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Research Proposal

Om Patel

CS 224: Intro to Research Methods

Linda Nicholl

April 16, 2024

Table of Contents

Abstract…………………………………………………………….……….………………3

Introduction……………………………………………………...….……….……..………4

Literature Review …………………………………………………………….………..…..5

Research Methods and Procedure……………………………………………….….……..10

Rationale…………………………………….…………………………….……..………..10

Types of Research ……………………………………………………………..………….10

Population and Sample Selection…………………………………….………..…….........11

Limitations………………………………………………………………..……………….11

Limitations……………………………………………………………..………………….11

Sources of Data..……………………………………………………….……….………....12

Collection of Data…………………………………………………….……….……….....12

Analysis of Data………….……………………………..…………….……….…………13

Study Rigour……….…..………………………….…………………………….………..13

Informed consent…………………………………………..……………….…………….13

Limitations……………………………………………………………………………….14

Benefits of study.……..……………………………………………………..……………14

Findings……………………………………………………………………….………….14

References…………………………………………………………………….………….15
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Abstract
Smoking is a significant modifiable risk factor for periodontal disease, a chronic
inflammatory condition affecting the supporting structures of teeth. Despite extensive
research on the detrimental effects of smoking on periodontal health, there remains a gap in
understanding the long-term implications of smoking cessation on periodontal outcomes.
This research proposal aims to investigate the long-term effects of smoking cessation on
periodontal health through a quantitative longitudinal cohort study. The study will recruit
individuals who have recently quit smoking and assess their periodontal health at regular
intervals over a period of several years. Clinical examinations and patient-reported outcomes
will be utilized to evaluate changes in periodontal parameters and oral health-related quality
of life following smoking cessation. The study will provide valuable insights into the benefits
of quitting smoking for periodontal health, informing clinical practice, public health
initiatives, and healthcare policies. Dissemination of study findings through scientific
publications, conference presentations, educational outreach, media engagement, and
collaborative initiatives will amplify the impact of the research and contribute to improving
periodontal health outcomes among individuals who smoke.
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What are the long-term effects of smoking cessation on periodontal health?

Introduction

Periodontal disease, characterized by chronic inflammation of the supporting

structures of teeth, presents a significant global health concern (Chahal et al., 2017, p. 3).

Among the multifactorial etiological factors implicated in its pathogenesis, smoking stands

out as a crucial modifiable risk factor with profound implications for periodontal health

outcomes (Apatzidou, 2022, para. 11). Despite extensive research documenting the

detrimental effects of smoking on periodontal tissues, there remains a critical gap in

understanding the long-term consequences of smoking cessation on periodontal health

(Chahal et al., 2017, p. 5).

Smoking has been consistently associated with an increased risk of periodontal

diseases, including gingivitis and periodontitis, as well as compromised responses to

periodontal therapy (More et al., 2017, para. 11). However, the literature on the long-term

effects of smoking cessation on periodontal health is limited and inconclusive. While some

studies suggest that quitting smoking can lead to improvements in periodontal parameters,

such as reduced probing depths and decreased clinical attachment loss, others have reported

only marginal or temporary benefits (More et al., 2017, para. 15).

Understanding the long-term effects of smoking cessation on periodontal health is

crucial for informing clinical practice, public health initiatives, and healthcare policies aimed

at reducing the burden of periodontal disease among individuals who smoke (More et al.,

2017, para. 12). By elucidating the benefits of quitting smoking for periodontal health, this

research aims to empower smokers to make informed decisions about their oral health and

motivate them to adopt healthier behaviors (Chahal et al., 2017, p. 15).

In response to this gap in knowledge, this research proposal proposes a quantitative

longitudinal cohort study to investigate the long-term effects of smoking cessation on

periodontal health outcomes (Chahal et al., 2017, p. 22). By tracking individuals who have

recently quit smoking and assessing their periodontal health at regular intervals over several

years, this study seeks to provide valuable insights into the benefits of quitting smoking for

periodontal health (Chahal et al., 2017, p. 21). The findings of this study have the potential to

inform clinical practice, public health interventions, and healthcare policies aimed at

promoting smoking cessation and improving periodontal health outcomes among individuals

who smoke (Apatzidou, 2022, para. 15).

