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.     

Laser doppler estimation of the influence of tobacco-smoking on the blood microcirculation in the periodont at the patients with the different stages of periodontal diseases

Smoking appears to be one of the most significant risk factors in the development and progression of periodontal disease. Smoking is also a risk factor in the development of peripheral vascular diseases. Blood vessels in smokers are fewer and are subjected to stenosis. Clinically, it is well known that bleeding on probing, gingival exudates and redness and swelling in gingival sites of smokers are less than in non-smokers. According to previous studies, there is a relative increase in gingival blood flow immediately after smoking, while gingival blood flow itself is considerably decreased in healthy smokers in comparison with non-smokers. In this investigation, we used laser Doppler flowmetry to study gingival microcirculation in smokers with light, moderate and heavy periodontitis in comparison with non-smokers with the same diseases. Our results show, that smoking decreases gingival blood flow in smokers with periodontitis comparing to non-smokers with periodontitis. Immediately after smoking there is an increase in gingival microcirculation. In 30 minutes we observed a marked decrease in gingival blood flow in all groups, followed by gradual restoration of blood flow rate, registered before smoking. This restoration took 1.5-2 hrs in group with light periodontitis, 2 hrs in group with moderate periodontitis and more than 2 hrs in group with heavy periodontitis. We suppose, that constant changes in blood supply of periodontal tissue caused by smoking may contribute to higher prevalence and faster progression of inflammatory periodontal diseases in smokers.     

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.     

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.     

EVALUATION OF CLINICAL PERIODONTAL CONDITIONS IN SMOKERS AND NON-SMOKERS

Given that tobacco smoking habit is a risk factor for periodontal diseases, the aim of this study was to compare clinical periodontal aspects between smokers and non-smokers. The clinical status were assessed in 55 patients, 29 smokers and 26 non-smokers, aged 30 to 50 years, with mean age of 40. The clinical parameters used were: probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), gingival recession (GR) and gingival bleeding index (GBI) for arches (upper and lower) and teeth (anterior and posterior). Tooth loss was also evaluated in both groups. Multiple regression analysis showed: tendency of greater probing depth and clinical attachment level means for smokers; greater amount of plaque in smokers in all regions; greater gingival index means for non-smokers with clinical significance (p<0.05) in all regions. Although, without statistical significance, the analysis showed greater gingival bleeding index means almost always for non-smokers; similar gingival recession means in both groups and tendency of upper tooth loss in smokers and lower tooth loss in non-smokers. The findings of this study showed that clinical periodontal parameters may be different in smokers when compared to non-smokers and that masking of some periodontal signs can be a result of nicotine''s vasoconstrictor effect.     

吸烟对牙周基础治疗效果影响的研究

目的评价吸烟与非吸烟慢性牙周炎患者牙周基础治疗1个月后的疗效差异。方法选择36例慢性牙周炎患者,吸烟组20例,非吸烟组16例,基线时两组牙周炎病情相似。从牙列的4个象限选取探诊深度在5～9mm范围的位点1～2个,吸烟组108个位点,非吸烟组88个位点,观察这些位点在牙周基础治疗前、治疗后1个月临床指标的变化,包括菌斑指数(PLI),牙龈出血指数(BI),牙周袋探诊深度(PPD)和附着丧失(AL);在作临床观察的同时,对治疗前后龈沟液白介素(IL)-1β进行检测。结果治疗前(基线时)两组PLI、BI、PPD、AL以及IL-1β差异不显著,牙周基础治疗1个月后,两组的各项指标均有明显的改善,但吸烟组改善程度明显低于非吸烟组(P<0.05)。结论慢性牙周炎患者,吸烟者牙周基础治疗的效果差于     

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.     

The effect of different cigarette smoking levels on gingival crevicular fluid volume and periodontal clinical parameters in Saudi Arabia

