Symposium: Smoking and periodontal health. Current state of the art

The literature on smoking and periodontal health or disease amounts to over 300 articles today enabling an objective estimation of the possible impact of smoking on the periodontal health and allowing a solid base for evidence interpretation to be made. A scrutiny of the literature proves that clinical and radiographic measures of periodontal morbidity such as periodontal pocket formation, periodontal attachment loss, and periodontal bone loss are markedly increased in smokers when compared with non-smokers. In addition, tooth loss is more extensive in the average smoker. Studies that explored the relation between increasing levels of exposure to smoking and periodontal morbidity further suggest that gradually increasing exposures correspond to increasing morbidity levels. In addition, studies conclude that individuals who have given up smoking are less frequently affected or exhibit less severe symptoms than those who continue, suggesting that quitting smoking is beneficial to the periodontium. The outcome of periodontal treatment is less favourable or even unfavourable in smokers when compared with non-smokers. Consequently, treatment failure and relapse of disease are predominantly encountered in smokers. Summarising the large body of literature, there is currently firm evidence in support of the contention that smoking bears a strong relationship to destructive periodontal disease. We still lack large-scale long-run cohort and exposure-response studies to reach conclusive evidence as to the causality aspect of this relationship. No doubt, however, the evidence base is sufficiently strong to encourage action against avoidable smoking, against avoidable treatment, and against avoidable cost in the periodontal setting.