Literature Review

Periodontal disease, characterized by chronic inflammation affecting the supportive

structures of teeth, presents a significant global health concern (Apatzidou, 2022, para. 12).

Among the multifactorial etiological factors implicated in its pathogenesis, smoking stand out

as a crucial modifiable risk factor with profound implications for periodontal health outcomes

(More et al., 2021, para. 5). Understanding the intricate interplay between smoking and

periodontal disease is imperative for devising effective preventive and therapeutic

interventions to mitigate its detrimental effects.

This literature review, embarks on a comprehensive exploration of the extensive body

of research elucidating the relationship between smoking and periodontal health. Initially, we

provided an in-depth overview of periodontal disease, encompassing its etiology,

pathophysiology, and clinical manifestations. Key terminologies such as periodontitis,

gingivitis, clinical attachment loss, and probing depth are meticulously defined, laying the

groundwork for a nuanced analysis of the subject matter (Apatzidou, 2022, p. 5).

The primary objective of this literature review is to critically evaluate existing

evidence concerning the association between smoking and periodontal disease, elucidating

the underlying mechanisms by which tobacco use exerted adverse effects on periodontal

tissues. Central to our inquiry was the overarching question: What was the impact of smoking
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on periodontal health, and how did it influence disease prevalence, severity, and treatment

outcomes? Of particular interest were variables such as the comparative prevalence of

periodontal disease between smokers and non-smokers, the effects of smoking on various

periodontal clinical parameters, and the responsiveness of smokers to different periodontal

therapies (Apatzidou, 2022, p. 7). Through a comprehensive synthesis of findings from

diverse studies spanning epidemiology, clinical trials, and basic science research, we aimed to

offer valuable insights into the multifaceted relationship between smoking and periodontal

health (Apatzidou, 2022, p. 6).

It is crucial to emphasize that this literature review did not seek to establish causality

but rather endeavored to elucidate patterns, trends, and associations between smoking and

periodontal disease. By critically appraising the existing body of literature, we endeavored to

address key questions surrounding the impact of smoking on periodontal health, thereby

providing actionable insights for clinicians, researchers, and policymakers.

Chahal et al. (2017) extensively explored the detrimental impact of cigarette smoking

on periodontal health, underscoring its significant role in elevating the risk of periodontal

diseases (p. 2). Through comprehensive epidemiological data analysis, the authors established

a clear association between smoking and the heightened prevalence and severity of

periodontitis among smokers in comparison to non-smokers (Chahal et al., 2017, p. 3)

Moreover, their research emphasized the compromised response of smokers to periodontal

therapy, as evidenced by clinical studies showcasing lesser improvement post-treatment when

compared to their nonsmoking counterparts. Furthermore, Chahal et al. (2017) highlighted

smoking as a major risk factor contributing to the incidence and progression of periodontitis,

supported by epidemiological evidence revealing a notable fourfold increase in the likelihood

of developing periodontitis among smokers, even after adjusting for various demographic

factors (para. 15). This comprehensive assessment underscored the critical need for targeted
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interventions and smoking cessation efforts to mitigate the adverse effects of smoking on

periodontal health (Chahal et al., 2017, p. 4)

More et al. (2021) conducted a comprehensive examination of the adverse effects of

tobacco smoking on oral health, revealing a plethora of risks including tooth staining,

periodontal diseases, impaired wound healing, heightened risk of dental implant failure,

precancerous conditions, and oral cancer (p. 2). This delineation underscored the imperative

of enhancing awareness among smokers regarding the detrimental consequences of smoking

on oral health, aiming to empower them with the knowledge necessary for informed decision-

making and fostering smoking cessation initiatives (More et al., 2017, para. 15).

Furthermore, More et al. (2021) accentuated the pivotal role of dentists in advocating

smoking cessation and oral health education (para. 23). They advocated for the integration of

smoking cessation counseling within dental practice, emphasizing regular engagement with

patients to educate them on the hazards of smoking. This stance underscored the potential of

dental professionals to significantly contribute to public health endeavors aimed at mitigating

tobacco-related morbidity and mortality. Additionally, More et al. (2021) noted a gap in

participants' awareness regarding the effects of smoking on dental implants, indicating a need

for further education in this domain to ensure comprehensive understanding and informed

decision-making among individuals considering dental implant procedures (para. 33).

