[Smoking and periodontal health]

The nature of the relationship between smoking and periodontal disease is not clear. However, from the information available today, the evidence, when carefully weighted, strongly suggests that smoking exerts a substantial and detrimental effect on periodontal health and disease. It is associated with an increased disease rate in terms of periodontal bone loss, attachment loss as well as periodontal pocket formation and it seems to worsen the host's defense by means of its major metabolite, nicotine. Nevertheless, new, sensitive and adequate investigations should be developed and performed in order to better explain the pathogenic mechanisms.