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Tobacco Cessation




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Home > Tobacco Use Cessation Program > Didactic Components > Tobacco and Periodontal Diseases

Tobacco and Periodontal Diseases

Smoking is a major risk factor for periodontal diseases

  • Both current and former smokers have an increased prevalence and severity of periodontal diseases
  • There is a significant positive association between the amount smoked and the severity of periodontitis
  • There is a linear and direct correlation between smoking and attachment loss with effects even at a low level of smoking
  • The periodontal status of former smokers ranks between current smokers and those who have never smoked
  • 86-90% of refractory periodontitis cases are smokers

Clinical appearance of smoking-associated periodontitis

  • Gingiva tends to be fibrotic with thickened rolled margins
  • Minimal gingival redness or edema relative to disease severity
  • Relatively severe and widespread disease (more probing depth, attachment loss, and tooth loss) compared to a person the same age who never smoked
  • Proportionately greater pocketing in anterior and maxillary lingual sites
  • Gingival recession in anterior segments
  • No association between periodontal status and plaque or calculus scores

From: Haber J Current Opinion in Periodontology 1994

Smokeless (Spit) tobacco use increases the risk of localized recession but its effect on periodontitis is unclear

Nicotine and other tobacco products produce local and systemic effects

  • Locally the cytotoxic and vasoactive substances from tobacco smoke can inhibit tissue perfusion and cell proliferation and metabolism
  • Systemically smoking causes immuno-suppression and impairment of soft tissue and bone cell function
    • Impairs serum antibody response to some periodontal pathogens
    • Alters PMN leukocyte function (effects rate of chemotactic migration and/or phagocytic activity)
    • ↑ TNF-a and PGE2 in GCF
    • ↑ neutrophil collagenase and elastase in GCF
    • May be associated with reduction of skeletal bone mineral content
    • May interfere with fibroblast attachment


  • The possibility that smoking might favor a specific periopathogenic microflora is still unclear
  • There are conflicting studies but there may be ↑ levels of periodontal pathogens in smokers vs. nonsmokers.

Smoking delays wound healing

  • There is impaired healing and poorer clinical results to both nonsurgical (S/RP, locally delivered antibiotics) and surgical periodontal therapy of smokers vs. nonsmokers
    • Less reduction of bleeding on probing
    • Less reduction of probing depths (even with good oral hygiene)
    • Smaller gain of attachment
  • Studies have found that smokers have less success with open flap debridement, osseous resection, soft tissue and bone graft procedures, and guided tissue regeneration procedures
  • The implant failure rate in smokers is significantly higher than in nonsmokers
  • Cigar and pipe smokers have similar adverse effects on periodontal health as cigarette smokers
  • The following may contribute to impaired wound healing
    • Smoking impairs revascularization of bone and soft tissue
    • PMN altered chemotaxis, phagocytosis, and adherence
    • Altered antibody production
    • Negative effect on bone metabolism may influence osteoporosis and periodontitis by similar mechanisms

Smoking status should be considered in periodontal diagnosis, prognosis, and treatment planning

    • Smoking status is a clinically useful predictor of future disease activity
    • Smoking cessation should be considered a part of periodontal treatment

The benefits of smoking cessation

    • Periodontal status stabilizes for a majority of patients and attachment loss ceases or slows
    • It may take a number of years after cessation before the rate of tooth loss is similar to that of nonsmokers
For more indepth information relevant to tobacco use and periodontal diseases, please refer to the the American Academy of Periodontology Position Paper.

Tobacco use is an oral health problem and the dental office is a logical place for a tobacco cessation program….and the entire office team should be involved

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