The effect of cigarette smoking on the severity of periodontal disease among older Thai adults

BACKGROUND: The aim of this study is to determine the effect of cigarette smoking on the severity of periodontitis in a cross-sectional study of older Thai adults. METHODS: The study population consisted of 1,960 subjects (age 50 to 73 years old). All subjects received both medical and dental examinations. Periodontal examinations, including plaque score, probing depth, and clinical attachment level, were done on all teeth present in two diagonal quadrants. Sociodemographic characteristics and smoking status were obtained by questionnaires. Multinomial logistic regression was used to address the association between cigarette consumption and mean clinical attachment level. RESULTS: In this study population, 48.7% were non-smokers, 14.4% were current smokers, and 36.9% were former smokers. Current smokers had higher percentage of sites with plaque, deeper mean probing depth, and greater mean clinical attachment level than former smokers and non-smokers. The odds of having moderate and severe periodontitis for current smokers were 1.7 and 4.8 times greater than non-smokers, respectively. Former smokers were 1.8 times more likely than non-smokers to have severe periodontitis. Quitting smoking reduced the odds of having periodontitis. For light smokers (<15 packyear), the odds for severe periodontitis reverted to the level of non-smokers when they had quit smoking for > or =10 years. For moderate and heavy smokers (> or =15 packyear), the odds of having severe periodontitis did not differ from those of non-smokers when they had quit smoking for > or =20 years. CONCLUSIONS: There was a strong association between cigarette smoking and the risk of periodontitis among older Thai adults. Quitting smoking appears to be beneficial to periodontal health.     

Longitudinal association between plaque and gingival bleeding in smokers and non-smokers

BACKGROUND/AIMS: Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site-specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non-smoking young adults. METHODS: 65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non-smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site-specific analyses considering the correlated structure of data were performed. RESULTS: At the outset and after 6 months, smokers had significantly more supragingival plaque than non-smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site-by-site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non-smokers (median Mantel-Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non-bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking. CONCLUSIONS: In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non-bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.     

Tobacco smoking and periodontal health in a Saudi Arabian population

BACKGROUND & AIM: Tobacco smoking exerts a harmful effect on the periodontal tissues manifested by periodontal pockets, attachment loss and periodontal bone loss. Current evidences on the effects of tobacco on periodontal health mainly concern cigarette smoking. In view of the increasing popularity of water pipe smoking in Arabian countries and reports confirming that water pipe smoking has health effects similar to those of cigarette smoking, there is a need for a better understanding of the potential harm of this smoking habit. The present thesis was carried out in order to explore whether water pipe smoking is associated with periodontal health in a manner similar to cigarette smoking. MATERIAL & METHODS: Residents in Jeddah City, Saudi Arabia, were invited to participate in the study by means of announcements in two daily newspapers. 355 individuals, 100 women and 255 men (17-60 years) responded to a standardized questionnaire and digital panoramic dental radiographs were taken. The questionnaire included information about oral hygiene practices, dental care and smoking habits. Of these subjects, 262 (73%) also volunteered for clinical examination, including assessments of oral hygiene, gingival inflammation and probing depth. Subgingival microbial test was carried out in 198 individuals for the detection of 12 different bacterial species most commonly associated with periodontal disease using the checkerboard DNA-DNA hybridization technique. Participants were stratified into water pipe smokers 33%, cigarette smokers 20%, smokers of both water pipe and cigarettes (mixed smokers 19%) and non-smokers 28%. RESULTS: Tobacco smoking is associated with a suppression of the gingival bleeding response to plaque accumulation. A suppressive effect was observed in both cigarette and water pipe smokers compared to non-smokers (Study I). Both cigarette and water pipe smoking were associated with the presence of more than 10 pockets of > or = 5 mm probing depth. The relative risk for periodontal disease was 5.1-fold and 3.8-fold increased in water pipe and cigarette smokers, respectively, compared to non-smokers (p < 0.01). The relative risk associated with heavy smoking was about 8-fold elevated in water pipe smokers and 5-fold elevated in cigarette smokers, suggesting an exposure-response effect (Study II). Tobacco smoking was associated with a reduction of the periodontal bone height. The reduction was of similar magnitude in water pipe smokers and cigarette smokers. The relative risk of periodontal bone loss of more than 30% of the root length was 3.5-fold and 4.3-fold elevated in water pipe and cigarette smokers, respectively, compared to non-smokers (p < 0.01). The relative risk associated with heavy smoking was 7.5-fold elevated in water pipe smokers and 6.3-fold elevated cigarette smokers (Study III). Further more, cigarette smokers, water pipe smokers and non-smokers exhibited similar periodontal microflora (Study IV). CONCLUSION: Tobacco smoking is associated with inferior periodontal health. The impact of water pipe smoking is of largely the same magnitude as that of cigarette smoking. The association between tobacco smoking and an inferior periodontal health seems to be independent of the subgingival microflora. Water pipe smoking habit should be considered in periodontal health.     

