Refractory periodontitis is aggravated by: A. Areca nut chewing B. Smoking C. Menstruation D. Hormone PG and oestrogen The correct answer is B. Smoking. The impact of cigarette smoking on the long-term effects of periodontal therapy in a population undergoing Supportive Periodontal Therapy (SPT) has been reported. Smokers displayed less favorable healing responses both at re-evaluation and during a 6-year period of SPT (Baumert-Ah et al. 1994). This was confirmed in another study in which higher percentages of heavy smokers experienced more multiple (≥9) residual pockets (≥5 mm) than non-smokers both after active periodontal therapy (31.2% versus 7.3%, respectively) and after 11 years of SPT (52.4% versus 14.8%, respectively) (Matuliene et al. 2008). In this study, heavy smoking was found to be a significant risk factor for periodontitis progression. Moreover, smoking was the main statistically significant risk factor for the recurrence of periodontitis after 10.5 years of SPT in the 8...