TOBACCO AND PERIODONTAL DISEASE 1
Tobaccoand Periodontal Disease
Periodontitisrefers to several inflammatory diseases that afflict the foursupporting tissues of the tooth. These tissues include periodontalligaments, alveolar bone, and gingiva. Collectively, the tissues arereferred to as periodontium. Reliable statistics estimate that about90% of the world’s population suffers from a form of periodontaldiseases (Bojorevic, 2012). Perhaps the most prevalent of thesediseases is gingivitis. It is caused by the massing of pathogenicbiofilm close to the gums. Gingivitis is characterized by red,swollen gums that bleed when pricked. Granted, gingivitis isreversible since it poses no threat to the underlying structures thatbind gums and teeth. However, gingivitis could advance toperiodontitis if left untreated. The development of periodontaldiseases is influenced by genetic and environmental factors (Hayman,Steffen, Stevens, Badger, Tempro, Fuller, McGuire, Thomas &Ebersole, 2010). Nevertheless, tobacco use poses the greatest riskfor the initiation and development of periodontal disease.
Approximately33% of the world’s population are active smokers (Bojorevic, 2012).Men comprise the larger share of smokers compared to women. The deathtoll from tobacco use has deprived developing nations of skilledlabor and resourceful markets. People continue to take up smoking atprogressively lower ages. It has been observed that new cases ofsmoking arise continually by over 3% annually (Bojorevic, 2012). Theprogression of periodontal disease is invariably linked to tobaccouse. Therefore, it is expected that cases of periodontal disease willcontinue to increase as smoking also rises. Smoking not onlyinitiates and enhances periodontal diseases but also lowers thelikelihood of successful treatment. Smoking also has a direct bearingon the extent and severity of periodontal disease.
Periodontaldisease is characterized by the weakening of clinical attachment. Itcauses the alveolar bone to erode and thereby destroy the connectivetissue. The weakening of bone support ultimately leads to tooth loss(Hujoel, 2008). Periodontal disease is recognized as the leadingcause of tooth loss among adults. The disease is classified intochronic and aggressive periodontitis. It could also occur as a frontfor systemic illness. Both chronic and aggressive periodontitis areinitiated by bacterial biofilm on the tooth lining.
Scientificresearch has highlighted how smoking affects the supporting tissuesof the teeth. The tissues comprising the periodontium are made offatty acids and lipids. The smoke from tobacco use causes structuralalterations to the periodontium. These alterations occur due tomodifications of the 3-OH fatty acids present in the supportingtissues of the tooth (Bojorevic, 2012). It can be noted that smokerswith chronic periodontal disease experience less clinicalinflammation of gums. This occurs because tobacco use reduces thepotential for inflammation in chronic periodontal disease. Reducedclinical inflammation occurs concurrently with increased periodontalpathogens.
Tobacco usecreates an immunosuppressant effect due to the nicotine. This makessmokers susceptible to periodontal diseases. As mentioned, smokinghinders the efficiency of treatments undertaken for periodontaldiseases. Such treatments include implant procedures, soft tissuegrafting, and regenerative procedures. Smoking interferes withimmunologic and vascular reactions (Sherwin, Nguyen, Friedman &Wolff, 2013). This destroys the versatility of the periodontium. Italso weakens the capacity of the tissues to support the tooth.Studies have shown the negative impact of smoking on success rates.Smoking also increases the chances of losing teeth at progressivelyearlier ages. Young populations below 30 years have the highest casesof periodontal diseases compared to older persons (Arbes,Ágústsdóttir & Slade, 2001). The widespread popularity ofsmoking among young populations is due to the existing forms ofentertainment.
Smokers havebeen estimated to develop severe periodontal disease at a rate fivetimes higher than non-smokers (Arbes, Ágústsdóttir & Slade,2001). The majority of movies and music videos feature instances oftobacco use. Besides, cigarette smoking is portrayed as a preserve ofthe wealthy and powerful. Depictions of smoking as pleasurable andprestigious have led young people to experiment with cigarettes at anearlier age. Youths have harbored erroneous ideas to the effect thatsmoking is inconsequential. Therefore, tobacco use has been used as asocial identification mark of class and finesse.
Lawmakers andother ruling authorities have attempted to curb this disturbing trendthrough the enaction of acts. For example, cigarette manufacturersare legally required to display warning statements on packs ofcigarettes. Such warnings alert buyers of cigarettes to thepotentially harmful effects caused by smoking. Retailers are alsolegally bound to avoid selling cigarettes to persons below 18 years.As a last resort, high taxes are levied on cigarettes for twofundamental reasons. The first aim concerns redistribution of wealthdue to the large number of wealthy tobacco users. The other goal isto discourage persons from smoking. Nevertheless, such measures havedone little to curb tobacco use. In fact, periodontal disease can beobserved in early childhood before other smoking-related diseasesoccur (Hujoel, 2008). By extension, cases of periodontal diseaseshave also remained at previous highs.
