Relationship of smoking and smoking cessation with number of teeth present: JPHC Oral Health Study*

Background: Smoking is associated with the number of teeth. The purpose of this study was to determine the relationship of number of teeth with smoking and smoking cessation. Methods: Subjects included 547 males aged between 55 and 75 years. Oral examinations were conducted in 2005. Smoking status information was collected from questionnaire surveys conducted in 1990, 1995, 2000, and 2005. The relationship between having more than eight missing teeth and smoking status was estimated with adjusted odds ratio. Results: Comparing with never smokers, odds ratios of having more than eight missing teeth among current and former smokers were 1.96 and 1.86, respectively. The odds ratios in those who had stopped smoking for ≤10 years was 3.02, and for those who had ceased smoking for 11–20 years was 2.66. In those who stopped smoking for 21 years or more, there was no increase in the odds ratio. Conclusion: Smoking had a positive association with the number of missing teeth and smoking cessation is beneficial for maintaining teeth. The odds of having more than eight missing teeth in those who had never smoked was equal to that of individuals who reported that they had stopped smoking for 21 years or more.     

Molar furcation involvement associated with cigarette smoking in periodontal referrals

Abstract The aim of this study was to investigate the relationship between cigarette smoking and furcation involvement in molar teeth. A consecutive group of 50 smokers were recruited from referrals to a periodontal clinic and age and gender matched with never smokers. Smokers consumed an average of 18.0 (SD 6.7) cigarettes per day and had smoked for 20.7 (SD 6.5) years. Radiographs of all molar teeth were assessed 2 × by an examiner blinded to the smoking status. Smokers had slightly fewer molar teeth 6.7 (SD 2.6) than the never smokers. 7.3 (SD 2.3), t= 1.2, P=0.22. More smokers (72%) had evidence of furcation involvement than never smokers (36%), χ²=13.0, P=0.0003. The odds ratio for a smoker having 1 molar with furcation involvement was 4.6 (c.i. 2 – 10.6). Smokers had more molars with furcation involvement 1.94 (SD 1.7) compared with never smokers, 0.94 (SD 1.4), t= 3.1. P= 0.003. It is concluded that cigarette smoking is associated with a greater expression of molar furcation involvement in periodontitis affected subjects.     

Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss

BACKGROUND: Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss. METHODS: A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking. RESULTS: Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models. CONCLUSION: The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.     

The influence of current and former smoking on gingival bleeding: the Hisayama study

BACKGROUND: Previous studies have shown that smoking is a risk factor for periodontitis and that it has a suppressive effect on gingival bleeding. This study examined the relationship between smoking, including past smoking, and periodontal conditions, mainly gingival bleeding, in a community-based health investigation. METHODS: Smoking status was examined in 958 subjects, along with the quantity of tobacco currently or previously smoked (never, former light, former heavy, current light, and current heavy). We analyzed the influence of smoking on probing depth (PD), clinical attachment loss (CAL), and gingival bleeding on probing (BOP). Results: In multivariate logistic regression analyses, current heavy smokers were at a significantly greater risk for having a higher proportion of teeth with PD > or =4 mm and a higher proportion of teeth with CAL > or =5 mm; however, they had a lower risk for having a high BOP than did those who had never smoked. Moreover, both former light and former heavy smokers had significantly lower risks for high BOP. When the analysis was limited to subjects with PD > or =4 mm, former heavy and current heavy smokers showed a significant suppression of high BOP compared to never smokers. CONCLUSION: This study suggests that smoking is significantly associated with PD and CAL and that current and past smoking has a suppressive effect on BOP.     

