Impact of lifestyle behaviors on clinical outcomes of steps 1 and 2 of periodontal therapy in stage iii-iv periodontitis: a cohort study

Objective: Given the inconsistent evidence in the literature, the aim of this prospective cohort study was to evaluate the impact of lifestyle on the clinical response to Steps 1 and 2 of periodontal therapy in patients with severe periodontitis. Materials and methods: Patients with untreated stage III/IV periodontitis received non-surgical periodontal therapy and were re-evaluated 3 months later (T1). Based on baseline self-administered questionnaires, four lifestyle factors - physical activity, dietary habits, smoking, and alcohol consumption- were scored as either healthy (1 point) or unhealthy (0 point). An overall healthy lifestyle variable was calculated for each patient by summing the individual scores (ranging from 0 to 4 points), and its impact on clinical outcomes was analyzed. The primary outcome of the study was disease control (≤ 4 residual probing pocket depth (PPD) ≥ 5 mm). Results: A total of 120 patients were treated. At T1, a statistically significant association was observed between the overall lifestyle score and treatment response (p = 0.029). Specifically, 55.1% of patients with healthy lifestyle behaviors (score 3–4) achieved the primary endpoint, compared to 29.0% and 32.5% of those with partial (score 2) or poor health attentiveness (score 0–1), respectively. Additionally, health-conscious individuals demonstrated better control of gingival inflammation, despite having comparable oral hygiene levels (p < 0.001). In the logistic regression model, attentiveness to one’s health (OR 3.39, 95% CI 1.13–9.47, p = 0.020), normal body weight (OR 2.93, 95% CI 1.12–7.70, p = 0.029) and percentage of sites with PPD ≥ 6 mm at baseline (OR 0.90, 95% CI = 0.84–0.97, p = 0.006) were significantly associated with treatment outcome. Conclusion: Adherence to positive healthy lifestyle factors contributes to better clinical outcomes following periodontal therapy in patients with stage III/IV periodontitis. Clinical relevance: The adoption of healthy lifestyle behaviors should be considered as part of the overall management strategy for patients with severe periodontitis.