Tobacco Use and Periodontal Disease

Question:

What is the link between Tobacco Use and Gum Disease (Periodontal Disease)?

Answer:

We all are getting to be very familiar with the link between the use of tobacco, lung cancer and heart disease. Did you know that tobacco could wreak havoc in your mouth, from bad breath to oral cancer? Compared to nonsmokers, smokers are many times more likely to develop gum disease, larger deposits of tartar on their teeth, cavities (due to a drier mouth) and eventual tooth loss (from periodontal disease). Smoking can also act to delay healing after surgical procedures or tooth extractions. In addition, smoking has also been shown to be detrimental to the successful integration of implants. Recent studies have identified cigarette smoking as a major independent risk factor for periodontal disease (the disease that affects the bone and tissue surrounding your teeth).

Research has shown that when variables such as oral hygiene, age, gender, systemic diseases, medications, and frequency of dental visits are controlled, cigarette smoking is the strongest predictor for developing periodontal disease. Smokers tend to develop gum disease at earlier ages and have more severe cases of it. Research has found that cigarette smoking more than doubled the rate of tooth loss for an individual, and increased the possibility of becoming completely toothless by 4 times.
When a smoker is in need of periodontal therapy, a deep dental scaling tends to not result in significant reduction of pocket depths. In addition, surgical gum therapy does not usually result in longstanding reductions of pocket depths in patients who smoke. Smokers tend to respond poorly to gum therapy and heal much slower than non-smokers.

The Centers for Disease Control and Prevention (CDC) have conducted several comprehensive studies; the most recent data indicated that smokers were 4 times as likely to develop gum disease, and former smokers were 1.7 times more likely, than non-smokers. For current smokers, there is a dose dependant relationship between cigarettes smoked and the likelihood of developing periodontal disease. For example, if someone smoked 9 or less cigarettes per day they were 2.8 times as likely, whereas is they smoked 31 or greater, the odd increased to almost 6 times.

Cigarettes not only affect the teeth and their surrounding structures, but they act to suppress the immune system, decreasing one’s ability to fight off infections and disease. Most people are surprised to learn that each year one person dies every hour from oral cancer. Approximately 75% of these cancers are attributed to the use of tobacco (primarily cigarette, pipe and cigar smoking) when combined with alcohol. When alcohol is combined with tobacco, the risk for oral cancer increases by more than 15 times. It has been well documented that the use of tobacco increases the prevalence and severity of periodontal disease and subsequent tooth loss. Recent studies have shown that more than 50 % of the cases of periodontal disease that affects our nation’s adult population may be attributable to cigarette smoking.

Smokeless tobacco users are 4 times more likely to develop oral cancer than non-users. Chewing tobacco and snuff are the two main categories of smokeless tobacco. Their use has been well established as a cause of oral cancer. Tobacco is considered to be the single most significant initiator of the development of oral squamous cell carcinoma.

It has been estimated that over 100 billion is spent each year on direct medical care for smoking-related illnesses. This seems a bit outlandish considering that tobacco is the single most preventable cause of disease and death in the world. Despite increased public awareness and tobacco cessation products, a large percent of the population still smokes, and many more are involuntarily subject to second-hand smoke. The Surgeon General’s report stated, among its major findings, that “Lifestyle behaviors that affect general health, such as tobacco use, excessive alcohol use, and poor dietary choices, affect oral and craniofacial health as well.”

• Historical Summary of Surgeon General’s Reports on Oral Health and Tobacco
• Since 1964, oral cancer and tobacco have been linked. Evidence relating pipe smoking and lip cancer established.
• Effects of tobacco on gingivitis, periodontal disease, nicotine stomatitis identified in 1969.
• Alcohol found to work synergistically with tobacco reported in1980
• By 1986 all types of tobacco products – cigars, cigarettes, pipes and smokeless tobacco – were implicated in the development of oral cancer.

The dental profession, as a whole, has become increasingly more aware of the detrimental health effects of tobacco, and has begun to take measures to stop its use. Recent surveys are showing that dentists are becoming involved in tobacco-cessation activities, and many feel that it is their duty to encourage and assist their patients to end or at least limit their tobacco use. Dentists are also in a good position to help prevent the initial or continued use of tobacco by children and adolescents through positive anti-tobacco messages. The dentist should advise the teen or young adult to quit, citing reasons that include: reduced athletic ability, mouth odors, and stained teeth, in addition to educating them on the risks of lung cancer, oral cancer and heart disease. Since people tend to visit their dentist more regularly than they see their physician, the dentist should accept the role of the primary educator on the harms of tobacco use.