{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T12:58:16Z","timestamp":1791896296957,"version":"4.3.4"},"reference-count":83,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T00:00:00Z","timestamp":1715904000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Periodontal Research"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>The present systematic review with meta\u2010analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non\u2010users. The quality of studies was evaluated using the 10\u2010item risk\u2010of\u2010bias tool, and publication bias was addressed through the trim\u2010and\u2010fill method. Sensitivity analysis utilized the leave\u2010one\u2010out approach. Meta\u2010analysis and meta\u2010regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta\u2010analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non\u2010users (OR\u2009=\u20092.99; 95% CI: 2.10, 4.27;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high\u2010income countries (OR\u2009=\u20091.69; 95% CI: 1.20, 2.37;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) and even higher in lower\u2010middle\u2010income and lower\u2010income countries (OR\u2009=\u20093.91; 95% CI: 2.66, 5.77;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT\u2013periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jre.13274","type":"journal-article","created":{"date-parts":[[2024,5,17]],"date-time":"2024-05-17T06:11:08Z","timestamp":1715926268000},"page":"1062-1070","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Smokeless tobacco and periodontitis: A systematic review with meta\u2010analysis"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6349-6136","authenticated-orcid":false,"given":"Mir Faeq Ali","family":"Quadri","sequence":"first","affiliation":[{"name":"Texas Tech University of El Paso  El Paso Texas USA"},{"name":"Saveetha Dental College and Hospitals  Chennai India"},{"name":"University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed M.","family":"Kamel","sequence":"additional","affiliation":[{"name":"Cairo University  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maryam","family":"Nayeem","sequence":"additional","affiliation":[{"name":"University of Texas El Paso  El Paso Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tenny","family":"John","sequence":"additional","affiliation":[{"name":"Saveetha Dental College and Hospitals  Chennai India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anugeetha","family":"Thacheril","sequence":"additional","affiliation":[{"name":"Jazan University  Jazan Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianluca","family":"Tartaglia","sequence":"additional","affiliation":[{"name":"University of Milan  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Santosh","family":"Tadakamadla","sequence":"additional","affiliation":[{"name":"Dentistry and Oral Health La Trobe University  Bendigo Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,17]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-020-01677-9"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(23)00205-X"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.4178\/epih.e2017009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30084-1"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-2667(21)00065-7"},{"key":"e_1_2_10_7_1","volume-title":"Health Risks of Smokeless Tobacco. 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