Relationship of cigarette smoking to attachment level profiles

OBJECTIVES: The present investigation examined clinical features of periodontal disease and patterns of attachment loss in adult periodontitis subjects who were current, past or never smokers. MATERIAL AND METHODS: 289 adult periodontitis subjects ranging in age from 20-86 years with at least 20 teeth and at least 4 sites with pocket depth and/or attachment level >4 mm were recruited. Smoking history was obtained using a questionnaire. Measures of plaque accumulation, overt gingivitis, bleeding on probing, suppuration, probing pocket depth and probing attachment level were taken at 6 sites per tooth at all teeth excluding 3rd molars at a baseline visit. Subjects were subset according to smoking history into never, past and current smokers and for certain analyses into age categories <41, 41-49, >49. Uni- and multi-variate analyses examined associations between smoking category, age and clinical parameters. RESULTS: Current smokers had significantly more attachment loss, missing teeth, deeper pockets and fewer sites exhibiting bleeding on probing than past or never smokers. Current smokers had greater attachment loss than past or never smokers whether the subjects had mild, moderate or severe initial attachment loss. Increasing age and smoking status were independently significantly related to mean attachment level and the effect of these parameters was additive. Mean attachment level in non smokers <41 years and current smokers >49 years was 2.49 and 4.10 mm respectively. Stepwise multiple linear regression indicated that age, pack years and being a current smoker were strongly associated with mean attachment level. Full mouth attachment level profiles indicated that smokers had more attachment loss than never smokers particularly at maxillary lingual sites and at lower anterior teeth. CONCLUSIONS: In accord with other studies, smokers had evidence of more severe periodontal disease than past or never smokers. At all levels of mean attachment loss, smokers exhibited more disease than never smokers. Difference in mean attachment level between smokers and never smokers at individual sites was not uniform. Significantly more loss was observed at maxillary lingual sites and lower anterior teeth suggesting the possibility of a local effect of cigarette smoking.     

Use of water 'softening and conditioning systems' significantly increases the risk of periodontitis: smoking considerations

Background: The role of water in the etiology of periodontal disease is poorly understood. Objectives: The objective of this study was to examine the association amongst water softness, risk for periodontitis, and smoking status. Methods: We examined the association between use of water ‘softening and conditioning systems’ and the risk for periodontal disease in smokers and non‐smokers, using adult participants (18+ years), from the third National Health and Nutrition Examination Survey (NHANES III) data. Zero to 33 per cent (0–33%) of sites with periodontal attachment loss ≥ 3 mm was considered a healthy periodontium, and > 33% of sites with periodontal attachment loss ≥ 3 mm was defined as periodontitis. Soft water users were divided into ‘yes’ or ‘no’ using the question, ‘Does your home have a “softening or conditioning system?”.’ Smoking subjects were divided into groups as follows: current smokers (had smoked ≥ 100 cigarettes in their lifetime and currently smoked), former smokers (had smoked ≥ 100 cigarettes in their lifetime, not currently smoking), or never smokers (had not smoked ≥ 100 cigarettes in their lifetime). Data was analyzed by univariate analyses using SPSS^®. The 5% level of statistical significance was adopted throughout. Results: Subjects that answered the question ‘yes’ to soft water use had a significantly higher risk of periodontitis (p < 0.05), adjusting for confounders. When mineral intake from foods was added to the model, the significance of periodontitis risk remained the same for the non‐smoking, soft water‐using subjects, whereas for the smoking, soft water‐using subjects the risk for periodontitis increased significantly (p < 0.05) in most cases. Conclusions: Thus, use of water ‘softening and conditioning systems’ significantly increased the risk for periodontitis, and smoking increased this risk.     

Is Trying to Quit Associated With Tooth Loss and Delayed Yearly Dental Visit Among Smokers? Results of the 2014 Behavioral Risk Factor Surveillance System

Background: The rate of periodontitis in the US population has been estimated to be close to 50%. Patients with periodontitis, especially those who smoke, suffer from a high rate of tooth loss. The purpose of this analysis is to evaluate predictors of poor oral health and oral health habits among smokers and determine if trying to quit smoking is associated with better oral health or oral health habits in smokers in the United States. Methods: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. After limiting the dataset to smokers, the designated exposure was respondent’s report of trying to quit smoking (yes/no). Two logistic regression models were developed. One model identified factors associated with having a most recent dental visit longer than 1 year before the survey. The second model identified factors associated with loss of six or more teeth. Both models were controlled for confounding factors. Results: After controlling for confounding, among smokers in the 2014 BRFSS, trying to quit was associated with significantly lower odds of respondents having their most recent dental visit longer than a year before the survey (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.90 to 0.97) and was a significant risk factor for having lost six or more teeth (OR: 1.06; 95% CI: 1.02 to 1.10). Conclusions: Among smokers in the United States, trying to quit is associated with compliance with yearly dental visits and higher odds of lost teeth. Future research should investigate optimal approaches for providing smoking cessation services in the dental setting.     