IntroductionPeriodontal disease is a chronic inflammatory condition of the periodontium. It is the main cause of tooth loss and is considered one of the biggest threats to the oral cavity. Tobacco smoking has long been associated with increased risk for periodontal, peri-implant, and other medical diseases.ObjectiveTo evaluate the effect of smoking and its level on periodontal clinical parameters (probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), bleeding on probing (BOP), and the volume of gingival crevicular fluid (GCF)) in healthy and chronic periodontitis individuals.Material and MethodA total of 160 participants were recruited in the present study, who were equally divided into the following five groups: healthy controls (C), healthy smokers (HS), nonsmokers with periodontitis (PNS), light smokers with periodontitis (PLS), and heavy smokers with periodontitis (PHS). GCF volume and periodontal clinical parameters (PD, PI, GI, CAL, and BOP) were assessed for each participant and compared between the study groups.ResultThere was a statistically significant difference in PD, PI, GI, CAL, and BOP between healthy and periodontitis patients (p < 0.001). The mean PI, PD, and CAL were considerably higher in heavy smokers than light smokers and non-smokers (P < 0.001). In contrast, the mean GI and BOP were significantly lower in heavy smokers than in light smokers and non-smokers. There was a statistically significant difference in GCF between healthy and periodontitis patients (p < 0.001). The mean GCF readings were higher in heavy smokers than light smokers or non-smokers (P < 0.001).ConclusionThe present study confirms the influence of smoking on periodontal clinical parameters. Smoking was associated with increased PD, PI, CAL, and GCF readings; however, GI and BOP were decreased in smokers. The number of cigarettes played a key role in the volume of GCF and periodontal clinical parameters.     

Periodontal healing and periopathogenic microflora in smokers and non-smokers

Abstract The aim of the present study was to monitor the clinical and microbiological effects of non-surgical therapy in smokers and non-smokers. The subject material included 32 patients (age range 32–61 years), 11 men and 21 women with moderate to severe periodontitis. 17 patients were smokers ( l5 cigarettes/day) and 15 non-smokers. All patients were subjected to non-surgical periodontal therapy performed by a dental hygienist. Periodontal variables (plaque index, gingival index and probing depth) were registered and bacterial samples were collected before and 2 months alter treatment. The treatment resulted in significant reductions towards very low plaque and gingival indices in smokers and non-smokers alike (p<0.05). Although probing depth was reduced in both smokers and non-smokers, the probing pocket depth reduction was significantly smaller in smokers than non-smokers (p<0.05). Microbiologically, the same therapeutical efficacy was attained in both smoking groups, indicating an almost total eradication of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis. Concerning Prevotella intermedia, out of 14 smokers and 10 non-smokers positive at baseline, 9 and 5, respectively, remained positive after treatment. The results suggest a less favourable clinical outcome of non-surgical therapy in smokers than non-smokers in spite of the fact that the therapy was equally effective with regard to reducing the alleged periopathogens A. actinomycetemcomitans, P. gingivalis and P. intermedia.     

Tobacco smoking and neutrophil activity in patients with periodontal disease

BACKGROUND: Tobacco smoking has considerable negative effects on periodontal health. The mechanisms behind these effects are incompletely understood but may be related to the host response. The aim of the present study was to investigate the influence of tobacco smoking on the gingival crevicular fluid (GCF) levels of elastase, lactoferrin (LF), alpha-1-antitrypsin (alpha-1-AT), and alpha-2-macroglobulin (alpha-2-MG) under periodontally diseased conditions. METHODS: The study population included 15 smokers (5 women and 10 men) aged 34 to 69 years and 17 non-smokers (5 women and 12 men) aged 31 to 81 years. Clinical registration of gingival index (GI), plaque index (PI), probing depth, as well as sampling of GCF were made at 3 sites with severe lesions and 3 sites with moderate lesions in each individual. The elastase activity was measured with a chromogenic low molecular substrate and the LF, alpha-1-AT, and alpha-2-MG concentrations with ELISA. RESULTS: The results showed that, with regard to severe lesions, smokers had a significantly lower concentration of alpha-2-MG as well as significantly lower total amounts of alpha-2-MG and alpha-1-AT than non-smokers. With regard to moderate lesions, smokers tended to exhibit a lower concentration of alpha-2-MG, but the difference was not statistically significant. Comparing moderate and severe lesions, smokers exhibited no gradual increase with disease severity in contrast to non-smokers, who showed significantly or almost significantly increased levels of LF and alpha-2-MG in severe as compared to moderate lesions. CONCLUSIONS: The present results indicate that the levels of alpha-2-MG and alpha-1-AT are suppressed in smokers with periodontitis, suggesting that smoking interferes with these protease inhibitors. This may be one mechanism by which smoking affects the inflammatory response.     

