Cigarette smoking and periodontal bone loss

The association between smoking and loss of periodontal bone height was investigated in Swedish dental hygienists. The study group included 210 subjects: 24 to 60 years of age, 30% smokers, 32% former smokers, and 38% non-smokers. The study was based on bite-wing radiographs, where loss of the interproximal bone height was measured as the distance from the cemento-enamel junction (CEJ) to the interdental septum (IS). The magnitude of the CEJ-IS distance was read at 12 sites, representing 3 maxillary and 3 mandibular bone septa in each subject. The CEJ-IS distance was significantly greater for smokers when compared to non-smokers, mean +/- SEM 1.71 +/- 0.08 mm and 1.45 +/- 0.04 mm, respectively. The mean +/- SEM for former smokers was 1.55 +/- 0.05 mm. In smokers, the CEJ-IS distance increased with increased smoking exposure. The results, based on adults with good oral hygiene, suggest that loss of periodontal bone is related to smoking. The smoking related bone loss is not correlated with plaque infection.     

Tobacco smoking and periodontal bone height in a Saudi Arabian population

AIM: To study the association between tobacco smoking, in particular water pipe smoking, and periodontal bone height. METHODS: A study sample of 355 individuals in the age range 17-60 years was recruited from Jeddah, Saudi Arabia. The smoking behavior was registered through a questionnaire during interview. Participants were stratified into water pipe smokers (33%), cigarette smokers (20%), mixed smokers (19%) and non-smokers (28%). The periodontal bone height was measured from digital panoramic radiographs mesially and distally to each tooth and expressed as a percentage of the root length. RESULTS: The mean periodontal bone height was 76.2% for water pipe smokers, 75.8% for cigarette smokers, 80.2% for mixed smokers and 80.9% for non-smokers. The association between smoking and mean bone height was statistically significant controlling for age (p<0.001). The association between life-time smoking exposure and mean bone height controlling for age was statistically significant in water pipe smokers and cigarette smokers (p<0.01). The prevalence of bone loss in excess of 30% of the bone height was 27% in water pipe smokers, 24% in cigarette smokers, 9% in mixed smokers and 6% in non-smokers. The prevalence was significantly greater in water pipe smokers and cigarette smokers compared with non-smokers (p<0.001). The relative risk of periodontal bone loss associated with water pipe and cigarette smoking after adjustment for age was 3.5-fold and 4.3-fold elevated, respectively, compared with non-smoking (p<0.01). CONCLUSION: An association between tobacco smoking and periodontal bone height reduction is observed. The impact of water pipe smoking is of the same magnitude as that of cigarette smoking.     

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.     

Effect of cigarette smoking on periodontal status of healthy young adults

BACKGROUND: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population. METHODS: The study population consisted of 304 young Caucasian males (average age 19.38 +/- 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBI); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and non-smokers. RESULTS: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once a year. Over half (53%) were habitual smokers, 43% smoking between 5 and 20 cigarettes per day; 39% of the smokers had been smoking for less than 5 years. Mean PI was 31.24 +/- 14.88 (27.19 +/- 15.93 for smokers and 35.78 +/- 12.17 for non-smokers), with significant differences between non-smokers and those who smoked 5 to 20 cigarettes per day (26.85 +/- 16.11, P<0.0001). Mean PBI was 42.29 +/- 8.43 (non-smokers 44.67 +/- 6.53 and smokers 40.17 +/- 9.46). Significant differences were found between the PBI of the non-smokers and of those who smoked 5 to 20 cigarettes per day (39.90 +/- 9.64, P <0.0001). There were also differences in the PBI between those who brushed their teeth once (40.53 +/- 9.61) and twice (44.86 +/- 5.9) a day (P<0.0001). Mean PD was 1.62 +/- 0.43 mm (non-smokers 1.56 +/- 0.36 and smokers 1.68 +/- 0.49). Deeper probing depths were recorded among smokers than among non-smokers, with statistically significant differences (P<0.049); statistically significant differences were also found between those who attended (1.49 +/- 0.50) and those who did not attend (1.65 +/- 0.42) regular dental check-ups (P<0.031). Mean CAL 1.75 +/- 0.41 (non-smokers 1.64 +/- 0.32 and smokers 1.82 +/- 0.44). CONCLUSIONS: It may be concluded that, even at such an early age, tobacco consumption affects the periodontal health. It is necessary to inform young smokers of the risk of tobacco use regarding periodontal health.     