Smoking and oral health status

Clinical studies suggest that smokers have a higher than average risk of periodontal disease and poor oral health status. In 2003, the Canadian Community Health Survey--a multistage, nationwide household survey--asked a series of questions related to oral health status. This report is based on the population aged 18 and older who answered the optional module on oral health (33,777 respondents). This subsample represents a weighted population of 23.9 million. The overall survey response rate was 80.6%.In our sample, 24% of respondents were current cigarette smokers, 43% were former smokers and 33% had never smoked. The prevalence of current smoking declined with advancing age and was inversely associated with household income and level of education. The prevalence of edentulism was 15% among current smokers compared with 7% among those who had never smoked. In the dentate population, current smokers were less likely to have visited a dentist in the past 3 years and more likely to report sensitivity of teeth, tooth ache in the previous month, pain in the mouth or face and social limitations because of teeth. When age, sex, household income and dental insurance were controlled in a multivariate logistic regression model, current smokers and former smokers had higher odds of reporting oral-facial pain than people who had never smoked. Prevention of smoking onset and support for cessation of smoking could contribute to improved oral health status.     

Smoking-attributable periodontal disease in the Australian adult population

Background: The extent to which periodontitis is attributable to smoking in Australia has not been examined. Objectives: To investigate the smoking–periodontitis relationship and to estimate the public health impact of smoking on periodontitis in Australia. Material and Methods: The National Survey of Adult Oral Health 2004–2006 collected nationally representative oral epidemiologic data for the Australian adult population. Examiners measured probing pocket depth (PPD) and gingival recession at three sites per tooth to compute clinical attachment level (CAL). Moderate‐severe cases were defined as having: 2 interproximal sites (not on same tooth) with 4 mm CAL or with 5 mm PPD. Smoking status was defined as never‐, former‐ or current‐smoker. Current‐smokers were further classified into light‐, moderate‐ or heavy‐smoker using calculated pack‐years. Age, sex and socioeconomic position were examined as potential confounders. Results: Twenty‐three per cent were former‐smokers and 15% were current‐smokers. Prevalence of periodontitis was 23%. In unadjusted analyses, former‐ and current‐smokers had significantly higher periodontitis prevalence than never‐smokers. Relative to non‐smokers, adjusted prevalence ratios (95% confidence interval) for periodontitis were as follows: former‐smokers: 1.22 (1.03–1.46), moderate‐smokers: 1.63 (1.16–2.30); and heavy‐smokers: 1.64 (1.27–2.12). The population attributable fraction of smoking for moderate‐severe periodontitis was 32% (equivalent to 700,000 adults). Conclusion: Smoking has a significant impact on periodontal health of the Australian adults.     

Smoking behaviour and attitudes to periodontal health and quit smoking in patients with periodontal disease

Objective: The aim of this study was to assess oral health‐related beliefs and attitudes, health behaviour of smokers in relation to the Transtheoretical Model (TTM) of behaviour change, willingness to have smoking cessation provided together with periodontal treatment. Material and Methods: Postal questionnaire was sent to 500 referred patients. Part 1 looked at attitudes and beliefs about periodontal disease, Part 2 aimed at current smokers focused on the TTM and smoking cessation. Results: Response rate was 56% (n=277); 67% females, 33% males. Mean age was 44.9 years (SD 12.45); 24.5% current smokers, 30.3% past smokers, 45.5% never smokers. Fewer smokers reported “bleeding gums” (p=0.027), but more smokers reported “having loose teeth” (p=0.016). The TTM stages of change indicated that 31% of current smokers were in pre‐contemplation of quitting smoking, 46% were in contemplation and 23% were in preparation. Twenty‐three percent of the past smokers were in action and 77% in maintenance. Smokers showed differences in the “self‐re‐evaluation” (p=0.001) and “self‐liberation” (p=0.015) processes of change depending on their stage of change (pre‐contemplation or preparation). Nearly half (49%) of the current smokers who wanted to quit requested smoking cessation to be provided alongside their periodontal treatment. Conclusion: A large proportion of periodontal patient smokers may be considering quitting, and nearly half requested provision of smoking cessation intervention in conjunction with the periodontal treatment.     

