Impact of Tobacco Use on Periodontal Status

Abstract

This article reviews the effects of smoked and smokeless tobacco on periodontal status, including the impact of smoking on periodontal therapy and potential mechanisms for the adverse effects of tobacco on the periodontium. Approximately half of periodontitis cases have been attributed to either current or former smoking. Both cigar and cigarette smokers have significantly greater loss of bone height than nonsmokers, and there is a trend for pipe smokers to have more bone loss than nonsmokers. Unlike smokers, who experience widespread periodontal destruction, the most prevalent effects of smokeless tobacco are localized to the site of placement, in the form of gingival recession and white mucosal lesions. Smoking has an adverse effect on all forms of periodontal therapy, and up to 90 percent of refractory periodontitis patients are smokers. The pathogenesis of smoking-related periodontal destruction has been attributed to alterations in the microflora and/or host response. Some data indicates that smoking may increase levels of certain periodontal pathogens, but there is more evidence that smoking has a negative effect on host response, such as neutrophil function and antibody production. An encouraging finding is that periodontal disease progression slows in patients who quit smoking and that these individuals have a similar response to periodontal therapy as nonsmokers. The facts presented in this paper will assist dental health professionals in treatment-planning decisions and provide them with important information to share with patients who use tobacco products.

Periodontal conditions in male adolescents using smokeless tobacco (moist snuff)

“…Hence, the odds of finding a subject with a gingival recession were 3.7 fold greater for snuff‐users when compared with controls, and for the predominate location of the placement of snuff among Swedish users, the maxillary anterior tooth region, the odds were 5.1 fold greater. This finding is in agreement with results of other studies investigating the impact of smokeless tobacco on periodontal conditions (Offenbacher & Weathers 1985, Weintraub & Burt 1987, Robertson et al 1990, Johnson & Slach 2001). Offenbacher & Weathers (1985) reported the odds of having gingival recession to be nine times higher in users of smokeless tobacco as compared with non‐users.…”

“…smokeless tobacco (snuff), may have adverse effects similar to those of smoking, discloses comparatively few reports describing negative effects on the periodontal tissues. The pre‐dominant finding of adverse effects reported is an increased prevalence of gingival recessions among snuff users (Frithiof et al 1983, Greer & Poulson 1983, Poulson et al 1984, Offenbacher & Weathers 1985, Hart et al 1995, Johnson & Slach 2001, Rolandsson et al 2005).…”

Prevalence of periodontal disease among inpatients in a psychiatric hospital in India

“…With regard to the relationship between tobacco use and oral disease, in our study, the mean number of sextants with pockets was greatest in those subjects who used tobacco. This result is in agreement with previously reported evidence of a relationship between smoking and periodontal disease 26‐29 . However, LOA was found to be greatest in those who responded to the question about tobacco use with “Don't Know.” This finding is contrary to the current belief that there is an association between tobacco use and LOA.…”

Potential impact of subject‐based risk factor control on periodontitis

“…Also, a dose–response relationship has been demonstrated (Haber et al 1993, Kaldahl et al 1996, Tomar & Asma 2000). The reader is referred to recent reviews of this topic (Kinane & Chestnutt 2000, Johnson & Slach 2001, Rivera‐Hidalgo 2003, Bergstrom 2004b).…”

“…The use of the following tobacco products has been studied to describe their association with periodontal disease: cigarette (Haber et al 1993, Bergstrom et al 2000a, Bergstrom 2004b), cigar and pipe smoking (Krall et al 1999, Albandar et al 2000, Johnson & Slach 2001) as well as smokeless tobacco, i.e. chewing or spit tobacco and snuff (Greer & Poulson 1983, Poulson et al 1984, Offenbacher & Weathers, 1985, Robertson et al 1990).…”