Apatzidou (2022) posited that smoking significantly escalated the risk of periodontal

disease by exerting adverse effects on various facets of oral health, including periodontal

tissues, subgingival microbial flora, and host immune responses (p. 3). The author

underscored the detrimental impact of smoking on wound healing and treatment outcomes,

emphasizing the imperative of implementing smoking cessation interventions to ameliorate

oral health conditions. Moreover, Apatzidou (2022) shed light on the intricate relationship

between smoking and immune response, elucidating how smoking altered the function of
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white blood cells, bone marrow stimulation, and antibody production. These alterations

rendered individuals more susceptible to infections, as evidenced by systemic leukocytosis,

neutrophilia, and impaired neutrophil functions observed in smokers (para. 20).

Consequently, these immunological changes contributed to the progression of periodontal

disease and compromised wound healing processes, further emphasizing the critical need for

smoking cessation initiatives in improving oral health outcomes (Apatzidou, 2022, p. 5).

Apatzidou (2022) and More et al. (2021) both provided detailed analyses of the

detrimental effects of smoking on oral health, offering nuanced insights into its multifaceted

consequences. Apatzidou (2022) delved into the intricate mechanisms through which

smoking amplified the risk of periodontal disease, elucidating its impact on periodontal

tissues, subgingival microbial flora, and host immune responses. Similarly, More et al. (2021)

elaborated on the broader spectrum of adverse outcomes associated with smoking, including

tooth staining, impaired wound healing, and heightened susceptibility to precancerous

conditions and oral cancer. Both studies emphasized the profound implications of smoking on

wound healing processes and underscored its detrimental effects on dental implant success

rates. Moreover, they highlighted the imperative of assessing smokers' awareness of these

consequences and their receptivity to smoking cessation interventions (Apatzidou, 2022, p.

5). Additionally, Apatzidou (2022) and More et al. (2021) underscored the pivotal role of

healthcare professionals, particularly dentists, in disseminating knowledge about the risks of

smoking and spearheading efforts to promote smoking cessation among patients. This

alignment between the studies emphasized the urgency of concerted action by healthcare

practitioners to mitigate the adverse impact of smoking on oral health and improve overall

patient outcomes (Chahal et al., 2017).

In Apatzidou's study (2022), a meticulous exploration was conducted, primarily

focusing on elucidating the intricate influence of smoking on periodontal microbiota and

immune responses. The research highlighted how smoking disrupted the delicate balance of

oral bacteria and compromised host defense mechanisms. Conversely, More et al. (2021)

adopted a comprehensive perspective, delving into various facets of smoking's impact on

periodontal health, treatment outcomes, and disease progression. Their investigation

encompassed the role of smoking in shaping responses to therapy and underscored its broader

implications for oral health. In contrast, Chahal et al. (2017) presented a comprehensive

analysis, detailing smoking's multifaceted effects on periodontal health, treatment responses,

and the critical role of tobacco cessation counseling in dental practice. Their research

provided a holistic view, integrating various dimensions to underscore the profound

implications of smoking for periodontal care. This juxtaposition offered diverse insights into

smoking's influence on oral health, enriching our understanding of its multifaceted

consequences (Chahal et al., 2017).

In conclusion, the insights from Apatzidou (2022, para. 18), More et al. (2021, para.

