The influence of smoking on loss of attachment

Aim: The purpose of this investigation was to examine the long-term influence of smoking on periodontal health. Methods: The data derived from a 20-year longitudinal study of a group of Norwegian middle class males characterized by good to moderate oral hygiene and regular dental check-ups. The subjects were subset according to their smoking history into non-smokers and smokers. During the 20-year observation period there were cumulatively 1124 non-smokers and 239 smokers. Results: At every age level the smokers showed significantly higher mean calculus scores than the non-smokers (Table 4). Generally before 30 years of age, more than 82% of all the surfaces were calculus free in both groups (Figure 1). Thereafter, however, subgingival calculus (Cl =2,3) increased from 17% to 37% in smokers, whereas in the non-smokers subgingival calculus showed little increase (4% - 8%). The smokers exhibited more subgingival calculus formation in the maxilla and incisors of the lower jaw after the age of 30 years. At baseline, the mean loss of attachment for the non-smokers and smokers was 0.14mm. At all subsequent examinations the smokers had statistically fewer sites with no attachment loss (34%) than the non-smoking group (53%). At 50 years of age the cumulative mean loss of attachment was 1.59mm for the non-smokers and 2.22mm for the smokers. Linear regression indicated that ageing and smoking were independently significant related to mean loss of attachment. The slope of the regression line for the smokers was approximately 1.4-times that of the non-smokers, indicating that smoking had an increasing effect with increasing age. The slopes were significantly different from each other (p<0.05). Conclusions: Smoking was highly associated with increased calculus formation, especially in maxillary teeth and the incisors of the mandible, and could be confirmed as an important risk factor of periodontal disease progression.