) após o tratamento periodontal não cirúrgico (I) quando comparados a não tabagistas com a mesma doença periodontal (C), apresentam alguma alteração no seu perfil microbiológico subgengival (O). A seleção e avaliação dos estudos foi realizada por dois avaliadores em separado e incluídos apenas estudos com tempo de acompanhamento de pelo menos 2 meses onde os pacientes avaliados não possuíssem 1) doenças sistêmicas associadas à doença periodontal, 2) se mulher, que não estivessem grávidas ou lactantes e 3) não tivessem feito uso de antibiótico nos últimos 3 meses. A avaliação de qualidade dos estudos foi realizada através do teste metodológico proposto por Fowkes&Fulton. Resultados: Foram encontrados um total de 402 referências, e destes apenas sete estudos foram incluídos para avaliação. De acordo com o critério de elegibilidade, limitações foram identificadas, porém não comprometeram os resultados das pesquisas. Todas relataram que os grupos, tabagistas e não tabagistas, apresentaram redução na microbiota patogênica após a raspagem e alisamento radicular, porém dois estudos concluíram que a redução dessa microbiota nos fumantes não foi suficientemente efetiva quanto no grupo de não fumantes. Conclusão: Conclui-se, portanto, que a terapia periodontal não cirúrgica tende a ser um tratamento de escolha para fumantes e que é capaz de provocar alterações na microbiota subgengival destes pacientes com periodontite quando comparados a não fumantes. Ainda assim, estudos devem continuar sendo direcionados para elucidar a influência do tabagismo na composição microbiológica do hospedeiro. É importante que esses resultados sejam considerados com cautela uma vez que os trabalhos incluídos foram realizados com critérios limitados. (AU)

Background: Periodontitis is a chronic multifactorial inflammatory disease that results in loss of periodontal attachment and bone support, with smoking as a major risk factor for it. Nonsurgical periodontal treatment has been shown to improve probing pocket depths and clinical attachment level and over the years researchers have been investigating the microbiological changes that result from applying that therapy to smokers. Objective: This study conducts a systematic review to evaluate if there are subgingival microbial changes in periodontal pockets in smokers with periodontitis, after non-surgical treatment, when compared to non-smokers. Material and methods: The work is registered at PROSPERO under the entry: CRD420191197. A systematic search in the literature was carried out covering the period up to January 2019. It was conducted in the following electronic databases: Latin American and Caribbean Health Sciences Literature (LILACS), Brazilian Bibliography of Dentistry (BBO), PubMed , SCOPUS, Dentistry & Oral Sciences Source (EBSCO), and Web of Science (Thompson Reuters). Personal searches outside these databases were conducted as well. The PICO strategy was used to evaluate whether smokers with periodontitis (P) after nonsurgical periodontal treatment (I) when compared to non-smokers with the same periodontal disease (C), presented some change in their subgingival microbial profile (O). Selection and evaluation of studies were performed independently by two researchers, in order to determine whether or not they complied with the inclusion criteria. Quality assessment of included studies conformed with Fowkes & Fulton's critical appraisal of published research guidelines. Results: A total of 402 references were found, of which only seven studies were selected for evaluation. According to the eligibility criteria, limitations were identified, but did not compromise the results of the investigations. Most of them reported that smokers and nonsmokers had a reduction in the pathogenic microbiota after scaling and root planning, but two studies reported a lesser reduction in periodontal pathogens in smokers, as compared to nonsmokers. Conclusion: In summary, most studies indicate that non-surgical periodontal therapy reduces pathogenic periodontal microbiota in smokers. Nevertheless, researchers should keep investigating the influence of smoking on the composition of microflora, since the corresponding literature available for that still presents some limitations . (AU)

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