Smoking cessation and response to periodontal treatment

Smoking has detrimental oral effects. The aim of this study was to review the literature related to the impact of smoking cessation on periodontal health, periodontal disease and periodontal treatment outcome as well as to review the smoking cessation strategies and the dentist's role in the smoking cessation effort. Smoking cessation seems to have a positive effect on the periodontium, to decrease the risk for incidence and progression of periodontitis and to lead to a non‐significant trend for greater mean probing depth reductions after non‐surgical treatment over a 12‐month period. Smoking cessation effect on the periodontium should be further investigated. Dentists should inform their patients on the harmful effect of smoking and the beneficial effect of smoking cessation on oral health. They should advise, motivate and support their patients to quit smoking. Smoking‐control strategies should be incorporated in dental practise. The dentist's role in the smoking cessation effort is important. Guidelines on smoking‐control strategies applied in the dental office are required.     

Cigarette smoking and periodontal disease among 32-year-olds: a prospective study of a representative birth cohort

BACKGROUND: Smoking is recognized as the primary behavioural risk factor for periodontal attachment loss (AL), but confirmatory data from prospective cohort studies are scarce. AIM: To quantify the association between cigarette smoking patterns and AL by age 32. METHODS: Periodontal examinations were conducted at ages 26 and 32 in a longstanding prospective study of a birth cohort born in Dunedin (New Zealand) in 1972/1973. Longitudinal categorization of smoking exposure was undertaken using data collected at ages 15, 18, 21, 26 and 32. RESULTS: Complete data were available for 810 individuals of whom 48.9% had ever smoked (31.5% were current smokers). Compared with never-smokers, long-term smokers (and other age-32 smokers) had very high odds ratios (ORs of 7.1 and 5.7, respectively) for having 1 +sites with 5 +mm AL, and were more likely to be incident cases after age 26 (ORs of 5.2 and 3.2, respectively). Two-thirds of new cases after age 26 were attributable to smoking. There were no significant differences in periodontal health between never-smokers and those who had quit smoking after age 26. CONCLUSIONS: Current and long-term smoking in young adults is detrimental to periodontal health, but smoking cessation may be associated with a relatively rapid improvement in the periodontium.     

Smoking and Oral Health: a Population Survey in Finland

Objectives: A survey was conducted to study smokers' oral health behaviors and attitudes, and to determine if smokers were advised by their dentists to quit smoking. Methods : A random sample of 1,200 adults 15 to 64 years of age living in the province of North Karelia, Finland, was selected in each of two study years (1990 and 1991) and surveyed using a mail questionnaire. The 102-item questionnaire solicited information on smoking status, oral health behaviors, missing teeth, perceptions of tobacco's harmful effects on oral health, smoking status and quitting, and advice on smoking cessation provided by dentists. Variations in behaviors and opinions according to smoking status were analyzed. Results : Nonsmokers reported more frequent healthy oral health behaviors than did daily smokers, with the exception that no difference in toothbrushing frequencies existed among women. Daily smoking was associated with increased use of sugar in tea or coffee, and with more frequent alcohol consumption. Daily smoking was correlated with the number of missing teeth in bivariate analyses, but not in multivariate analyses. Fewer daily smokers than nonsmokers considered smoking to have harmful effects on oral health. The majority of daily smokers, however, wanted to quit. Eight percent of daily smokers reported that they had been advised by their dentist to quit. Conclusions : Dentists need to provide patients with counseling on tobacco use because of the desire of many smokers to quit. Counseling of smokers by the oral health team requires special attention and skills, because smokers' health behaviors and attitudes appear to be less favorable to oral health compared to nonsmokers.     

Dental patients’ perceptions and motivation in smoking cessation activities

Objective The aim of the present study was to investigate smokers’ perceptions of and motivation for smoking cessation activities in dentistry. Materials and methods Patients who smoked were consecutively recruited from general as well as specialist dental care clinics in Sweden. After a dental visit the patients completed a questionnaire about self-perceived oral health, smoking habits, motivation, reasons to quit and not to quit smoking, support to quit, smoking cessation activities and questions about smoking asked by dentists and dental hygienists. Results The sample consisted of 167 adult patients (≥?20 years) who smoked daily. During the last 6 months, 81% of the patients had experienced oral health problems. The most common complaints were discolourations of the teeth, periodontal problems and dry mouth (38%, 36% and 33%, respectively). Improved general health was a major reason to quit smoking (89%). It was also stated that it was important to avoid oral health problems. 71% of the patients preferred to quit by themselves and 16% wanted support from dentistry. High motivation to quit smoking was reported by 20%. Occurrence of periodontitis during the last 6 months was significantly associated with being highly motivated to stop smoking (OR?=?3.0, 95% CI?=?1.03–8.55). Conclusions This study revealed that, although it was important to quit smoking to avoid oral health problems, the patients were not aware that tobacco cessation activities can be performed in dentistry. Periodontal problems seem to be the most motivating factor among the patients who were highly motivated to stop smoking.     