A 10-year prospective study of tobacco smoking and periodontal health

BACKGROUND: To date only a few studies have evaluated the long-term influence of smoking and smoking cessation on periodontal health. The present study, therefore, was undertaken with the aim to prospectively investigate the influence of smoking exposure over time on the periodontal health condition in a targeted population before and after a follow-up interval of 10 years. METHODS: The primary study base consisted of a population of occupational musicians that was investigated the first time in 1982 and scheduled for reinvestigation in 1992 and 2002. The 1992 investigation included 101 individuals from the baseline study constituting a prospective cohort including 16 smokers, who had continued to smoke throughout the entire length of the 10-year period; 28 former smokers who had ceased smoking an average of approximately 9 years before the commencement of the baseline study; 40 non-smokers, who denied ever having smoked tobacco; and 17 individuals whose smoking pattern changed or for whom incomplete data were available. The clinical and radiographic variables used for the assessment of the periodontal health condition of the individual were frequency of periodontally diseased sites (probing depth > or =4 mm), gingival bleeding (%), and periodontal bone height (%). The oral hygiene standard was evaluated by means of a standard plaque index. RESULTS: The changes over the 10 years with respect to frequency of diseased sites indicated an increased frequency in continuous smokers versus decreased frequencies in former smokers and non-smokers. Controlling for age and frequency of diseased sites at baseline, the 10-year change was significantly associated with smoking (P <0.001). The differences between current smokers and non-smokers, and between current and former smokers, respectively, were statistically significant (P<0.001). Moreover, the 10-year change increased significantly with increasing smoking exposure controlling for age (P= 0.01). In terms of periodontal bone height, the 10-year changes implied statistically significant reductions within current as well as former smokers (P <0.001 and P <0.05, respectively), but not within non-smokers. The overall change was significantly associated with smoking controlling for age and bone height level at baseline (P<0.01), including statistically significant differences between current smokers and non-smokers and between current and former smokers, respectively (P<0.05). Moreover, the 10-year bone height reduction increased significantly with increasing smoking exposure controlling for age (P <0.05). With regard to gingival bleeding, the 10-year differences between smoking groups were not statistically significant. Plaque index remained low throughout in all smoking groups at an overall average level of about 0.8. CONCLUSIONS: The results suggest that periodontal health is compromised by chronic smoking as evidenced by an increase of periodontally diseased sites concomitant with loss of periodontal bone height, as compared to non-smokers whose periodontal health condition remained unaltered throughout the 10-year period of investigation. The periodontal health condition in former smokers, similar to that of non-smokers, remained stable, suggesting that smoking cessation is beneficial to periodontal health.     

Influence of smoking on the outcome of periodontal surgery

Abstract. The 5-year outcome following periodontal surgery was evaluated in 57 patients that had received regular maintenance care throughout the follow-up period. The study population included 20 smokers, 20 former smokers and 17 non-smokers in the age range 37–77 years. The clinical characteristics evaluated were supragingival plaque, gingival bleeding and pocket probing depth. The region assigned for surgery was, in addition, radiographically evaluated in terms of periodontal bone height. Furthermore, the occurrence of the periopathogens Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg) and Prevotella intermedia (Pi) and the gingival crevicular fluid (GCF) levels of tumor necrosis factor alpha (TNF-α) were assessed at follow-up. Plaque index was 28.5% at baseline and 32.9% at follow-up, indicating a good standard of oral hygiene, and gingival bleeding 31.7% and 24.9%, respectively, suggesting a low to moderate level of gingival inflammation. In regions assigned for surgery, pocket probing depth decreased significantly from on average 5.6 mm to 4.3 mm ( p <0.0001) and periodontal bone height increased significantly from on average 62.5% to 67.5% ( p <0.0001). In terms of bone height, the outcome was less favorable among smokers compared with non-smokers. There was a predominance of smokers among patients exhibiting loss of bone height after the 5 years of maintenance. No significant associations were found between the therapeutical outcome and supragingival plaque or subgingival occurrence of periopathogens. The associations between GCF levels of TNF-α and probing depth and bone height were unclear, whereas the level of TNF-α was significantly elevated in smokers.     