The role oftobacco consumption in causing periodontal disease is supported byfive proven facts. Firstly, a review of cross-sectional studiesreveals a higher prevalence of periodontal diseases among active andinactive smokers (Sherwin et al., 2013). Also, a consideration oflongitudinal studies reveals a higher incidence of periodontaldiseases among active smokers. Smoking also maintains a statisticallysignificant connection with periodontal diseases even after otherrisk factors are held constant. Besides, heightened amounts ofsmoking cause both increased incidence and prevalence of periodontaldiseases. Furthermore, scientific study has shed insight into thedestructive effects of smoking on periodontal tissues.
The positivecorrelation between periodontal diseases and tobacco use was firstestablished in the 19th century. Dentists such as JohnBurdell documented various oral changes that occurred after cigarettesmoking (Sherwin et al., 2013). They also experienced manydifficulties in their attempts to provide dentures for smokers.Besides, smokers and non-smokers exhibited different microbialprofiles. Persons that quit smoking had slightly better microbialprofiles than active smokers. The longer the period without smoking,the better the outcomes. In this regard, smokers have similarmicrobial profiles while quitters have divergent profiles. This isbecause people decide to stop smoking at different times. Bacterialbiofilm causes inflammation of the gums (Hayman et al., 2010).Cessation of smoking changes the level of bacterial biofilm.
RemedialTherapies and Treatments
Smokers wouldneed to quit tobacco use and adopt methods of ensuring better oralhygiene. The development and progression of periodontal disease slowin persons who quit tobacco use. It also helps to undertakeperiodontal therapy. This is because quitters and non-smokers respondin a similar way when both undertake therapy.
Therefore, somestudies have highlighted the importance of adopting a five-stepapproach. Dentists and other physicians that advice on oral care needto identify smokers among their patients. The second course of actionis to advise these smokers to quit. It may help to highlight not onlywarnings but also benefits that accrue to quitters and non-smokers.Subsequently, the physician needs to evaluate the person’swillingness to quit tobacco use (Sherwin et al., 2013). The relativereadiness to quit will guide the dentist in determining how muchassistance to provide. A patient that is serious and committedgenerally needs less assistance than one who is deeply attached tosmoking. The dentist also conducts follow-ups on the patient so as tomonitor his progress and provide additional assistance.
Smokingcessation is fundamental in ensuring faster recovery from periodontaldiseases. In this regard, various strategies can be applied to ensurepatients succeed in quitting smoking. Behavioral therapy helps toisolate situations that may trigger the urge to smoke. Nicotinereplacement therapies help to double rates of smoking cessation(Sherwin et al., 2013). This includes using a nicotine patch.Bupropion can also be used to help chain smokers. Besides, smokerswho have suffered many failed attempts can be helped by a combinationof these therapies. Some dental clinics have included counselingsessions for smoking cessation as standard protocol for patients thatsmoke.
Contrary views have cited systemic diseases and diabetes as theprimary causes of periodontal diseases. Others have also givenprominence to genetic predisposition and psychosocial stress. This isbecause of the high level of pathogenic microorganisms in dentalplaque. Some researchers have also cited studies that show higheroccurrences of plaque and gum-bleeding in non-smokers compared tosmokers (Hayman et al., 2010). This attempts to downgrade theoverstated effects of smoking on the onset of periodontal diseases.Nonetheless, the rates at which such conditions cause periodontaldiseases is less compared to the rates among smokers. Loss of teethis also exacerbated by instances of smoking. Numerous studies haveshown the direct relation between smoking and periodontal diseaseseven when other factors are held constant. Also, gum-bleeding isreversible upon early detection and treatment. However, periodontaldiseases require therapy in addition to improved oral hygiene.
Indeed, smokingis the most pertinent cause of periodontal diseases. Exposure tosmoking increases the odds of developing periodontal diseases by asmuch as three-fold. The effects of smoking are dose-dependent. Themore the instances of smoking, the more the severity of periodontaldiseases. Bone tissue infections escalate into the widespread loss ofteeth. Notwithstanding, it is possible to halt the prevalence ofperiodontal disease. A smoker would be required to quit tobacco use.This is because smoking cessation halts the progression ofperiodontal diseases. In this regard, various therapies can be usedto end tobacco use. For example, behavioral therapy helps to ward offpotential triggers of smoking. Nicotine replacement therapies such asnicotine patches also help to increase the chances of smokingcessation (Sherwin et al., 2013). Periodontal diseases can only beovercome when tobacco use ceases.
Arbes, S. J., Ágústsdóttir, H., & Slade, G. D. (2001,February). Environmental Tobacco Smoke and Periodontal Disease in theUnited States. American Journal of Public Health, 91(2),253-257.
Borojevic, T. (2012, December). Smoking and periodontal disease. MatSoc Med., 24(4), 274-276.
Hayman, L., Steffen, M. J., Stevens, J., Badger, E., Tempro, P.,Fuller, B., McGuire, A., Thomas, M. V., & Ebersole, J. L. (2010).Smoking and periodontal disease: discrimination of antibody responsesto pathogenic and commensal oral bacteria. Clinical andExperimental Immunology, 164, 118–126.
Hujoel, P. P. (2008, February 6). Destructive periodontal disease andtobacco and cannabis smoking. Journal of American MedicalAssociation, 299(5), 574-5.
Sherwin, G. B., Nguyen, D., Friedman, Y., & Wolff, M. S. (2013,November). The relationship between smoking and periodontal disease.The New York State Dental Journal, 52-57.