The effect of different types of smoking habits on periodontal attachment

The association between different types of smoking (cigarette, Shesha and Argela) and periodontal attachment loss was investigated in the Riyadh area. The study group included 150 subject 20-60 years of age. Of this, 27.5% were cigarette smokers, 20.3% were Shesha smokers, 20.3% were Argela smokers, and 32% were non-smokers (females 24.2%: 74% males). The study was based on clinical examination, periodontal parameters recorded by one examiner (AS) and included measurement of pocket depth (PD 1) followed by measurement of recession from the CEJ to gingival margin (GR 2). Attachment loss (AL) was calculated by adding recession or by subtracting gingival overgrowth to measurements of probing depth. The readings were taken from buccal and lingual surfaces of all teeth except third molars. The influence of age, sex and different types of smoking consumption on these periodontal parameters was statistically evaluated using an analysis of variance (ANOVA). The effect of smoking on periodontitis showed no association with sex, but it was associated with age. By performing both univariate and multivariate tests. P-value for smoking and periodontitis were GR (p = 0.0001), PD (p = 0.0001), and AL (p = 0.0001). The result showed that there is increased loss of attachment in smokers than non-smokers. However, when comparing Shesha smokers to cigarette smokers it was found that Shesha smokers had a greater attachment loss (p = 0.0001), recession (p= 0.0001) and deeper pocket depth (p = 0.001) than cigarette and Argela smokers. These findings suggest that all types of tobacco consumption increase periodontal disease severity and Shesha smoking had a greater effect than cigarette and Argela smoking on disease severity. This study confirms that tobacco is an important risk factor for periodontal disease. Since Shesha smoking is widely used among Saudi subjects of both sexes, additional studies should be conducted to study the effect of Shesha smoking on the periodontium.     

Risk of severe periodontal disease in a Swedish adult population

Abstract. In this study, potential risk factors for severe periodontal disease were identified in a cross-sectional sample from the county of Jönköping, Sweden, 547 adults 20–70 years of age were categorised clinically and radiographically by level of periodontal disease experience. These levels were used to divide the sample into groups – individuals without any reduction in periodontal bone level (60%) and those with severe periodontal bone loss (13%) – which were then used in univeriate and multivariate logistic regression analyses as dependent variable. Demographic, socio-economic, general health, smoking habits, clinical, and dental care variables were used in the different regression analyses. In the univariate model, age (20–70 years) was found to be correlated with more severe periodontal disease experience (odds ratio: 1.13; 95% CI; 1.10–1.17). The association with periodontal disease was more pronounced for the older age groups (50, 60, and 70 years), A negative financial situation was also related to severe periodontal bone loss when regressed univariately (odds ratio 2.20 [95%: 1.04–4.68]). Moderate-heavy smoking (3=10 cigarettes/day) appeared to be associated with severe periodontal destruction with an odds ratio of 9.78 (95% CI: 3.62–36.42), Of the clinical variables in the univariate model, higher mean levels of supragingival dental plaque and the presence of subgingival calculus were related to more severe periodontal disease with odds ratios of 1.02 (95%: 1.01–1.03) and 2.96 (95% 1.50–5.88), respectively When the same variables were regressed multivariately, age (continuous) (odds ratio 1.17 [95% CI: 1.12–1.22]). moderate-heavy smoking (odds ratio 11.84 [95% CI: 4.19–33.50]), and higher mean levels of plaque (odds ratio 1.02 [95% CI: 1.00–1.03]) remained significant. Light smoking (1–9 cigarettes/day) was not significantly associated with severe periodontal disease in the 2 regression models. The present study demonstrated that smoking, greater age, and higher mean levels of plaque are potential risk factors for severe periodontal disease in this specific population.     