The association of cigarette smoking with alveolar bone loss in postmenopausal females

BACKGROUND, AIMS: The purpose of this 2-year longitudinal clinical study was to determine the impact of smoking on alveolar bone height and density changes in postmenopausal females. METHODS: 59 postmenopausal women completed this study, including 38 non-smokers and 21 smokers. All subjects had a history of periodontitis, participated in 3- to 4-month periodontal maintenance programs and were within 5 years of menopause at the study outset. 4 vertical bite-wing radiographs of posterior sextants were taken at baseline and 2-year visits. Radiographs were evaluated using computer-assisted densitometric image analysis (CADIA); changes in interproximal alveolar bone density and changes in alveolar bone height were determined. Relative clinical attachment levels (RCAL) and presence/absence of plaque and bleeding on probing were recorded. RESULTS: Smokers exhibited a higher frequency of alveolar bone height loss (p<0.05) and crestal (p<0.03) and subcrestal (p<0.02) density loss relative to non-smokers. Smokers exhibited a trend (p<0.08) toward a higher frequency of > or =2.0 mm RCAL loss over the 2-year period. Plaque and bleeding on probing did not differ between smokers and non-smokers. A significant interaction, determined by repeated measures ANOVA, was noted between systemic bone mineral density (BMD) at the lumbar spine and smoking on alveolar bone density change (p<0.05). Only non-smoking patients with normal BMD realized a mean net gain in alveolar bone density; osteoporotic/osteopenic subjects (n=25) and smokers lost alveolar bone density. CONCLUSION: Postmenopausal female smokers were more likely to lose alveolar bone height and density than non-smokers with a similar periodontitis, plaque and gingival bleeding experience. In addition, both smoking and osteoporosis/osteopenia provided a negative influence on alveolar bone.     

Exposure to tobacco smoking and periodontal health

BACKGROUND: The influence of smoking behavior on the periodontal health condition was clinically and radiographically studied in 257 dentally aware adults in the age range 20-69 years, including 50 current smokers, 61 former smokers and 133 non-smokers. AIMS: The clinical variables to be investigated were frequency of diseased sites > or =4 mm, frequency of gingival bleeding sites and plaque index. In addition, the periodontal bone height was radiographically assessed as a % of the dental root length. METHODS: All variables were based on full-mouth examinations including all teeth and periodontia. RESULTS: The observations indicated an inferior periodontal health condition associated with smoking. This was evidenced by a significantly greater frequency of diseased sites and a significantly greater reduction of periodontal bone height in current smokers as compared to non-smokers. The condition of former smokers was intermediate between current smokers and non-smokers, suggesting that former smokers who have quit smoking have a better periodontal health condition than current smokers, although worse than that of non-smokers. The finding that former smokers exhibited less disease than current smokers suggests that smoking cessation may be beneficial and mitigate the untoward effects inflicted by smoking, allowing a normalization towards non-smoker conditions. Heavy exposure was consistently associated with more severe a condition than light exposure, suggesting that the relationship between smoking exposure and periodontal morbidity is dose-dependent. CONCLUSIONS: Altogether, the present observations identify a negative impact from smoking on periodontal health and provide further evidence that tobacco smoking is an avoidable risk for periodontal disease.     

