The impact of smoking on Tooth extraction Healing among Adults at a tertiary health facility in southern Nigeria: A prospective Cohort Analysis

Abstract

Context: Cigarette smoking is a recognised contributor to compromised wound healing; however, its precise effect on postoperative outcomes following routine dental extractions in general practice remains unclear.

Aim: To evaluate the effect of smoking on alveolar osteitis incidence, postoperative pain, soft tissue healing, and infection after dental extraction.

Materials and Methods: This prospective cohort study enrolled 420 adults (220 smokers, 200 non smokers) undergoing 620 extractions at the Oral and Maxillofacial Unit, University of Uyo Teaching Hospital (February 2022–January 2026). Extractions followed standardised protocols. Smokers were stratified as light (<10), moderate (10–19), or heavy (≥20 cigarettes/day). Primary outcome: alveolar osteitis. Secondary outcomes: pain (Visual Analogue Scale (VAS) at 24 h, days 3 and 7), soft tissue healing (modified Landry index at days 7 and 14), infection, and mucosal coverage time. Multivariable logistic regression adjusted for age, sex, tooth type, and surgical difficulty.

Results: Alveolar osteitis occurred in 9.7% of sockets: 13.3% in smokers vs 5.5% in non smokers (adjusted OR 2.45; 95% CI 1.33–4.50; P=0.004). A dose–response gradient was observed: 8.2%, 12.5%, and 18.6% in light, moderate, and heavy smokers, respectively. Smokers had higher pain scores at 24 h and day 3, delayed healing (Landry ≥4 at day 7: 54.2% vs 70.9%; P<0.001), and increased infection (5.8% vs 2.1%; adjusted OR 2.30; 95% CI 1.05–5.02; P=0.04).

Conclusion: Smoking is an independent, dose dependent risk factor for alveolar osteitis, pain, delayed healing, and infection after extraction, supporting routine perioperative smoking cessation counselling in oral surgical care.