To what extent does smoking affect gingival bleeding response to supragingival plaque? Site‐specific analyses in a population‐based study

Abstract

Background and objective The aim of this study was to investigate the influence of smoking on the site‐specific association between bleeding on gingival probing and supragingival plaque and to assess whether this differs in different regions of the dentition. Methods Data from a representative sample of 1911 adults (20‐79 years old) in Northern Norway were analyzed. Periodontal examinations consisted of full‐mouth recordings of periodontal probing depth (PD), bleeding on probing (BOP), and presence of supragingival plaque. Smoking status and background characteristics were self‐reported by questionnaire. The association between plaque and BOP was assessed in several three‐level (subject, tooth, and site) random intercept logistic regression models adjusted for PD, smoking status, socioeconomic factors, and body mass index. In a further model, it was assessed whether the association between supragingival plaque and BOP differed in different parts of the dentition. Results For plaque‐free sites, bleeding tendency was lower in smokers, the odds ratio (OR) was 0.773 with a 95% confidence interval of 0.678‐0.881 as compared to non‐smokers (OR: 1; ref., P < .001). The odds of BOP at plaque‐covered sites in non‐smokers were increased twofold (OR: 2.117; 2.059‐2.177). Albeit bleeding tendency was slightly increased in plaque‐covered sites in smokers, it was considerably lower as compared to plaque‐covered sites in non‐smokers (OR: 1.459; 1.282‐1.662, P < .001). Smoking ≥ 20 pack‐years further attenuated the association. In smokers, the odds of BOP were reduced in all parts of the dentition, lower and upper anterior and posterior teeth (χfalse(4false)2= 32.043, P < .001). When restricting the data to younger adults (20‐34 year old), smoking had only a slight effect on the association between plaque and BOP. For plaque‐free and plaque‐covered sites, differences in ORs were not statistically noticeable (P = .221 and P = .235, respectively). Conclusions Smoking considerably attenuates the site‐specific association between plaque and BOP with a dose‐dependent effect. The effect of smoking did not differ across tooth types.

Self-Perception of Periodontal Health and Associated Factors: A Cross-Sectional Population-Based Study

“…Heavy smoking (more than 10 cigarettes per day) was negatively related to self-awareness of gingival status. Since smoking attenuates the association between plaque and bleeding on probing in a dose-dependent manner, we considered in the logistic model the number of cigarettes smoked per day [53]. Thus, heavy smokers might not recognize the early symptoms of periodontal disease because tobacco consumption reduces the likelihood for gingival bleeding, both subjectively and clinically assessed [53][54][55].…”

“…Since smoking attenuates the association between plaque and bleeding on probing in a dose-dependent manner, we considered in the logistic model the number of cigarettes smoked per day [53]. Thus, heavy smokers might not recognize the early symptoms of periodontal disease because tobacco consumption reduces the likelihood for gingival bleeding, both subjectively and clinically assessed [53][54][55]. This may be due to decreased vascular density and angiogenesis in the swollen gingiva of smokers compared to non-smokers that mask clinical signs of inflammation [56].…”

Tobacco Use and Periodontal Disease—The Role of Microvascular Dysfunction

“…Gingival/periodontal inflammation can be assessed by diverse techniques and parameters, such as quantifying gingival bleeding upon probing (BOP) and GCF. The BOP parameter is known to be low in smokers [ 157 , 158 ], probably by the long-term perfusion decrease that hinders inflammation. Gingival crevicular fluid is an extracellular fluid that accumulates between gingiva and tooth cementum.…”

Reply to Dipti Singh

“…We appreciate the interest of Dr Singh and Dr Gangwar in our study 1 on the influence of subgingival plaque and calculus on bleeding on gingival probing (BOP) and would like to respond as follows.…”