Influence of tobacco smoking on periodontal bone height. Long-term observations and a hypothesis

AIM: The aim of the investigation was to estimate the magnitude of the long-term influence of chronic smoking on the periodontal bone height. METHODS: The study population included 19 continuous smokers, 28 former smokers and 44 non-smokers in the age range 20-60 years at baseline. The participants were examined at two points in time with an interval of 10 years. The height of the periodontal bone was determined from bite-wing radiographs of the first and second premolars of the maxilla and the mandible and measured from the cemento-enamel junction (CEJ) to the periodontal bone crest (PBC) mesially and distally to the preselected teeth. RESULTS: The mean (SD) CEJ-PBC distance at baseline was 1.82 (1.01) mm for smokers, 1.65 (0.81) mm for former smokers, and 1.16 (0.59) mm for non-smokers (p=0.016). The mean (SD) 10-year bone height reduction was 0.74 (0.59) mm for smokers as against 0.26 (0.31) mm for former smokers and 0.27 (0.29) mm for non-smokers. Controlling for age and baseline bone height level, the magnitude of the reduction was significantly dependent of smoking (p=0.000). The widening gap between smokers and non-smokers over time suggested that the bone height reduction of smokers took place at an accelerated rate. CONCLUSION: On the basis of the observations it is hypothesized that smoking induces an acceleration of the periodontal bone height reduction rate and that smoking cessation results in a return towards non-smoker rate.     

Longitudinal study of predictive factors for periodontal disease and tooth loss

Longitudinal assessment of risk factors for periodontal disease is necessary to provide evidence that a putative risk factor or risk indicator is a true risk factor. The purpose of the present study was to explore longitudinally a variety of markers as possible periodontal risk factors in subjects with little or no periodontal disease at baseline. 415 subjects with mild or little periodontal disease were examined: medical and dental history; socioeconomic profile, clinical measurements, microbial samples and radiographic assessment of bone height were performed at baseline, and at a follow-up examination 2 to 5 years later. Mean probing pocket depth (PPD) at baseline was 1.99+/-0.37 mm while mean overall change was 0.1 mm which amounts to an annual rate of 0.04 mm. Overall mean clinical attachment level (1.75+/-0.6 mm) at baseline resulted in mean attachment change of 0.28 mm (0.12 mm annually). Alveolar crestal height (ACH) at baseline (mean 2.05+/-0.85 mm) resulting in a mean net loss of 0.1 mm. Approximately 10% of all sites presented for the second visit with attachment loss exceeding the threshold (4.4% annually), while only 2.2% of all sites exhibited attachment gain (0.88% annually). Older individuals exhibited greater mean bone loss but the least amount of attachment loss. Current smokers exhibited greater disease progression compared to non-smokers. Tooth morbidity (0.17 teeth/patient/year) was associated with greater baseline CAL and ACH loss, and an assortment of systemic conditions. Subjects who harbored Bacteroides forsythus (Bf) at baseline had greater loss in ACH; likewise, these subjects experienced greater proportions of losing sites and twice as much tooth mortality compared to Bf-negative patients. Baseline clinical parameters correlated strongly with the outcome, i.e., subjects with deeper mean pocket depth at baseline exhibited greater increase in pocket depth overtime; while subjects with greater attachment loss at baseline exhibited greater attachment loss between the 1st and 2nd visits.     

The effect of smoking on periodontal conditions assessed by CPITN.

One hundred eighty subjects were examined to assess the effect of smoking on periodontal conditions by community periodontal index for treatment needs (CPITN). All subjects were interviewed regarding their oral hygiene habits. Data were entered to the computer and statistical analysis system (SAS) was utilised. Results showed that the frequency of smokers is 31% where 25.9% of this were male. Smokers use toothbrush in performing their oral hygiene more than non-smokers. Results also showed that periodontal conditions as measured by CPITN were not significantly different between smokers and non-smokers. However, further studies with more sensitive periodontal indices are recommended in the future to assess the differences between both groups.     

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.     

