Long-Term Effect of Smoking on Vertical Periodontal Bone Loss

Howard E. Strassler, DMD

Baljoon M, Natto S, Bergstrom J. J Clin Periodontol. 2005 Jul;32(7):789-97.

Abstract

OBJECTIVES: The objective of the present study was to investigate the influence of smoking on vertical periodontal bone loss over 10 years. MATERIAL AND METHODS: The study base consisted of a population that was examined on two occasions with a 10-year interval, including 91 individuals, 24 smokers, 24 former smokers, and 43 non-smokers. The assessment of vertical bone loss was based on full sets of intra-oral radiographs from both time points. The severity of vertical bone loss was expressed as the proportion of proximal sites with vertical defects per person. RESULTS: The 10-year increase in the proportion of vertical defects was statistically significant in all groups (p<0.001) and, in addition, significantly associated with smoking (p<0.05). In particular, the difference between smokers and non-smokers was significant (p<0.01), whereas former smokers did not differ from non-smokers. Moreover, the 10-year vertical bone loss was significantly greater in heavy exposure smokers than in light exposure smokers, suggesting an exposure-response effect (p<0.01). Compared with non-smokers, the unadjusted 10-year relative risk was 2.3-fold increased in light exposure smokers and 5.3-fold increased in heavy exposure smokers (p<0.05). CONCLUSIONS: The present observations indicate a significant long-term influence of smoking on vertical periodontal bone loss, yielding additional evidence that smoking is a risk factor for periodontal bone loss.

COMMENTARY

Current knowledge about the relationship between smoking and vertical periodontal bone loss is limited. There has been evidence from both cross-sectional and case-controlled studies in a variety of different populations that have demonstrated that adult smokers are approximately 3 times more likely than non-smokers to develop periodontitis. This study is important because it evaluates the relationship between smoking and vertical periodontal bone loss. Loss of tooth support has a major impact on treatment prognosis. This long-term study evaluated a large group of patients over 2 intervals 10 years apart. These types of studies are very powerful in terms of the data they reveal. For this study, measuring the severity of vertical bone loss based upon the proportion of vertical defects per person showed that the results were significantly different between the smoking and non-smoking groups. There is no doubt that with this study and other studies on the risk of periodontitis for smokers, dentists and dental hygienists need to be proactive in counseling their patients regarding tobacco use. Dental professionals need to play a role in tobacco cessation. From a review of “Cigarette smoking and the periodontal patient” (Johnson GK and Hill M, J Periodontol. 2004;75(2):196-209), dental professionals should use the five A’s: Ask—identify tobacco users; Advise—advise them to quit; Assess—evaluate the patient’s readiness to quit; Assist—offer assistance in cessation; and Arrange—follow-up on the patient’s cessation efforts. For smoking cessation programs to be successful, they cannot be one-size-fits-all. In many cases, the use of behavioral therapy and counseling needs to include pharmacotherapy, such as nicotine replacement therapy and bupropion to increase cessation rates.