Cigarette Smoking and the Periodontal Patient

Abstract

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask--identify tobacco users; advise--advise them to quit; assess--evaluate the patient's readiness to quit; assist--offer assistance in cessation; and arrange--follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far-reaching positive effects on our patients' oral and general health.

Assessment of Some Biochemical Oxidative Stress Markers in Male Smokers with Chronic Periodontitis

“…The balance between destructive cytokines such as IL-1a, IL-1b, TNFa, IL6, IL8 and prostaglandins and protective cytokines such as TGF-b, IGF and interferons shifts more towards destructive profile in smokers. Also it has been speculated that the interference of smoking with inflammatory signs and symptoms is mediated by vasoconstructive effects of nicotine [2,3,[19][20][21]. The present study has observed that smokers with chronic periodontitis exhibit more clinical periodontal damage and relatively higher oxidative stress compared to non-smokers with chronic periodontitis.…”

“…Tobacco smoking is one of the main risk factor associated with chronic destructive periodontal disease and there is an emerging evidence to suggest that subgingival calculus formation is more prevalent and severe in smokers compared to the non-smokers [2]. Smokers are almost three times as likely to have severe periodontitis compared to the non-smokers [3].Smoking is associated with oxidative stress. Smoke derived oxidants are a major factor in inflammatory reactions to cigarette smoke.…”

Prevalence of periodontopathogens and Candida spp. in smokers after nonsurgical periodontal therapy – a pilot study

“…However, NS had a better response to periodontal treatment, with a greater PPD reduction and CAL increase than SM after 3 and 6 months of evaluation. These results are consistent with previous studies 17,18,19 and confirm that smoking adversely influences the clinical response of patients after periodontal treatment. Scaling and root planing is the most usual periodontal therapy, leading to improvements in clinical parameters and to the reestablishment of the microbiota.…”

“…17,18,19 Few studies have evaluated longitudinal clinical and microbiological status of smokers undergoing periodontal maintenance therapy, yielding controversial results, with no difference in disease progression 20 or higher prevalence of tooth loss among smokers 21,22 than among nonsmokers. This pilot study aimed to evaluate the influence of smoking on clinical and microbiological parameters after nonsurgical periodontal therapy.…”

The impact of smoking and previous periodontal disease on peri-implant microbiota and health: a retrospective study up to 7-year follow-up

“…Several historical follow-up studies have shown that cigarette smoking is a significant risk factor from implant failure (17,18). Smokers are more susceptible to both periodontitis and peri-implantitis because of impairment of immune response (19) and compromised wound healing (20). Increased probing depths, plaque indices and bleeding on probing values have been observed in smoker sub-jects restored with dental implants.…”