Teeth:
Tobacco smoke produces black or brown stains on the tooth surface, which are caused by the tar products of tobacco consumption.
Oral Hygiene:
It has been found that smokers have more calculus (tartar) than non – smokers.
Smoking and ANUG (Acute Necrotizing Ulcerative Gingivitis – a potential destructive condition of the gums and the mouth):
Berzeron in 1859 first suggested a possible connection between smoking and ANUG.
In 1944, Stammers reported that smoking was an almost universal finding in 1017 recorded cases of ANUG.
In a more recent study by Edinburgh, Kowolik and Nisbet in 1983, it was found that ANUG was almost invariably associated with tobacco smoking. The possible mechanism for the increased susceptibility of ANUG in tobacco smokers include:-
1.Vasoconstriction of gingival blood vessels.
2.Reduced activity of oral leukocytes and
3.Proliferation of anaerobic fusospirochetal microrganisms
b) Periodontitis (Severe Gum Disease):
A meta analysis of data from a number of studies examining the effect of smoking on periodontal disease indicated that smokes were more likely to have severe periodontitis than non- smokers.
Six studies namely by Bergstrom in 1989, Haber and Kent in 1992, Locker in 1992, Haber et al in 1993,Stoltenberg et al in 1993 and Grossi et al in 1994 were used in this meta analysis. A total of 2361 subjects were amendable to such analysis and it was stated that current smokers were nearly 3 times more likely to have severe periodontitis than non-smokers.
On an average, smokers were 4 times more likely to have periodontitis as compared to non- smokers. Former smokers were 1.68 times more likely to have periodontitis than non- smokers.
Socransky & Haffajee, 2001 –
Deeper probing depths & greater attachment loss occurs in maxillary lingual area and mandibular anterior teeth in smokers suggesting a local effect of smoking.
High Periodontal cost of smoking is calculated to be 27 years of disease progression. For e.g. – a 32 year old smoker has similar attachment loss as a 59 year old non – smoker.
Proposed mechanisms for the negative periodontal effects of smoking –
1.Altered neutrophil function
2.Decreased IgG production
3.Decreased lymphocyte proliferation
4.Increased prevalence of periopathogens
5.Altered fibroblast attachment and function
6.Difficulty in eliminating pathogens by mechanical therapy.
7.Negative local effects on cytokine and growth factor production.
8.Nicotine binds to root surface of smokers.
9.Nicotine can also alter fibroblast attachment, integrin expression, decrease collagen production and increased collagenase production.
10.Local nicotine negatively impacts bone healing due to inhibited expression of growth factors & delayed revascularization.
Taken together all the above factors, account for the increased destruction observed in smokers.
Pocket depth & attachment loss:
It has been shown that smoking results in increase in pocket depth and attachment loss.
Alveolar bone
Smokers are associated with a greater bone loss.
Tooth loss :
A longitudinal study by Holm G in 1994 demonstrated that young individuals smoking more than 15 cigarettes a day showed the highest risk of tooth loss.
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