Smoking 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
• Level of risk is proportionate to number of pack years
• There is a linear and direct correlation between smoking and attachment loss with effects even at a low level of smoking
• Smokers show approximately half as much improvement in probing depths and clinical attachment levels following non surgical and various surgical modalities of therapy
• evidence from cross-sectional and case control studies in various populations demonstrates that adult smokers are approximately 3 times as likely as non-smokers to have periodontitis
• 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
Johnson G, Hill M (2004). Cigarette smoking and the periodontal patient. Journal of Periodontology;75:196-209.