Association between smoking different tobacco products and periodontal disease indexes

Six indexes of periodontal health were recorded in cigarette smokers, pipe/cigar smokers and nonsmokers from the Veterans Administration Dental Longitudinal Study. These indexes included calculus deposition, plaque accumulation, gingival inflammation, periodontal pocket depth, alveolar bone loss and tooth mobility. Cigarette smokers had significantly more calculus deposition than pipe/cigar smokers, although both smoker groups had more calculus than nonsmokers. Cigarette smokers accumulated slightly less plaque than pipe/cigar smokers, and both smoker groups accumulated less plaque than nonsmokers. Gingival inflammation and tooth mobility did not differ between smokers and nonsmokers, nor between the two smoker groups. Cigarette smokers had significantly greater pocket depth than nonsmokers, in contrast to pipe/cigar smokers who were not different from nonsmokers. Radiographic measurements indicated that cigarette smokers had significantly more alveolar bone loss than either pipe/cigar or nonsmokers. After covariance adjustment for age and calculus, all smokers had less plaque, gingival inflammation and tooth mobility than nonsmokers, similar periodontal pocket depth, but only cigarette smokers had greater bone loss. This finding of greater alveolar bone loss in cigarette smokers suggests a tobacco product-related effect in systemic physiologic action.