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A review of 42 in vitro studies suggests that the levels of nicotine in cigarettes, vapes, and nicotine replacement therapy (NRT) products like nicotine gum seem unlikely to be cytotoxic to periodontal and gingival cells in humans

Nevertheless, elucidating the potential biological pathways, such as systemic inflammation, through which smoking might influence outcomes in hypertensive patients remains a crucial endeavor for risk stratification and intervention, regardless of the ultimate causal nature of the association