Smoking and Periodontal Disease Smoking

Smoking and Periodontal Disease

Smoking and its Effect on Periodontal Health

Smoking continues to be the greatest danger to health and the leading cause for developing many chronic and fatal diseases. Besides its harmful effects on the heart and the lungs, smoking is also identified to be an important risk factor for periodontal diseases. However, public awareness as to the effects of smoking on periodontal health is very low. [R Joshi] Periodontis is the second leading cause for tooth loss among adults and smoking is directly implicated in the progression of the disease. [Murray Thomson] Most of the research conducted over the last decade, implicate smoking as an important risk factor for periodontal damage. A brief overview of some research studies would help highlight smoking as a predisposing factor for periodontal diseases.

Smoking and Periodontis

Periodontis is the most common disease caused by bacterial infection affecting gum tissue and alveolar bone. [Enrique Bimstein, 229] it is the second largest cause for tooth loss among adults. The toxins in tobacco drastically reduce peripheral blood flow, cause inflammatory response and affect the periodontium. Though periodontal infections frequently recover naturally smoking has the effect of hampering this natural recovery process as it compromises the immune system. Several epidemiological studies have confirmed that smoking increases the rate of progression of periodontal diseases.. [Murray Thomson] it is also observed that smokers in general have decreased secretion of saliva and consequently greater dental calculus. Smoking suppresses immune response against the formation of plagues. Due to vasoconstriction of the gingival tissues, smokers do not recover sufficiently from gingival tissue damage. Studies have also shown an increased proliferation of anaerobic microorganisms in the gingival tissues of smokers clearly indicating reduced peripheral blood flow. [PEIRO]

Literature review

Elizabeth et.al (1999) was a longitudinal study, which examined 690 subjects triennially over a period of 23 years and gathered data on various attributes such as number of remaining teeth, plague levels, tooth mobility, gingival bleeding and alveolar bone loss. The results from the study showed that the relative risk for loss of tooth when compared with nonsmokers was very high. (RR=1.3-95 confidence interval). The study also found that smokers have a heightened risk for alveolar bone loss. [Elizabeth a Kraal, 1999] Haffajee et.al (1997) showed that smokers tend not to recover fast when compared to non-smokers or past smokers. The researchers found that while non-smokers and past smokers responded very well after scaling and root planning procedures (SRP) (reduced levels of oral microbia) current smokers remained non-responsive as measured by the persistent levels of oral microbial such as T.denticola, B.Forsythus and P.gingivalis. [D.F.Kinane, 2000] Evidence for increased levels of subgingival microbes was also asserted by Zambon et.al (1996). The researchers of this study found that subgingival levels of Bacteroides forsythus and actinobacillus was more among smokers when compared with non-smokers. Umeda et.al (1998) also reported that smokers had increased levels (or = 4.61) of Treponema denticola. These studies clearly show that smokers have increased oral pathogenic bacterial infection. [D.F.Kinane, 2000]

Smoking induced alveolar bone loss was confirmed by a 1991 Swedish study. In this radiographic study the Swedish dental hygienists observed that all the smoking subjects showed a pattern of greater distance between the cemento enamel junction and the interdental septum when compared to nonsmokers. [D.F.Kinane, 2000] Another longitudinal Swedish study conducted over a period of 10 years, which analyzed 293 young people, reported that young smokers who smoked more than 15 cigarettes per day carried a 78% risk for developing periodontal disease. Martinez -Canut et.al (1995), a Spanish study involving 889 patients found that smoking status was an important criteria that determined gingival recession, pocket depth and probing attachment level in the subjects. The researchers reported that probing attachment levels increased with the increase in the number of cigarettes consumed per day. (from.5% for one cigarette to 10% for 20 cigarettes) [D.F.Kinane, 2000]