Smoking, Plaque, and Chronic Periodontitis - a Need to Refocus?

Current epidemiological estimates suggest that 50% to 80% of all chronic periodontitis (CP) cases are attributable to smoking and that 75% of all type II diabetes cases are caused by obesity. These data suggest that, from a public health perspective, smoking may be to CP what obesity is to diabetes. However, while the importance of obesity to diabetes was recognized since the 19th century, the importance of smoking to CP has remained largely unrecognized during the 20th century. The inability to identify smoking as a major risk factor for CP raises several questions to which evidence-based answers could be explored. What epidemiological evidence justified the plaque-hypothesis and 40-years of research focused on plaque-related microbiology and immunology in the 20th century? Why did the epidemiological smoking-CP evidence remain largely ignored in best-selling textbooks and authoritative periodontal reviews? Is it possible that the power of smoking-CP association remains, once again, largely unrecognized in current CP-systemic disease research? And, can the dynamic changes in smoking prevalences across the world be used to understand changes in periodontal treatment needs? National US statistics indicate that the utilization of CP treatments has drastically declined which has already led to a refocusing of the periodontal specialty on dental implants and esthetic surgeries. An evidence-based review of epidemiological evidence on the causes of CP should determine whether a refocusing of the periodontal research agenda is required. NIDCR R-01 DE13912