Investigation of periodontal destruction patterns in smokers and non-smokers

BACKGROUND: Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease. Objective: To test the hypothesis that smokers have more disease in the upper anterior region. METHODS: A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels. RESULTS: The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3+/-25.5%, non-smokers: 48.3+/-31.2%, p<0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3+/-6.8%, non-smokers: 9.8+/-8.8%; p=0.050). CONCLUSION: The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.     

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.     

The effect of smoking and periodontal treatment on salivary composition in patients with established periodontitis.

BACKGROUND: The purpose of this study was to evaluate the effect of smoking on the periodontal status and the salivary composition in subjects with established periodontitis before and after periodontal therapy. METHODS: Our study group included 26 healthy subjects, 12 smokers and 14 non-smokers with established periodontitis. Clinical measurements and non-stimulated whole saliva were obtained and analyzed at baseline and after scaling and root planing. Smokers presented at baseline with significantly greater probing depth (4.16+/-0.26) compared to non-smokers (3.52+/-0.32) which was statistically significant (P = 0.0268); likewise, baseline clinical attachment level was greater in smokers (4.49+/-0.31 compared to non-smokers 3.87+/-0.13; P = 0.0620). Mean plaque index was also greater in smokers compared to non-smokers (0.86 and 0.65, respectively; P = 0.0834). Baseline pretreatment sodium values were significantly greater in non-smokers (14.36 mEq/l compared to 9.31 mEq/l in smokers; P = 0.0662); likewise non-smokers exhibited 50% greater salivary calcium levels (6.04 mg/100 ml compared to 4.32 mg/100 ml in smokers; P = 0.0133). RESULTS: Post-treatment probing depth and clinical attachment level were not different between smokers and non-smokers; this in spite of significant difference in plaque index in smokers (0.35 compared to 0.13 in non-smokers; P = 0.0135). Post-treatment, smokers had reduced calcium concentration (3.58 mg/100 ml compared to 5.11 mg/100 ml in non-smokers; P = 0.0438). Treatment affected albumin level in smokers only, consequently non-smokers had significantly greater salivary albumin concentration (1.1 mg/100 ml compared to 0.38 mg/100 ml in smokers; P = 0.0274). CONCLUSIONS: Subjects with established periodontitis exhibited elevated concentrations of salivary electrolytes and proteins. Within this study group, smokers exhibited greater disease level but reduced sodium, calcium, and magnesium concentrations. Smokers responded favorably to treatment. The clinical improvement eliminated the differences in salivary composition.     

The clinical and microbiological effects of non-surgical periodontal therapy in smokers and non-smokers

Abstract. 28 patients, 13 smokers and 15 non-smokers with untreated advanced periodontal disease, were subjected to a series of oral hygiene instructions and treated with non-surgical periodontal therapy. Baseline values regarding clinical data did not differ significantly between the groups. 6 months following therapy the full-mouth bleeding score among smokers was 36.5% as compared to 22.7% for non-smokers ( p <0.05). Probing depth was reduced by 1.9 mm for smokers and by 2.5 mm for non-smokers. This difference was statistically significant ( p <0.05). The level of P. gingivalis and P. intermedia/nigrescens was reduced in both groups as compared to baseline. A. actinomycetemcomitans , however demonstrated a slight increase in mean values at 6 months. This was especially notable for smokers in which A. actinomycetemcomitans were more difficult to eradicate. Conclusively, the microbiological response found in this study seems to be in conformity with the clinical response with little influence of the smoking habits     

Effect of periodontal therapy in smokers and non-smokers with advanced periodontal disease: results after maintenance therapy for a minimum of 5 years