Pocket oxygen tension in smokers and non-smokers with periodontal disease

BACKGROUND: Smoking is associated with destructive periodontal disease. Pocket oxygen tension (pO2) is likely to be a major environmental determinant of the subgingival microflora, which is a primary etiological factor of the disease. This study aimed to compare the pocket pO2 in smokers and non-smokers with periodontal disease. METHODS: Pocket oxygen tension was compared in 27 smokers and 34 non-smokers by considering 2 confounding factors, probing depth and oxygen saturation of hemoglobin (S(O2)), in the gingiva. The pO2 was determined using oxygen microelectrode by polarographic method with an electronic compensation circuit for subgingival temperature. Gingival S(O2) was determined using tissue reflectance spectrophotometry. RESULTS: No significant difference was found in the modified gingival index and the plaque index between smokers and non-smokers. The pO2 was significantly lower in smokers (21.9+/-9.6 mmHg) than in non-smokers (33.4+/-8.4 mmHg). The difference was highly significant (P <0.0001) and was consistent when the confounding factors were considered. Correlation between the PO2 and probing depth approached statistical significance in smokers (r = -0.36, P = 0.0674) and significance in non-smokers (r = -0.41, P = 0.0174). Correlation of the PO2 to the gingival S(O2) was highly significant in non-smokers (r = 0.57, P = 0.0005), but no association was found in smokers (r = -0.08, P= 0.6975). CONCLUSIONS: These findings indicate that pO2 is lower in smokers than in non-smokers, and that the pO2 in smokers is not influenced by gingival oxygen sufficiency. The present study may provide the basis of understanding environmental factors possibly associated with microbial flora in the pockets of smokers.     

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.     

Relationship between smoking and folic acid, vitamin B12 and some haematological variables in patients with chronic periodontal disease

AIM: The purpose of this study was to investigate the relationship between cigarette smoking and the serum levels of folic acid, vitamin B(12) and some haematological variables in patients with periodontal disease. PATIENTS AND METHODS: The study base consisted of 88 volunteer patients with periodontal disease, including 45 current smokers in the age range 31-68 years and 43 non-smokers in the range 32-66 years. The clinical parameters included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL). Folic acid, vitamin B(12) and haematological variables were determined from peripheral blood samples. RESULTS: PI, PD and CAL means were significantly higher in smokers than non-smokers (p<0.05). The serum folic acid concentration of smokers was lower than that of non-smokers (p<0.05), whereas the white blood cell count was higher in smokers than in non-smokers (p<0.05). CONCLUSION: The results of this study suggest that among patients with periodontal disease the serum folic acid concentration is lower in smokers compared with non-smokers.     

Effects of smoking on clinical parameters and the gingival crevicular fluid levels of IL-6 and TNF-alpha in patients with chronic periodontitis

OBJECTIVE: Smoking is an important environmental risk factor for the initiation and progression of periodontal diseases. The aim of this study was to evaluate the effects of smoking on clinical parameters and the gingival crevicular fluid (GCF) contents of the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels in patients with chronic periodontitis. MATERIAL AND METHODS: The study base consisted of 41 patients including 22 volunteer current smokers with an age range of 32-59 (44.41+/-7.88) years and 19 volunteer non-smokers with an age range of 36-59 (46.94+/-6.07) years. The first month after non-surgical periodontal therapy was accepted as the baseline of the study. The clinical parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) were recorded and GCF samples were collected for analysis of GCF contents of IL-6 and TNF-alpha levels. At the 3rd and 6th months, all of these procedures were repeated. RESULTS: In smokers, only CAL was significantly higher at the 3rd month compared with non-smokers (p<0.05). GI and BOP were higher in non-smokers than smokers in both periods (p<0.05). PI showed increases from the initial to the 6th month in smokers (p<0.05). Although the differences between two groups with regard to IL-6 and TNF-alpha were not significant (p>0.05), the total amount of TNF-alpha in GCF decreased from the initial to the 6th month in smokers (p<0.05). There were no significant correlations between the mean total amount of IL-6 and TNF-alpha in GCF and clinical parameters in both evaluation periods in smokers (p>0.05). CONCLUSION: The present study demonstrated that cigarette smoking increases the amount of dental plaque over time in smokers and does not influence GCF contents of IL-6 and TNF-alpha.     

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.     

Cigarette smoking as risk factor in chronic periodontal disease

Patients admitted to the School of Dentistry, Stockholm, for treatment of chronic periodontal disease during the years 1980-82 were retrospectively investigated with respect to their smoking habits. The investigation was designed as a case control study and covered all patients 30, 40, or 50 yr of age upon admission, in all 155. As control served a random sample of the Stockholm population. The periodontal variables under scrutiny were frequency of periodontally diseased teeth, frequency of periodontally diseased sites (probing depth greater than 4 mm), gingival index, and plaque index. The overall occurrence rate of smokers in the sample of cases was 56%, which is significantly greater than the population at large. This held true for all three age cohorts and for men as well as women. The risk ratio was 2.5, indicating more prevalent disease among smokers. Further, significantly greater frequencies of periodontally involved teeth and diseased sites were found in smokers, indicating more severe disease among smokers. Gingival index and plaque index did not notably differ between smoking groups. The results suggest increased prevalence as well as severity in smokers. Smoking, therefore, should be considered a risk factor for chronic periodontal disease.     