21), and Chahal et al. (2017, para. 31) revealed a unanimous agreement on the detrimental

consequences of smoking for periodontal health. Apatzidou (2022, para. 18) delved into the

intricate balance of oral bacteria and host defense mechanisms disrupted by smoking, while

More et al. (2021, para. 10) offered a comprehensive overview of smoking's effects on

periodontal health, treatment outcomes, and the vital role of dentists in promoting smoking

cessation. Chahal et al. (2017, para. 30) complemented this by emphasizing smoking's

multifaceted impact on periodontal health and the importance of tobacco cessation

counseling. This research held significant implications for public health and clinical practice,

highlighting the urgent need for raising awareness about smoking's adverse effects on oral

health. Dentists played a crucial role in educating patients about the risks of smoking and

facilitating smoking cessation interventions to mitigate these risks. However, despite these

valuable insights, gaps persisted in understanding the full extent of smoking's impact on
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periodontal health and effective intervention strategies. Future research should focus on

elucidating the underlying mechanisms, exploring novel cessation interventions, and

evaluating their long-term effectiveness. Additionally, longitudinal studies tracking the effects

of smoking cessation on periodontal health were necessary to inform evidence-based

strategies for preventing and managing periodontal diseases in smokers.

Research Methods and Procedures

Rationale

This research aims to investigate the long-term effects of smoking cessation on

periodontal health. Despite known associations between smoking and periodontal disease,

limited evidence exists on the lasting benefits of quitting smoking for periodontal outcomes.

Understanding these effects is crucial for informing clinical practice, public health

interventions, and healthcare policies aimed at reducing the burden of periodontal disease

among individuals who smoke. By filling this gap in knowledge, the research seeks to

provide evidence-based recommendations for promoting smoking cessation and improving

periodontal health outcomes.

Type of Research

A quantitative longitudinal cohort study is chosen for its ability to establish a temporal

relationship between smoking cessation and changes in periodontal health over time. By

following individuals who have recently quit smoking and assessing their periodontal health

at regular intervals, this study design allows for the observation of changes in periodontal

parameters before and after cessation, while minimizing biases associated with retrospective

recall. The quantitative nature of data collection enables precise measurement of periodontal

outcomes, facilitating robust statistical analysis to examine the long-term effects of smoking

cessation on periodontal health. This approach offers valuable insights into the persistence or
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progression of periodontal disease following cessation, informing clinical practice and public

health interventions aimed at promoting smoking cessation and improving periodontal health

outcomes.

Population and Sample Selection

The population for this study will consist of individuals who have recently quit

smoking. The sample will be recruited from dental clinics, smoking cessation programs, or

community health centers. Inclusion criteria will include adults aged 18 years and above,

former smokers who have quit smoking within the past 1-2 years, no history of periodontal

treatment within the past six months, and willingness to participate in regular follow-up

examinations for the duration of the study. Sampling methods may include convenience

sampling or random sampling, depending on the availability and accessibility of the target

population. The sample size will be determined through statistical power analysis to ensure

adequate power to detect meaningful differences in periodontal health outcomes between

baseline and follow-up assessments.

Inclusion criteria

The inclusion criteria for participants in this study will include adults aged 18 years

and above who have recently quit smoking, defined as having abstained from smoking for at

least six months. Participants must have a history of smoking for at least five years prior to

quitting. Additionally, participants should have no history of periodontal treatment within the

past six months and be willing to participate in regular follow-up examinations for the

duration of the study. Individuals with systemic conditions or medications known to affect

periodontal health will be excluded. The study will aim to recruit a diverse sample of

participants, including individuals from different socioeconomic backgrounds and ethnicities,

to ensure the generalizability of findings.

Exclusion criteria

The exclusion criteria for participants in this study will include individuals who are

currently smoking or have resumed smoking within the past six months. Participants with a

history of periodontal treatment within the past six months will also be excluded to minimize

the potential confounding effects of recent interventions on periodontal health outcomes.

Additionally, individuals with systemic conditions or medications known to affect periodontal

health, such as uncontrolled diabetes or immunosuppressive therapy, will be excluded from

the study to reduce the influence of confounding variables. Pregnant individuals will also be

excluded due to potential hormonal fluctuations affecting periodontal health during

pregnancy. Finally, individuals unable to provide informed consent or participate in regular

follow-up examinations will be excluded from the study.

Sources of Data

The primary data sources for this study will include clinical examinations and patient-

reported outcomes. Clinical data related to periodontal health parameters such as probing

depth, clinical attachment loss, plaque index, and gingival inflammation will be collected

through comprehensive periodontal assessments conducted by trained dental professionals.

Patient-reported outcomes, including self-reported smoking history, oral health behaviors,

and quality of life related to periodontal health, will be obtained through structured interviews

or validated questionnaires.