BACKGROUND: Longitudinal clinical studies show smoking is a risk factor for periodontal disease progression. It has also been documented that smoking impairs healing after periodontal therapy. However, the longitudinal effect of smoking on treatment results in patients who undergo long-term maintenance therapy has not been extensively investigated. This study clinically and radiographically compared smoking and non-smoking patients who had been treated for advanced periodontal disease and who received maintenance therapy for a minimum of 5 years. METHODS: Twenty-nine patients were selected over a 6-month period when they presented for a regularly scheduled visit in a private office. Patients were selected on the basis of initially having lost 50% of bone support on 50% of their teeth; had received follow-up therapy for at least 5 years; were compliant at 75% of the appointments; and had plaque scores < 20% in 75% of the visits. All patients had received non-surgical and surgical therapy as required for pocket elimination. Fourteen were active smokers during the entire maintenance period. Clinical measurements of probing depths and presence of plaque and gingivitis and a new set of standardized radiographs were taken. RESULTS: Smokers had higher mean radiographic bone loss values prior to treatment (7.52 +/- 1.39 versus 6.65 +/- 1.39) and at the final examination (7.32 +/- 1.42 versus 6.29 +/- 1.29) mean radiographic bone loss as well as initial, immediate post-therapy, and final percent of pockets > or = 6 mm (1.42% +/- 1.87% versus 0.60% +/- 1.11%). Differences were not statistically significant. Over 5 to 8 years, seven sites in four non-smokers and 11 sites in six smokers exhibited radiographic bone loss > or = 2 mm. One tooth in a non-smoker and three teeth in two smokers were lost. In a logistic regression analysis, smoking increased the odds ratio 10.7 times of having > or = 1 site with bone loss > or = 2 mm. CONCLUSION: The present study on a small group of patients treated for advanced periodontal disease and well maintained over 5 to 8 years showed no statistically significant differences between smokers and non-smokers in clinical probing depth and radiographic bone loss measurements.     

Smoking influences decision making in periodontal therapy: a retrospective clinical study.

BACKGROUND: Mechanical periodontal therapy consists of a non-surgical course, followed by surgical treatment to eliminate or reduce remaining pathological pockets. Only if diligent mechanical therapy fails are additional measures considered. It has been documented that smoking interferes with the host defense mechanisms. This study addresses the question is meticulous non-surgical periodontal therapy equally successful in smokers and non-smokers? If not, is a thorough and cumbersome non-surgical approach in smokers worth undertaking? METHODS: Thirty-five smokers and 35 non-smokers were selected retrospectively from a pool of 306 patients treated in a private practice over a 17-month period. All had at least 14 teeth present with 8 presenting with gingival pockets > or =6 mm. Non-surgical treatment was performed in 6 to 10 appointments and results were evaluated 6 to 12 weeks after therapy. Bleeding on probing sites with probing depths > or =5 mm were then considered for surgical treatment. RESULTS: Before treatment smokers had statistically significantly higher mean percent of pockets 4 to 5 mm and > or =6 mm (40.36+/-10.65 and 26.51+/-11.95, respectively, compared to 30.38+/-7.57 and 20.42+/-10.03 for non-smokers) and showed significantly lower proportional reduction of these parameters with treatment (50.80+/-33.76 and 81.36+/-19.82 for pocket 4 to 5 mm and 6 mm, compared to 68.43+/-21.23 and 91.7+/-8.92 for nonsmokers). A multivariate analysis gave smoking, plaque control, and initial percent of sites > or =6 mm to be significant predictors of the percent of teeth in need of further therapy. In non-smokers, treatment was apparently successful in all tooth types with the exception of upper first and second molars (28.5% failure) and lower second molar (20% failure). In smokers, rates of further treatment needs were particularly high in the premolar-molar area in both jaws, ranging from 31.4% to 48.5% for an individual tooth type; 42.8% of smokers and 11.5% of non-smokers needed further treatment in 16% of their teeth (pretest probability). A decision analysis showed that for smokers with at least 1 of 5 sites > or =6 mm, one should initiate surgical treatment, rather than first treat non-surgically. If the point of indifference that the decision is correctly set at 95%, the pretest probability should be >12%. There is a higher risk that non-surgical therapy will fail, for instance if we lower the point of indifference to 60%, the pretest probability should be >31%. CONCLUSIONS: It is concluded that smoking impairs healing after nonsurgical periodontal therapy. The decision analysis of this study questions the need for a thorough course of non-surgical treatment in smokers with advanced periodontal disease.