BACKGROUND Controversial findings exist in the literature regarding the association between tobacco smoking and development of apical periodontitis or need for root canal treatment, with some studies reporting an increase in the prevalence of these outcomes in smokers, whilst others reporting no association. AIM To evaluate if there is scientific evidence to support an association between tobacco smoking and a greater prevalence of apical periodontitis and/or root canal treatments. DATA SOURCES A systematic search was performed using MeSH terms and free terms in the PubMed, Scopus, Virtual Health Library (VHL), Cochrane library and Open Gray databases. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Observational studies that evaluated the association between smoking and the development or healing of periapical lesion and/or the prevalence of root canal treatment in humans were included. STUDY APPRAISAL AND SYNTHESIS METHODS A quality assessment of included studies was performed, and the relevant information and findings were evaluated. A meta-analysis using nine included studies was performed through RevMan software, and the certainty of evidence was evaluated through GRADE. RESULTS Fifteen studies were included, of which 10 were classified as low risk of bias, 4 were considered as moderate risk of bias and 1 as high risk of bias. Ten studies reported that smoking was associated with a greater prevalence of periapical periodontitis and/or root canal treatment. Five studies reported no association. Nine studies were included in the pooled meta-analysis, comprising two subgroups: apical periodontitis and root canal treatment. From these nine studies, eight studies were included in the apical periodontitis subgroup meta-analysis and demonstrated that this condition was significantly more prevalent in smokers when compared to the nonsmokers (odds ratio = 2.78[CI: 1.60, 4.85], P < 0.001; I2 = 79%; no adjusted odds ratio). Three studies were included in the root canal treatment subgroup meta-analysis and demonstrated an increased prevalence in smokers when compared to the nonsmokers (odds ratio = 2.73 [CI: 1.06, 2.83], P < 0.001; I2 = 72%; no adjusted odds ratio). The pooled meta-analysis demonstrated that smokers had twice the chance of having apical periodontitis and/or root canal treatment when compared to nonsmokers (odds ratio of 2.42 [CI: 1.59, 3.68], P < 0.01; I2 = 85%). The GRADE analysis demonstrated moderate certainty of evidence. LIMITATIONS Several confounding factors were identified such as misinformation regarding the period of time subjects had smoked, as well as the frequency of smoking and the number of cigarettes consumed. No adjustment in odds ratio data for confounding was performed. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS This systematic review and meta-analysis indicate that tobacco smokers have an increased prevalence of periapical periodontitis and root canal treatments with moderate certainty of evidence.

中文翻译：

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吸烟是否易患根尖周炎，需要牙髓治疗吗？系统回顾和荟萃分析。

背景 关于吸烟与根尖周炎的发展或根管治疗需求之间的关联，文献中存在有争议的发现，一些研究报告吸烟者这些结果的患病率增加，而其他研究报告没有关联。目的 评估是否有科学证据支持吸烟与根尖周炎和/或根管治疗的高发病率之间存在关联。数据来源 在 PubMed、Scopus、Virtual Health Library (VHL)、Cochrane 图书馆和 Open Gray 数据库中使用 MeSH 术语和免费术语进行系统搜索。学习资格标准，参与者和干预措施 评估吸烟与根尖周病变的发展或愈合和/或人类根管治疗流行率之间关系的观察性研究被纳入。研究评估和综合方法 对纳入研究进行质量评估，并评估相关信息和发现。通过 RevMan 软件对纳入的九项研究进行荟萃分析，并通过 GRADE 评估证据的确定性。结果 共纳入 15 项研究，其中 10 项属于低偏倚风险，4 项属于中度偏倚风险，1 项属于高偏倚风险。十项研究报告说，吸烟与根尖周炎和/或根管治疗的患病率更高有关。五项研究报告没有关联。九项研究被纳入汇总荟萃分析，包括两个亚组：根尖周炎和根管治疗。在这 9 项研究中，8 项研究被纳入根尖周炎亚组荟萃分析，结果表明，与非吸烟者相比，这种情况在吸烟者中更为普遍（优势比 = 2.78[CI: 1.60, 4.85]，P < 0.001； I2 = 79%；未调整优势比）。三项研究纳入根管治疗亚组荟萃分析，表明吸烟者的患病率高于非吸烟者（优势比 = 2.73 [CI: 1.06, 2.83]，P < 0.001；I2 = 72%；未调整优势比率）。汇总荟萃分析表明，与不吸烟者相比，吸烟者患根尖周炎和/或根管治疗的机会是非吸烟者的两倍（优势比为 2. 42 [CI: 1.59, 3.68], P < 0.01; I2 = 85%）。GRADE 分析显示了中等质量的证据。局限性 确定了几个混杂因素，例如关于受试者吸烟时间段的错误信息，以及吸烟频率和消耗的香烟数量。未对优势比数据进行混杂调整。主要发现的结论和意义 本系统评价和荟萃分析表明，吸烟者患根尖周炎和根管治疗的患病率增加，证据质量中等。以及吸烟的频率和消耗的香烟数量。未对优势比数据进行混杂调整。主要发现的结论和意义 本系统评价和荟萃分析表明，吸烟者患根尖周炎和根管治疗的患病率增加，证据质量中等。以及吸烟的频率和消耗的香烟数量。未对优势比数据进行混杂调整。主要发现的结论和意义 本系统评价和荟萃分析表明，吸烟者患根尖周炎和根管治疗的患病率增加，证据质量中等。