Smoking cessation advice for patients with chronic periodontitis

BACKGROUND: There are limited data on the utility of dental professionals in providing smoking cessation counselling in the UK. OBJECTIVES: The purpose of this study was to determine quit rates for smokers with chronic periodontitis who were referred to a dental hospital for treatment. MATERIALS AND METHODS: Forty-nine subjects with chronic periodontitis who smoked cigarettes were recruited. All subjects received periodontal treatment and smoking cessation advice as part of an individual, patient-based programme provided by dental hygienists trained in smoking cessation counselling. Smoking cessation interventions included counselling (all patients), and some patients also received nicotine replacement therapy (NRT) and/or Zyban medication. Smoking cessation advice was given at each visit at which periodontal treatment was undertaken (typically four to six visits) over a period of 10-12 weeks. Smoking cessation advice was also given monthly during the programme of supportive periodontal care over the following nine months. Smoking status was recorded at three, six and 12 months and was confirmed with carbon monoxide (CO) monitors and salivary cotinine assays. RESULTS: Forty-one per cent, 33%, 29% and 25% of patients had stopped smoking at week four, months three, six and 12, respectively. Gender, age, the presence of another smoker in the household, and baseline smoking status (determined using subject-reported pack years of smoking) were not significant predictors of quit success (P < 0.05). Baseline CO levels were significantly associated with quit success, however, and were significantly higher in those subjects who continued to smoke compared to those subjects who were quitters at week four, month three and month six (P < 0.05). CONCLUSION: Success rates in quitting smoking following smoking cessation advice given as part of a periodontal treatment compared very favourably to national quit rates achieved in specialist smoking cessation clinics. The dental profession has a crucial role to play in smoking cessation counselling, particularly for patients with chronic periodontitis.     

Association between passive and active smoking evaluated by salivary cotinine and periodontitis

AIM: This study attempted to determine the relationship between passive and active smoking on the basis of salivary cotinine levels and periodontitis severity. METHODS: Japanese workers (n=273) were surveyed via an oral examination, a self-administered questionnaire and collection of whole saliva. Probing pocket depth (PPD) and clinical attachment level (CAL) served as periodontal parameters. Periodontitis was defined as the presence of two or more teeth with PPD > or =3.5 mm and CAL > or =3.5 mm. Salivary cotinine was determined using ELISA. Statistical methods included Wilcoxon's rank-sum test and multiple logistic regression analysis. RESULTS: Based on the results of receiver-operating characteristic plots for cotinine-level classification derived from self-reported smoking status, non-, passive and active smokers were defined as those subjects exhibiting cotinine levels of 0, 1-7 and > or =8 ng/ml, respectively. Numbers of teeth displaying CAL > or =3.5 mm in passive and active smokers were significantly higher than those in non-smokers. Multiple logistic regression analysis revealed significantly higher periodontitis odds ratios in passive and active smokers relative to non-smokers following adjustment for other lifestyle factors; odds ratios were 2.87 [95% confidence interval (CI); 1.05-7.82] and 4.91 (95% CI; 1.80-13.35), respectively. CONCLUSION: These findings suggest that passive smoking classified in terms of salivary cotinine level may be an independent periodontitis risk indicator.     

Influence of smoking on marginal bone loss and tooth loss--a prospective study over 20 years

AIMS: The aim was to investigate the influence of smoking on longitudinal marginal bone loss and tooth loss in a prospective study over 20 years. In addition, the effect of cessation of smoking on bone loss and the interaction between smoking, plaque and marginal bone loss were evaluated. MATERIAL AND METHODS: A total of 507 dentate individuals from an epidemiological study were examined in 1970 and 1990. The clinical investigation included registration of number of remaining teeth and presence of plaque. The marginal bone level was determined by assessments on the proximal surfaces on the radiographs from 1970 and 1990. The marginal bone loss was defined as the difference in marginal bone level over 20 years. The subjects were interviewed about smoking habits. Stepwise multiple regression analyses were adopted to calculate the influence of the independent variables on longitudinal marginal bone loss and tooth loss. RESULTS: In 1970, 50.7% of the subjects were smokers, while the corresponding relative frequency in 1990 had decreased to 31.0%. Smoking was significantly correlated to an increased marginal bone loss over 20 years. Individuals who stopped smoking between 1970 and 1990 lost significantly less marginal bone during this period than those who declared that they smoked during the 20-year period. Smoking was not found to be significantly correlated to tooth loss over 20 years. CONCLUSIONS: The results support the hypothesis that smoking is a significant risk factor of periodontal disease.     