Cigarette smoking and alveolar bone in young adults: a study using digitized radiographs

BACKGROUND: Evidence indicates that cigarette smoking is one of the most significant risk factors for periodontal diseases; however, there have been few radiographic prospective studies of alveolar bone in young populations. The purpose of this study was to evaluate the effect of smoking on alveolar bone in young adults. METHODS: Eighty-one dental students (mean age: 20.5 years), considered not to have periodontitis according to clinical criteria, participated in this study. Forty-two subjects were smokers (mean consumption was 14.1 cigarettes/day for > or =2 years), and 39 subjects had never smoked. A parallel-arm prospective design was used. All subjects took part in a dental hygiene program (DHP) that included oral hygiene instructions, mechanical debridement, and polishing. The following clinical variables were measured before and after the DHP: plaque index (PI), gingival crevicular fluid (GCF) flow rate, gingival index (GI), probing depth, and clinical attachment level (CAL). Standardized posterior vertical bitewing radiographs were taken and digitized preexperimentally and on days 180, 365, and 545. The following analyses were performed: bone height measurement (BHM), computer-assisted densitometric image analysis (CADIA), and qualitative analysis of digital subtraction radiography (DSR). Repeated-measures multiple-way analysis of variance (ANOVA) was performed between the groups, and one-way ANOVA was performed within the groups. RESULTS: The mean PI and GI were significantly greater in the smokers (P <0.01). The mean GCF flow rate was significantly lower in the smokers (P <0.01). CAL and the number of sites with recession were significantly greater in the smokers (P <0.001). The BHM indicated a significantly lower mean alveolar bone height in the smokers (P <0.01). The smokers showed significantly lower CADIA values, which indicated a lower bone density on days 0 (P <0.05), 180, 365, and 545 (P <0.01). CADIA values decreased during the study in the smokers, with significant differences on day 545 (P <0.05). The smokers had a significantly higher mean percentage of sites that had decreased density, as assessed by DSR (P <0.001). In the smokers, the mean percentage of sites with decreased density, as assessed by DSR, had increased significantly by days 365 (P <0.05) and 545 (P <0.01). CONCLUSIONS: Smoking produces an adverse effect on clinical periodontal variables and alveolar bone height and density, acting as a potential risk factor for alveolar bone loss, even at an early age with low tobacco consumption. It is very important to inform young smokers about the risk of this habit in relation to periodontal health.     

