Scandinavian and North American Moist Snuff and Periodontitis: A Systematic Review and Meta-Analysis

To answer the focused PECOS question: in humans (P), what is the effect of Scandinavian or North American moist snuff (MS) (E), in comparison to non-use (C), in terms of periodontitis (O) as demonstrated in clinical studies (S)?

Electronic databases (MEDLINE, EMBASE and Cochrane) and grey literature were searched for relevant studies reporting clinical and/or patient-reported periodontal outcomes. Qualitative and quantitative syntheses (random-effects meta-analysis with pooled odds ratios [ORs] or effect sizes [ESs] and 95% confidence intervals [CIs]) were performed to determine the associations between MS use and primary (periodontitis) or secondary outcomes (gingival recession, gingivitis). Risk of bias (Newcastle-Ottawa scale) and certainty of evidence (GRADE) were assessed.

Twenty-two mostly cross-sectional studies from Sweden (n = 11), the United States (n = 10) and Norway (n = 1) were included. MS use was most frequently associated with buccal recession. Qualitatively, an association between MS use and periodontitis (n = 16) was judged to be unlikely. Based on studies with high clinical heterogeneity, no significant associations were found between MS use and periodontitis (n = 2 [12,775 participants], OR = 1.49 [CI: 0.71-3.16]), recessions (n = 9 [3719 participants], ES = -0.04 [CI: -0.98 to 0.90]) or gingivitis (n = 3 [1429 participants], ES = 0.09 [CI: -0.36 to 0.55]). The certainty of evidence was judged to be very low.

The current evidence, mostly based on cross-sectional studies and very low certainty, suggests that Scandinavian or North American MS use is not associated with periodontitis.

CRD42023417652.