Collection of Data

Data will be collected through a combination of clinical examinations and structured

interviews/questionnaires administered at baseline and follow-up visits. Clinical

examinations will be conducted according to standardized protocols to ensure consistency

and reliability across assessments. Structured interviews or questionnaires will be

administered to gather information on smoking history, smoking cessation interventions, oral

hygiene practices, and perceptions of periodontal health. Data collection procedures will be

conducted in a private and confidential setting to ensure participant privacy and

confidentiality.

Analysis of Data

The collected data will be analyzed using appropriate statistical methods for

longitudinal data analysis. Descriptive statistics will be used to summarize baseline

characteristics of the study population and periodontal health parameters at each time point.

Longitudinal analysis techniques, such as mixed-effects models or generalized estimating

equations, will be employed to examine changes in periodontal health outcomes over time

following smoking cessation. Subgroup analyses may also be conducted to explore potential

moderators or mediators of the relationship between smoking cessation and periodontal

health outcomes.

Study Rigour

The study will aim to maximize validity and reliability through rigorous study design,

standardized data collection procedures, and appropriate statistical analysis techniques.

Validity will be enhanced by using validated measures for assessing periodontal health and

patient-reported outcomes. Reliability will be ensured through training and calibration of

examiners, standardized protocols for data collection, and regular quality control checks to

minimize measurement error and bias.

Informed Consent

Informed consent will be obtained from all human subjects participating in the study.

Participants will be provided with detailed information about the study objectives,

procedures, potential risks and benefits, confidentiality measures, and their rights as research

participants. Written informed consent will be obtained from each participant prior to their
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inclusion in the study. Participants will be assured of their voluntary participation and their

right to withdraw from the study at any time without repercussions.

Limitations of Study

Possible limitations of the study may include selection bias due to the use of

convenience sampling, potential confounding factors not accounted for in the analysis, loss to

follow-up over the study duration, and reliance on self-reported data for certain variables

such as smoking history and oral health behaviors. Additionally, the generalizability of the

study findings may be limited to the population under study and may not be applicable to

broader populations with different characteristics or settings.

Implications of Study

Benefits

The study holds several key benefits, including informing clinical practice by

highlighting the benefits of smoking cessation for periodontal health, empowering individuals

with the knowledge to make informed decisions about their oral health, and potentially

leading to improved treatment strategies for smokers. Additionally, the findings can inform

public health interventions by supporting targeted smoking cessation programs and policies

aimed at reducing smoking prevalence and preventing periodontal disease. Furthermore, the

study may influence healthcare policies by advocating for comprehensive tobacco control

measures and resource allocation to support smoking cessation initiatives within healthcare

systems, ultimately contributing to improved periodontal health outcomes and overall public

health.

Findings

Findings will be shared without sharing the names of individuals and submitted to the

scientific publications, community health organization and patient advocacy groups.

References

Apatzidou, D. A. (2022). The role of cigarette smoking in periodontal disease and treatment

outcomes of dental implant therapy. Periodontology 2000, 90(1), 45–61.

https://confederation.primo.exlibrisgroup.com/permalink/01OCLS_CONFED/

1bnehun/cdi_openaire_primary_doi_dedup_8a4aa2863bfd7609ada0c67331dd1ff4

Chahal, G. S., Chhina, K., Chhabra, V., & Chahal, A. (2017). Smoking and its effect on

periodontium - revisited. Indian Journal of Dental Sciences, 9(1), 44-51.

https://confederation.primo.exlibrisgroup.com/permalink/01OCLS_CONFED/

1bnehun/

cdi_doaj_primary_oai_doaj_org_article_dbc2e1312e224c6892b14f41bacc39ef

More, A. B., Rodrigues, A., & Sadhu, B. J. (2021). Effects of smoking on oral health:

Awareness among dental patients and their attitude towards its cessation. Indian

Journal of Dental Research, 32(1), 23–26.

https://confederation.primo.exlibrisgroup.com/permalink/01OCLS_CONFED/

1bnehun/

cdi_doaj_primary_oai_doaj_org_article_9760b78ca5f84f618d50102638803471