Smoking and Risk for Periodontitis

The impact on periodontitis by smoking is alarming. Thirty percent of Americans have moderate to severe periodontitis; this represents approximately 93 million people. In addition, the institutions that we trust to keep our statistics up to date have warned that our current estimates under-represent the number of actual cases of periodontitis by as much as 50 percent. Suddenly, it seems that periodontitis is even more prevalent that we once thought.

If so many people have periodontitis, what are the causes? We know that periodontal diseases are multi-factoral and can be impacted by systemic disease, medication, personal oral hygiene, and genetics, but the greatest single modifiable behavior associated with the disease is smoking. At least 20 percent of periodontitis cases are attributed to smoking.

It is common knowledge that smoking is a vasodilator, but less well-known is that smoking heavily influences the immune response, in more ways than decreased blood flow. For instance, nicotine and carbon monoxide found in cigarette smoke negatively influence wound healing. In fact, patients who smoke are expected to respond less favorably, or unfavorably to periodontal treatment.

The Surgeon General has made statements recognizing the dangers of cigarette smoke, and has linked smoking to causation of periodontal disease. So while no formal name exists for smoking- induced periodontitis, we do know that smoking causes periodontitis in a dose-dependent relationship.