Cigarette smoking in patients referred for periodontal treatment

369 adult patients with moderate to severe periodontitis were compared with a survey sample from the population of Stockholm regarding smoking habits. The results showed that the frequency of daily cigarette smokers was significantly greater in the periodontitis sample. The odds ratio for a smoker to appear among periodontitis patients was more than doubled as compared to the population at large. In addition, the periodontal variables of PlI, GI, probing depth and the patient's experience of gingival bleeding were recorded and compared between smoking and non-smoking patients. PlI was found to be similar in smokers and non-smokers. Signs and symptoms of gingivitis as evidenced by the patients' experience of gingival bleeding and by GI were less pronounced in patients who smoke. Only 25% of smokers reported bleeding gingiva as compared to 51% of non-smokers. No differences were observed regarding probing depth except for lingual pockets of the maxilla where a significantly greater probing depth was observed in smokers. It was concluded that smokers may run an increased risk for periodontitis. Furthermore, gingival inflammatory symptoms seem to be suppressed in patients who smoke.     

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.     

Periodontal disease in Hispanic Americans with type 2 diabetes

BACKGROUND: Diabetes is a major risk factor for the development of periodontal disease in certain populations. The prevalence of type 2 diabetes is increased in Hispanic Americans, but its impact on the extent and severity of periodontal disease in this population has not been determined. METHODS: Sixty-three Hispanic Americans, aged 33 to 72 years, from South Texas were grouped based on the presence or absence of type 2 diabetes. Past medical histories, including smoking, were obtained. Periodontal status was evaluated by measuring probing depth (PD), clinical attachment level (CAL), plaque, bleeding on probing, visual gingival inflammation, and calculus. RESULTS: Type 2 diabetes was associated frequently with major medical complications in this population. Diabetes was associated with significantly more calculus formation and tooth loss and an increased extent and severity of periodontitis. Subjects with diabetes had nearly three times the mean CAL and frequency of PD >6 mm than subjects without diabetes and nearly twice the frequency of moderate to advanced attachment loss (> or =3 mm). Smoking and diabetes had significant independent effects on mean CAL and the frequency of deep pockets. Diabetes and smoking combined were associated with a significantly higher frequency of sites with CAL > or =3 mm compared to healthy non-smokers, healthy smokers, and non-smokers with diabetes. CONCLUSIONS: Hispanic Americans with type 2 diabetes had more supra- and subgingival calculus, an increased extent and severity of periodontal destruction, and an increased frequency of tooth loss due to periodontitis. An additive/synergistic contribution of type 2 diabetes and smoking for increasing the extent of periodontal disease was observed.     

Smoking and periodontal disease severity

Abstract This study was performed to assess the influence of smoking on periodontal disease severity. Data concerning periodontal status and smoking habits were collected from 889 periodontal patients: 340 male and 549 female. 21 to 76 years of age. 47.4% being non smokers and 52.6% smokers. Periodontal parameters, recorded by the same examiner (PMC), were: gingival recession (GR), Pocket depth (PD), Probing attachment level (PAL), and mobility (M). The influence of age, sex and tobacco consumption on these periodontal parameters was statistically evaluated using an analysis of variance (ANOVA) with covariates. A non-linear effect model was also fitted by taking the natural logarithms of the response variables (GR. PD, PAL) closer to bio-medical phenomena. Mobility was analyzed by a x²-test. The effect of smoking on periodontitis showed no association with age or with sex. Smoking, age and sex were shown to be statistically significant for periodontitis, by performing both univariate (I-test for equal means) and multivariate tests. p-values for smoking and periodontitis were: GR (p= 0.000). PD (p= 0.000), PAL (p= 0.000) and M (p= 0.015). Smoking one cigarette per day. up to 10, and up to 20, increased PAL by 0.5%, 5% and 10%. respectively. The impact of tobacco is comparable to the impact resulting from the factor of age in this sample, increasing PAL by 0.7% for each year of life. Comparison between smokers of less than 10 cigarettes per day (PAL mean 3.72 mm±0.86) and non-smokers (PAL mean 3.84±0.89) showed no differences in PAL (p= 0.216). while comparison for smokers from 11 to 20 cigarettes (PAL mean 4.36±1.23) and for more than 20 cigarettes PAL mean 4.50±1.04) demonstrated significant differences (p = 0.000). These findings suggest that: (i) tobacco increases periodontal disease severity; (2) this effect is clinically evident above consumption of a certain quantity of tobacco.