Association
of Smoking and Periodontal Disease
Cigarette smoking has long been recognized
as a major health risk. Well-documented associations between
cigarette smoking and lung cancer and cigarette smoking and
cardiovascular disease have been reported. Smoking also contributes
to the development of oral and pharyngeal cancer. In addition,
studies published in the past decade have identified cigarette
smoking as a major independent risk factor for periodontitis.
Smokers develop periodontitis at an earlier
age and have a greater extent and severity of periodontitis
than non-smokers. Of equal significance, smokers respond
poorly to periodontal therapy. A disproportionate number
of patients who are considered refractory to conventional
treatment approaches are smokers.
Characteristically, patients who smoke demonstrate
less gingival inflammation and bleeding following probing
than non-smokers. In contrast, increased probing depth, especially
in furcations and lingual/palatal surfaces of the teeth,
has been observed (see Table 2)
| Table 2 |
- Gingiva is fibrotic and thickened.
- Less inflammation and bleeding following probing
than expected when considering disease severity.
- More disease (extent and severity) than comparably
aged non-smokers.
- Plaque and calculus levels may be less than expected
when considering disease severity.
- Proportionally greater probing depth in anterior
regions, on the palatal surfaces of teeth and in
furcations.
- Recession observed for the maxillary and mandibular
anterior teeth.
- Scaling and root planing does not result in significant
reduction in probing depths
- Surgical periodontal therapy does not result in
long-standing reduction in excessive probing depths.
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This issue of Periodontics Report examines
the smoking-periodontitis relationship. Included are studies
on the magnitude of this association from a national health
survey, the level of oxygen in the periodontium of smokers
and non-smokers, the nature of the subgingival bacterial
infection in smokers and non-smokers and the contribution
of cigarette smoking to periodontitis in women when skeletal
bone density and menopause are considered. With thorough
documentation of the oral and systemic sequels of cigarette
smoking, dentists should consider becoming active participants
in smoking cessation/smoking prevention programs for their
patients.
• Smoking
as a Risk Factor for Periodontitis
• Subgingival
Oxygen Levels and Smoking
• Smoking
and Periodontal Bacteria
• Bone
Mineral Density, Smoking and Alveolar Bone Loss |
