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 biomedical phenomena. Mobility was analyzed by a chi2-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 (t-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: (1) tobacco increases periodontal disease severity; (2) this effect is clinically evident above consumption of a certain quantity of tobacco.

The purpose of this cross-sectional epidemiological study was to determine the prevalence of pathologic tooth migration (PTM) among periodontal patients and to investigate the relationship and degree of association between PTM and the following factors: bone loss, tooth loss, gingival inflammation according to the gingival index, age, lingual interposition, parafunctions and oral habits. 852 periodontal patients (36.7% male, 63.3% female) whose ages ranged from 19 to 72 years (mean 42.5 +/- 9.9) were studied. PTM was defined as the presence of a developing diastema in the upper anterior sextant, which was not present in the past or already existed but increased. Statistical analysis was performed using the Wald test and the Mantel-Haenszel test. Estimates odds ratio were also calculated to assess increased PTM probability as a function of a single variable, or a combination of several. PTM prevalence of 55.8% was found, and it was statistically associated with bone loss (p<0.001), tooth loss (p<0.001) and gingival inflammation (p<0.001), while no association was observed with the remaining variables. The odds ratio indicated that PTM probability increased between 2.95 to 7.97 times as bone loss increased. For tooth loss this probability increased 2.76 times when no tooth loss was compared to 4 or more teeth lost. Likewise the probability increased 2.23 times when the gingival index was above 2. According to the single effect as well as the combined effect of these 3 main factors, it was concluded that: (1) no single factor by itself is clearly associated with PTM: (2) the factor mainly related to PTM is bone loss, followed by tooth loss and gingival inflammation: (3) as bone loss increases, the association of additional factors with PTM, such as tooth loss and gingival inflammation, increases.

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