Tobacco smoking and periodontal health in a Saudi Arabian population

BACKGROUND: The objective of this study was to examine the association between tobacco smoking, in particular water pipe smoking, and periodontal health. METHODS: A total of 262 citizens of Jeddah, Saudi Arabia in the age range from 17 to 60 years volunteered to participate in the study. The clinical examinations were carried out at King Faisal Specialty Hospital and Research Center in Jeddah and included assessments of oral hygiene, gingival inflammation, and probing depth. Smoking behavior was registered through a questionnaire and confirmed by an interview. Participants were stratified into water pipe smokers (31%), cigarette smokers (19%), mixed smokers (20%), and non-smokers (30%). RESULTS: The mean probing depth per person was 3.1 mm for water pipe smokers, 3.0 mm for cigarette smokers, 2.8 mm for mixed smokers, and 2.3 mm for non-smokers. The association between smoking and probing depth was statistically significant controlling for age (P <0.001). The association between lifetime smoking exposure and mean probing depth was statistically significant in water pipe as well as cigarette smokers controlling for age (P <0.001). Using multivariate analysis, besides smoking, the gingival and plaque indexes were associated with increased probing depth. The prevalence of periodontal disease defined as a minimum of 10 sites with a probing depth > or =5 mm was 19.5% in the total population, 30% in water pipe smokers, 24% in cigarette smokers, and 8% in non-smokers. The prevalence was significantly greater in water pipe and cigarette smokers compared to non-smokers (P <0.001). The relative risk for periodontal disease increased by 5.1- and 3.8-fold in water pipe and cigarette smokers, respectively, compared to non-smokers (P <0.001 and P <0.05, respectively). CONCLUSIONS: An association was observed between water pipe smoking and periodontal disease manifestations in terms of probing depth measurements. The impact of water pipe smoking was of largely the same magnitude as that of cigarette smoking.     

Study of the patterns of periodontal destruction in smokers with chronic periodontitis.

Cigarette smoking is a well-established risk factor for periodontitis and carries an increased risk for loss of periodontal attachment as well as for bone loss. AIMS: The purpose of the study was to investigate the pattern of the intraoral distribution of periodontal destruction among cigarette smokers with periodontitis by assessing the periodontal probing depth (PPD) and clinical attachment level (CAL). MATERIALS AND METHODS: Thirty smokers with chronic periodontitis were enrolled in the study. PPD, CAL, plaque index (PI), and bleeding on probing (BOP) were measured. The data was pooled for the anterior sextant and the posterior sextant as well as for the facial and lingual surfaces. The degree of periodontal destruction was compared in these sextants. STATISTICAL ANALYSIS: Comparisons were made between maxillary anterior, maxillary posterior, mandibular anterior, and mandibular posterior using the one-way analysis of variance (ANOVA) test. When the overall ANOVA showed statistical significance, post hoc testing (Tukey-Kramer multiple comparisons test) was performed to explore the differences between any two groups. P -values < 0.05 were considered significant. RESULTS: The maxillary anterior sextant showed significantly higher PPD and CAL loss than the other sextants. Similarly, the maxillary palatal area showed higher probing depth and clinical attachment loss than the facial sites and the mandibular regions. CONCLUSIONS: From the results it can be concluded that there is variation in the periodontal tissue destruction in different areas of the oral cavity, with the maximum periodontal destruction in the maxillary palatal region. These observations emphasize the deleterious effects of smoking on the periodontal tissues.     

Periodontal Inflammatory Conditions Among Smokers and Never‐Smokers With and Without Type 2 Diabetes Mellitus

Background : There is a dearth of studies regarding the influence of cigarette smoking on periodontal inflammatory conditions among patients with type 2 diabetes mellitus (T2DM). The aim of the present study is to assess periodontal inflammatory conditions among smokers and never‐smokers with and without T2DM. Methods: One hundred individuals (50 patients with T2DM [25 smokers and 25 never‐smokers] and 50 controls [25 smokers and 25 never‐smokers]) were included. Information regarding age, sex, duration and daily frequency of smoking, duration and treatment of diabetes, and oral hygiene was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) were measured. Hemoglobin A1c (HbA1c) levels were also recorded. Results: Mean age, monthly income status, and education levels were comparable among smokers and never‐smokers with and without T2DM. Mean HbA1c levels were significantly higher among patients with T2DM (8.2% ± 0.1%) compared with controls (4.4% ± 0.3%) (P <0.05). Smokers in the control group were smoking significantly greater numbers of cigarettes (15.5 ± 2.5 cigarettes daily) compared with smokers with T2DM (6.2 ± 2.1 cigarettes daily) (P <0.05). Periodontal parameters were comparable among smokers and never‐smokers with T2DM. Among controls, periodontal parameters (PI [P <0.05], AL [P <0.05], PD ≥4 mm [P <0.05], and MBL [P <0.05]) were significantly higher in smokers than never‐smokers. Never‐smokers with T2DM had worse periodontal status than smokers and never‐smokers in the control group (P <0.05). Conclusions: Periodontal inflammatory conditions are comparable among smokers and never‐smokers with T2DM. Among controls, periodontal inflammation is worse among smokers than never‐smokers.     

Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey

BACKGROUND: The principal objectives of this study were to examine the relationship between cigarette smoking and periodontitis and to estimate the proportion of periodontitis in the United States adult population that is attributable to cigarette smoking. METHODS: Data were derived from the Third National Health and Nutrition Examination Survey, a nationally representative multipurpose health survey conducted in 1988 to 1994. Participants were interviewed about tobacco use and examined by dentists trained to use standardized clinical criteria. Analysis was limited to dentate persons aged > or =18 years with complete clinical periodontal data and information on tobacco use and important covariates (n = 12,329). Data were weighted to provide U.S. national estimates, and analyses accounted for the complex sample design. We defined periodontitis as the presence of > or =1 site with clinical periodontal attachment level > or =4 mm apical to the cemento-enamel junction and probing depth > or =4 mm. Current cigarette smokers were those who had smoked > or =100 cigarettes over their lifetime and smoked at the time of the interview; former smokers had smoked > or =100 cigarettes but did not currently smoke; and never smokers had not smoked > or =100 cigarettes in their lifetime. RESULTS: We found that 27.9% (95% confidence interval [CI]: +/-1.8%) of dentate adults were current smokers and 23.3% (95% CI: +/-1.2%) were former smokers. Overall, 9.2% (95% CI: +/-1.4%) of dentate adults met our case definition for periodontitis, which projects to about 15 million cases of periodontitis among U.S. adults. Modeling with multiple logistic regression revealed that current smokers were about 4 times as likely as persons who had never smoked to have periodontitis (prevalence odds ratio [ORp] = 3.97; 95% CI, 3.20-4.93), after adjusting for age, gender, race/ethnicity, education, and income:poverty ratio. Former smokers were more likely than persons who had never smoked to have periodontitis (ORp = 1.68; 95% CI, 1.31-2.17). Among current smokers, there was a dose-response relationship between cigarettes smoked per day and the odds of periodontitis (P <0.000001), ranging from ORp = 2.79 (95% CI, 1.90-4.10) for < or =9 cigarettes per day to ORp = 5.88 (95% CI, 4.03-8.58) for > or =31 cigarettes per day. Among former smokers, the odds of periodontitis declined with the number of years since quitting, from ORp = 3.22 (95% CI, 2.18-4.76) for 0 to 2 years to ORp = 1.15 (95% CI, 0.83-1.60) for > or =11 years. Applying standard epidemiologic formulas for the attributable fraction for the population, we calculated that 41.9% of periodontitis cases (6.4 million cases) in the U.S. adult population were attributable to current cigarette smoking and 10.9% (1.7 million cases) to former smoking. Among current smokers, 74.8% of their periodontitis was attributable to smoking. CONCLUSIONS: Based on findings from this study and numerous other reports, we conclude that smoking is a major risk factor for periodontitis and may be responsible for more than half of periodontitis cases among adults in the United States. A large proportion of adult periodontitis may be preventable through prevention and cessation of cigarette smoking.     

