Smoking and periodontal disease. A review

From the many epidemiological and clinical studies we have looked at there is considerable evidence supporting a positive association between smoking and periodontal disease. In conclusion therefore we can see that smoking can cause a number of changes within the periodontium which can predispose an individual to the progression of periodontal disease. Both the frequency and severity of periodontal disease appears to be greater among smokers than non-smokers. The smoking habit is associated with a variety of deleterious changes in the oral cavity. The periodontal tissues are firstly compromised by the initial vasodilatation and then the decreased blood flow to the gingiva, due to the vasoconstricting actions of nicotine. This also acts to decrease the crevicular fluid flow, which increases the susceptibility of the host to bacterial growth. The vasoconstriction also acts to inhibit what are normally early signs of periodontal problems by decreasing gingival inflammation, redness and bleeding. Evidence suggests that smoking is consistently associated with poorer levels of oral hygiene and consequently smokers have increased accumulations of plaque and calculus. The immune response of smokers is also impaired where the chemotactic and phagocytic ability of combination of these factors which enhances the breakdown of periodontal tissues in smokers. I believe that the dentist has an important role in making patients aware of the detrimental effects that smoking has on periodontal tissues and health in general. The smoking habits of all patients should be inquired about during an oral examination and the patient should be strongly advised to stop smoking by pointing out the risks involved and the positive benefits gained from breaking this habit. It is essential that the dentist is supportive in this role in an attempt to improve the oral status of the individual.