Cigar, Pipe, and Cigarette Smoking as Risk Factors for Periodontal Disease and Tooth Loss

Department of Periodontology, Temple University School of Dentistry, Philadelphia, PA 19140, USA.
Journal of Periodontology (Impact Factor: 2.71). 12/2000; 71(12):1874-81. DOI: 10.1902/jop.2000.71.12.1874
Source: PubMed


Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss.
A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking.
Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models.
The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.

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    • "In this study, the crude prevalence of periodontal disease was 13.2% in the nonsmoking group. This is in accordance with previous studies that showed the prevalence of periodontal disease in nonsmokers to range from 7.4% to 13.1% (Albandar et al, 2000; Ababneh et al, 2012). In the current study, we showed that cigarette smoking was associated with a 4.6-fold increase in the odds of developing clinically detectable periodontitis. "
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    ABSTRACT: Purpose: To determine the effect of waterpipe smoking on periodontal health. Materials and methods: The study included 190 participants who were categorised into four groups; cigarette smokers, waterpipe smokers, dual smokers and nonsmokers. Intraoral examination included plaque (PI), gingival (GI) and calculus (CI) indices, probing pocket depth (PPD), clinical attachment level (CAL) and bleeding on probing (BOP). Results: The four groups differed significantly in the prevalence and extent of periodontal disease. Pairwise comparison tests showed that the means of percentages of sites with PPD > 3 mm, PPD > 4 mm, CAL > 1 mm and bleeding on probing were significantly higher among smoking groups compared to the nonsmoking group (p < 0.05). After adjusting for age, cigarette smokers (OR = 4.6), waterpipe smokers (OR = 4.3) and dual smokers (OR = 4.9) were significantly more likely to have periodontal disease compared to nonsmokers. When data were analysed according to the smoking method, no significant differences in the odds of periodontal disease were detected between different smoking groups (p > 0.05). Conclusion: Waterpipe tobacco smoking is not an alternative, safe way of smoking considering periodontal disease. Thus, global actions against waterpipe smoking are required.
    No preview · Article · Sep 2014 · Oral health & preventive dentistry
    • "Moreover, periodontal disease is multifactorial. One of the most well recognized risk factor is tobacco smoking whose association has been proven by several land mark epidemiological studies.[1] The numerous deleterious components like nicotine, benzene, benzo-pyrene, acrolein and tar contained in tobacco smoke cause oxidative burden and stimulate hyper inflammatory state. "
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    ABSTRACT: Background:Ki-67 which is a non-histone nuclear protein which is expressed in proliferating cells, during all the active phases of the cell cycle. Increased Ki-67 expression has been seen in several inflammatory and malignant conditions like diabetes, rheumatoid arthritis, atherosclerosis, pancreatitis and squamous cell carcinoma.Aim:The aim of the present study is to analyze the expression of Ki-67 in gingival tissues by immunohistochemistry in smokers and non-smokers with healthy gingiva and chronic periodontitis.Materials and Methods:Gingival biopsies (n = 32) were obtained from smokers who had clinically healthy gingiva (n = 8), smokers with periodontitis (n = 8), chronic periodontitis (n = 8) and healthy gingiva (n = 8). The expression of Ki-67 was evaluated immunohistochemically. Statistical analysis used: Mean and standard deviation were estimated for the gingival tissue extract sample for each study group. Mean values were compared between different study groups by, one way ANOVA, post hoc analysis. In this study P < 0.05 was considered as the level of significance.Results:The mean number of Ki-67 positive cells/field was higher in the smokers with periodontitis group. When the mean Ki-67 positive cells were compared between different groups, statistical significant difference was observed between healthy and both the periodontitis groups (P = 0.000) and between smokers group (P = 0.001).Conclusions:Ki-67 was maximally expressed in smoker with periodontitis followed by chronic periodontitis patients, healthy smokers and healthy control patients which shed light on the toxic effects of tobacco in dysregulating the cell cycle and cellular proliferation. The findings of this study also help us to understand the role of the cell cycle in resolution of periodontal inflammation which is a salient feature in the pathogenesis of chronic periodontitis.
    No preview · Article · Mar 2014 · Journal of Indian Society of Periodontology
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    • "glutathione peroxidase) and immune system function [4,5]. Hence, a reduction of the Igs contained in saliva can represent an increased risk factor for the host mucosa with respect to pathogenic microorganisms, including periodontal pathogens [6]. Although bacteria are the main etiological factor in the appearance of periodontal diseases, the individual’s response is a crucial factor in his or her susceptibility to disease [7]. "
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    Full-text · Article · Feb 2014 · BMC Immunology
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