Effect of smoking on periodontal health in molar teeth

BACKGROUND: It is generally accepted that the primary cause of periodontitis is bacterial infection of long duration. In addition, there are several risk factors that may increase the probability and severity of periodontitis. For example, an increased breakdown of alveolar bone has been observed in smokers compared to never-smokers. The objective of this study was to investigate the association between cigarette smoking and periodontal health, in particular, furcation involvement in molar teeth. METHODS: One hundred twenty (120) adult regular dental patients, presenting with at least 20 teeth each, third molars excluded, were evaluated. Sixty of the subjects consumed an average (+/- SD) of 16.8 +/- 3.8 cigarettes daily and had smoked for 21.4 +/- 5.7 years. The remaining subjects presented a negative history of smoking. Periodontal conditions for the molar teeth were recorded at the first and second mandibular molar buccal furcation area. RESULTS: Oral hygiene standards and dental care habits did not differ notably between smokers and never-smokers. Smokers exhibited significantly fewer molar teeth than never-smokers (2.2 +/- 1.1 versus 3.0 +/- 0.8; P<0.01). Also, smokers exhibited significantly advanced gingival recession, probing depth, clinical attachment loss, furcation involvement, and tooth mobility compared to never-smokers (P<0.01). CONCLUSIONS: The results of this study suggest that long-term cigarette smoking significantly worsens periodontal health including degree and incidence of furcation involvement in molar teeth.     

The influence of gingival dimensions on bleeding upon probing in young adults with plaque-induced gingivitis

In both cross-sectional and longitudinal studies of young adults with plaque-induced gingivitis it has been observed that bleeding upon probing is only weakly associated with supragingival plaque. It has been speculated that gingival bleeding may be influenced by several independent factors other than plaque. Great intra- and interindividual variation of gingival thickness and width has been reported. Based on respective observations, the existence of different gingival phenotypes has been suggested. The aim of the present study was to investigate the possible influence of gingival thickness and width on bleeding on probing. Forty young adults with mild, plaque-induced gingivitis, 24 non-smokers and 16 smokers, participated in this cross-sectional study. In addition to periodontal probing depth, clinical attachment loss, width of gingiva, bleeding on probing, and presence of plaque, gingival thickness was measured with an ultrasonic device. Multivariable models were separately calculated for buccal, mandibular lingual, and palatal surfaces and generally adjusted for tooth type. Generalised Estimation Equation methodology was employed in order to adjust for correlated observations. Plaque was significantly associated with bleeding upon probing only at buccal sites (odds ratio 1.80, 95% confidence interval 1.19-2.72) An influence of similar magnitude was identified for smoking (odds ratio 1.76; 1.07-2.89). At lingual sites in the mandible, bleeding was influenced by smoking (odds ratio 2.25; 1.18-4.25) and gingival thickness (odds ratio for thick gingiva >1 mm of 1.93; 1.02-3.65), but not plaque. At palatal sites, only periodontal probing depth had an influence (odds ratio 1.89; 1.25-2.84). It was concluded that, apart from supragingival plaque, smoking was an independent risk factor for gingival bleeding on probing. Thin and vulnerable gingiva of insufficient width was not more likely to bleed after probing than thicker tissue.     

Aggressive periodontitis among young Israeli army personnel

BACKGROUND: The aim of this study was to assess the prevalence of aggressive periodontitis among young Israeli army recruits and to evaluate its association with smoking habits and ethnic origin. METHODS: The study population consisted of 642 young army recruits (562 men [87.5%] and 80 women [12.5%]), aged 18 to 30 years (average: 19.6 +/- 1.6 years), who arrived at a military dental clinic for dental examinations between January and December 2004. Subjects filled out a questionnaire regarding their ethnic origin and family periodontal history, followed by radiographs and a clinical periodontal examination of four first molars and eight incisors. RESULTS: Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). At least one site with a probing depth > or =5 mm was found in 20.1% of the subjects. A radiographic distance between crestal bone height and the cemento-enamel junction >3 mm was found in 43 (6.7%) subjects. Current smokers (39.9%) (P = 0.03) and subjects of North African origin (P <0.0001) correlated with a high prevalence of aggressive periodontitis. CONCLUSION: A relatively high prevalence of aggressive periodontitis was found in young Israeli army recruits, which was particularly associated with smoking and ethnic origin.     

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.     