Effects of smoking on periodontal tissues

BACKGROUND/AIMS: Most studies about the association between tobacco and periodontal disease have shown that tobacco negatively affects periodontal tissues, although some authors have failed to demonstrate such association. Very few studies have tried to find out whether the effect of tobacco on periodontal tissues was similar for women and men. The aims of this investigation were to confirm the possible relationship between tobacco consumption and periodontitis, to study the correlation between intensity of smoking and disease severity, and to investigate any differences between genders related to the effects of tobacco consumption in periodontal health. MATERIAL AND METHODS: In this case-control study, 240 dental patients were selected according to previously defined criteria and were divided in two groups according to their periodontal status. Patients with established periodontitis constituted the case group. The remaining patients constituted the control group. Smoking status, probing depth, gingival recession, clinical attachment level, tooth mobility, periodontal bleeding index and plaque index were determined for each participant. Generated data were processed for statistical analysis using multiple comparisons, covariance analysis and logistic regression analysis. RESULTS: Logistic regression analysis showed that smokers had 2.7 times and former smokers 2.3 times greater probabilities to have established periodontal disease than non-smokers, independent of age, sex and plaque index. Among cases, probing depth, gingival recession and clinical attachment level were greater in smokers than in former smokers or non-smokers, whereas plaque index did not show differences. Bleeding on probing was less evident in smokers than in non-smokers. There was a dose-effect relationship between cigarette consumption and the probability of having advanced periodontal disease. The association between tobacco smoking and periodontal disease was more evident after 10 years of smoking, independent of age, gender and plaque index. Finally, it was observed that tobacco affected periodontal tissues more severely in men than in women. CONCLUSIONS: Smoking is a risk factor strongly associated with periodontitis. The effects of smoking on periodontal tissues depend on the number of cigarettes smoked daily and the duration of the habit. The effect of tobacco on periodontal tissues seems to be more pronounced in men than in women.     

Smoking, a weak predictor of periodontitis in older adults

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.     

Cigarette Smoking,Tooth Loss,and Chronic Obstructive Pulmonary Disease: Findings From the Behavioral Risk Factor Surveillance System

Background: Cigarette smoking and tooth loss are seldom considered concurrently as determinants of chronic obstructive pulmonary disease (COPD). This study examines the multiplicative effect of self‐reported tooth loss and cigarette smoking on COPD among United States adults aged ≥18 years. Methods: Data were taken from the 2012 Behavioral Risk Factor Surveillance System (n = 439,637). Log‐linear regression–estimated prevalence ratios (PRs) are reported for the interaction of combinations of tooth loss (0, 1 to 5, 6 to 31, or all) and cigarettes smoking status (never, former, or current) with COPD after adjusting for age, sex, race/ethnicity, marital status, educational attainment, employment, health insurance coverage, dental care utilization, and diabetes. Results: Overall, 45.7% respondents reported having ≥1 teeth removed from tooth decay or gum disease, 18.9% reported being current cigarette smokers, and 6.3% reported having COPD. Smoking and tooth loss from tooth decay or gum disease were associated with an increased likelihood of COPD. Compared with never smokers with no teeth removed, all combinations of smoking status categories and tooth loss had a higher likelihood of COPD, with adjusted PRs ranging from 1.5 (never smoker with 1 to 5 teeth removed) to 6.5 (current smoker with all teeth removed) (all P <0.05). Conclusions: Tooth loss status significantly modifies the association between cigarette smoking and COPD. An increased understanding of causal mechanisms linking cigarette smoking, oral health, and COPD, particularly the role of tooth loss, infection, and subsequent inflammation, is essential to reduce the burden of COPD. Health providers should counsel their patients about cigarette smoking, preventive dental care, and COPD risk.