The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review

Smoking is associated with greater pain intensity and pain-related occupational disability in Japanese workers

PURPOSE

Pain symptom, such as that caused by musculoskeletal disorders, is a major cause of occupational disability. As nicotine intake from smoking increases pain sensitivity, smokers may experience stronger pain and be more likely to experience pain-related disability than non-smokers. The study aim was to examine whether smoking was associated with pain-related occupational disability via pain intensity.

METHODS

Participants were 1189 workers with pain aged 20-74 years in Japan. Participants completed a self-report questionnaire, which included a question to measure pain-related occupational disability with ordinal-option: (1) without pain-related disability, (2) pain-related presenteeism, and (3) pain-related absenteeism. An ordinal logistic regression model was used to calculate multivariable-adjusted proportional odds ratios (OR) with 95% confidence intervals (CI) for the prevalence of pain-related occupational disability according to smoking status. A multiple mediation analysis was also conducted to assess whether pain sensitivity mediated the association between smoking and pain-related occupational disability. Adjusted variables were demographic variables, socioeconomic status, work-related psychosocial factors, general psychological factors, and pain duration.

RESULTS

Current smoking and pain were associated with pain-related occupational disability compared with non-smoking and pain (multivariable OR 1.78; 95% CI 1.26-2.52). Greater pain intensity partially mediated the association of current smoking and pain with pain-related occupational disability. The mediation rate (indirect/total effect) was 25%.

CONCLUSION

Smoking and pain were associated with pain-related occupational disability, partially through greater pain intensity, among Japanese workers.

The All-on-4 treatment concept for the rehabilitation of the completely edentulous mandible: A longitudinal study with 10 to 18 years of follow-up

BACKGROUND

There is a need for studies evaluating the long term outcomes of the All-on-4 treatment concept.

PURPOSE

To evaluate the long term clinical and radiographic outcomes of the All-on-4 treatment concept in the mandible.

MATERIALS AND METHODS

This retrospective longitudinal case series study included 471 patients (women: 286, men: 185, average age = 57.7 years) rehabilitated with 1884 implants in immediate function supporting 471 fixed full-arch mandibular prostheses and followed for 10 to 18 years. Primary outcome measures were prosthetic survival and implant success and survival (estimated using life tables). Secondary outcome measures were marginal bone loss (MBL) at 10 and 15 years, biological and mechanical complications. Multivariable analysis was used to estimate potential risk indicators for implant failure (Cox regression to estimate hazard ratios and 95% confidence intervals (95%CI)), MBL > 3 mm at 10 and 15 years, biological and mechanical complications (binary logistic regression to estimate odds ratios [ORs] with 95%CI).

RESULTS

Twenty-seven patients deceased (5.7%) and 149 patients (31.6%) were lost to follow-up. The cumulative prosthetic survival rate was 98.8%; the implant cumulative survival and success rate was 93% and 91.7%, respectively up to 18 years of follow-up. Previous biological complications (HR = 4.43) were significantly associated with implant failure. Average (95% CI) MBL at 10- and 15-years were 1.72 mm (95%CI: 1.59, 1.85) and 2.32 mm (95% CI: 1.98, 2.66). Smoking (OR = 2.72), previous failure of a contiguous implant (OR = 3.89) and biological complication (OR = 8.11) were associated with MBL > 3 mm. The incidence of biological complications was 11.8% at implant level, with previous failure of a contiguous implant (OR = 5.56), smoking (OR = 1.75), and systemic condition (OR = 1.65) were significantly associated. The incidence of mechanical complications was 36.7% with male gender (OR = 1.67) and type of prosthetic material used in the restoration significantly associated (metal-acrylic OR = 0.30; metal-ceramic OR = 0.22)).

CONCLUSIONS

Considering the implant, prosthetic and MBL outcomes it is concluded that the All-on-4 is a viable treatment option validated in the long term. Nevertheless, biological and mechanical complications can occur.

The Effect of Tobacco Smoking on Bone Mass: An Overview of Pathophysiologic Mechanisms

Recent evidence demonstrates that tobacco smoking causes an imbalance in bone turnover, leading to lower bone mass and making bone vulnerable to osteoporosis and fracture. Tobacco smoke influences bone mass indirectly through alteration of body weight, parathyroid hormone-vitamin D axis, adrenal hormones, sex hormones, and increased oxidative stress on bony tissues. Also, tobacco smoke influences bone mass through a direct effect on osteogenesis and angiogenesis of bone. A RANKL-RANK-OPG pathway is an essential regulatory pathway for bone metabolism and its importance lies in its interaction with most of the pathophysiologic mechanisms by which smoking influences bone mass. Both first- and secondhand smoke adversely affect bone mass; smoking cessation seems to reverse the effect of smoking and improve bone health. Recent advances in research on bone turnover markers could advance scientific knowledge regarding the mechanisms by which smoking may influence bone mass.