Relationship between smoking status and periodontal conditions: findings from national databases in Japan

BACKGROUND AND OBJECTIVE: The association between cigarette smoking and periodontitis was examined employing two nationally representative samples of adults in Japan. MATERIAL AND METHODS: Data were derived from the Survey of Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999. In the SDD, periodontal conditions were evaluated by calibrated dentists utilizing the Community Periodontal Index (CPI), whereas in the NNS, participants were interviewed on the basis of smoking status by enumerators. Among 6805 records electronically linked via a household identification code, 4828 records of individuals aged 20 yr or older were analyzed. RESULTS: The prevalence of periodontal disease varied significantly by smoking status (p < 0.0001): 39.3%, 49.5% and 47.3% (CPI > or = 3), and 7.9%, 11.7% and 12.4% (a more severe form of periodontitis, CPI = 4), for nonsmokers, former smokers and current smokers, respectively. In adults aged > or = 40 yr (n = 3493), logistic regression models revealed greater probabilities (approximately 1.4 times higher) of periodontitis [CPI > or = 3, odds ratio = 1.38 (1.12-1.71), p = 0.0024] and a more severe form of periodontitis [odds ratio = 1.40 (1.04-1.89), p = 0.0288] in current smokers compared with nonsmokers, following adjustment for possible confounding factors. CONCLUSION: Based on the findings of this study and other numerous reports, cigarette smoking leads to deterioration of periodontal conditions in Japanese adults.     

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.     

Comparison of Clinical and Radiographic Periodontal Status Between Habitual Water‐Pipe Smokers and Cigarette Smokers

Background: There is a dearth of studies that have compared clinical and radiologic markers of periodontal inflammation between water‐pipe smokers (WPs) and cigarette smokers (CSs). The aim of the present study is to compare the clinical and radiographic periodontal status between habitual WPs and CSs. Methods: In total, 200 males (50 WPs, 50 CSs, and 100 controls) with comparable mean age and education were included. Demographic information was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) and numbers of missing teeth (MT) were recorded. Results: The duration of each smoking session for WPs and CSs was 50.2 ± 6.7 and 15.3 ± 0.4 minutes, respectively. Number of MT [P <0.0001], PI [P <0.0001], AL [P <0.0001], PD ≥4 mm [P <0.0001], and MBL [P <0.0001]) was significantly higher among WPs and CSs than controls. BOP was significantly higher among controls than WPs (P <0.0001) and CSs (P <0.0001). There was no statistically significant difference in the aforementioned parameters between WPs and CSs. Conclusions: Males in a Saudi Arabian community who were CSs or WPs had more MT and poorer periodontal condition than never smokers. The periodontal condition of WPs was equally as poor as CSs. Additional clinical observational studies with emphasis on sex and sociodemographic characteristics are needed.     

Multivariate multilevel models for repeated measures in the study of smoking effects on the association between plaque and gingival bleeding

Multivariate multilevel modeling was applied to analyze repeated measures data on the influence of heavy smoking on the association between the amount of supragingival plaque and gingival bleeding on probing (BOP) in a steady-state plaque environment. Data acquired in 65 systemically healthy young adults with mild plaque-induced gingivitis were analyzed. 33 heavy smokers consumed at least 20 cigarettes per day while 32 were non-smokers. Periodontal examinations at the outset consisted of periodontal probing depth, clinical attachment level, BOP, plaque index, and presence of calculus at 6 sites of every tooth present. They were repeated 3 times every 8 weeks. A multivariate 4-level variance component model revealed that the odds of BOP was twice as high in smokers. In addition, females had a lower likelihood for BOP but, with increasing bleeding scores during the course of the study, this effect attenuated. Low biserial correlations for BOP at the site level of between 0.11 and 0.2 were found. At the tooth level, correlations were moderate (0.2–0.5), and highest at the subject level (0.8–0.9). Variations at subject and tooth levels were very large at the outset but notably attenuated in the course of the study. Plaque consistently influenced the tendency for BOP with an odds ratio of about 1.7–1.8 for each increase in score in both smokers and non-smokers. The present study did not reveal evidence for attenuation of the plaque/gingival bleeding relationship in heavy smokers.     

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.     

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.