Researchers analyzed government health data on 13,650 people aged 18 and older who had their teeth. This is the first study to estimate the proportion of periodontal disease cases that can be attributed to cigarette smoking.

“Cigarette smoking may well be the major preventable risk factor for periodontal disease,” said the study’s lead researcher, Scott Tomar, D.M.D., Dr.P.H., of the Division of Oral Health at the Centers for Disease Control and Prevention (CDC). “The good news is that quitting seems to gradually erase the harmful effects of tobacco use on periodontal health.”

The study also found that there is a dose-response relationship between cigarettes smoked per day and the odds of periodontitis. “Smokers who smoked less than a half a pack per day were almost three times more likely than nonsmokers to have periodontitis. Those who smoked more than a pack and a half per day had almost six times the risk,” explains Tomar.

A recent online survey of periodontists conducted by the AAP found that the vast majority of periodontists routinely (79 percent) or most of the time (14 percent) advise their patients to quit smoking.

“Everyday periodontists see the destruction smoking causes in the mouths of their patients,” said Jack Caton, D.D.S., M.S., president of the American Academy of Periodontology. “I hope the staggering statistics from this study will compel even more dental care providers to get involved in tobacco cessation efforts.”

Tobacco’s negative effect on periodontal health is well documented. Smoking interferes with healing, making smokers more likely to not respond to treatment and to loose teeth. “Tobacco use reduces the delivery of oxygen and nutrients to gingival tissue,” explains Robert Genco, D.D.S., Ph.D., editor of the Journal of Periodontology. “Smoking impairs the body’s defense mechanisms, making smokers more susceptible to an infection like periodontal disease.”

In addition to being a major cause of tooth loss, periodontal disease has been linked to increased risk of heart disease, stroke, poorly controlled diabetes, respiratory disease and premature babies.

The American Academy of Periodontology (AAP) has a section entitled The Mouth-Body Connection on its Web site at WWW.PERIO.ORG to educate people about tobacco’s effects on periodontal health.

“We hope smokers will think about the fact that they are putting their teeth and their health at jeopardy,” said Caton. “We encourage smokers who want to quit ask their health and dental care providers for help.”

A referral to a periodontist in your area and free brochure samples including one titled Tobacco and Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

Studies have shown that smoking can impair the body’s ability to heal itself immediately after surgery; but, this most recent study also showed that when a patient has periodontal plastic surgery, smoking can damage the ability of that procedure to stay intact over a long period of time.

“People who smoke and have had some sort of periodontal plastic surgery should be aware of the negative side effects of smoking. It can be costly to have to repeat a surgery because the desirable outcomes might have been undone by smoking,” explained Dr. Preston D. Miller, DDS, and AAP president. “Therefore, it is important patients and doctors agree to a smoking cessation program prior to any periodontal surgery. This will help a patient’s chance of achieving optimal results.”

To learn more about the oral health risks associated with smoking, you can get a referral to a periodontist in your area and free brochure samples including one titled Tobacco & Gum Disease by visiting the AAP’s Web site at www.perio.org or calling 800-FLOSS-EM.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

Researchers from University of Murcia in Spain investigated if smoking impacts the ability of a dental implant to succeed. They found that smoking is a risk factor with regard to tooth loss and dental implant failure.

“People who smoke are at a greater risk of infection following surgery, and may heal more slowly,” said Dr. Arturo Sanchez Perez, Department of Periodontology at the University of Murcia. “When an implant is placed in a smoker, it is more likely to fail. This means a patient’s smile may be negatively affected, and the potential for more bone loss in the areas surrounding the gums and teeth.”

Smoking negatively affects blood flow to the bone and tissues surrounding the gums and teeth, which impairs bone healing. Implants fail because of a failure to integrate with the surrounding bone tissues. The study followed 66 patients over 5 years, who received 165 implants. They found that 15.8% of implants failed in smokers, versus 1.4% of implants in non-smokers.

“Tobacco use has been shown to be a risk factor for periodontal diseases, which is the main cause of tooth loss in adults,” said Dr. Preston D. Miller, DDS, President of the American Academy of Periodontology, “This research shows that if you want your dental implant to last, you should not smoke. Also, the treating dentist should make sure their patients are aware of this before placing an implant, and emphasize the importance of quitting smoking.”

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

The study followed a group of 219 factory workers in Japan from 1999 to 2003 in an attempt to evaluate the effect of different lifestyle factors on the progression of periodontal diseases. Each worker was evaluated on a list of the following lifestyle factors: physical exercise, alcohol consumption, tobacco use, hours of sleep, nutritional balance, mental stress, hours worked and eating breakfast. The study found that the number one lifestyle factor that independently impacted the progression of periodontal disease was smoking; hours of sleep closely followed. Over 41% of study participants who showed periodontal disease progression from 1999 to 2003 were current smokers. In addition, lack of sleep was identified as a significant lifestyle factor that may play a role in the progression of periodontal disease. The participants who received seven to eight hours of sleep exhibited less periodontal disease progression than those who received six hours of sleep or less. High stress levels and daily alcohol consumption also demonstrated a significant impact on periodontal disease progression.

“Our findings are in line with other studies that have identified smoking as a strong lifestyle factor affecting oral health,” said study author Muneo Tanaka, DDS. “However, studies that have looked at hours of sleep as an independent factor affecting periodontal health are limited. From this study, we can speculate that shortage of sleep can impair the body’s immune response which may lead to the progression of diseases such as periodontal disease.”

“This study points out to patients that there are lifestyle factors other than brushing and flossing that may affect their oral health. Simple lifestyle changes, such as getting more sleep, may help patients improve or protect their oral health,” explained Dr. Preston D. Miller, DDS, and AAP president. “It is also important to keep these in mind as the body of evidence linking oral disease with systemic diseases continues to grow because ultimately these lifestyle factors might impact a patient’s overall health.”

To find out if you are at risk for periodontal diseases, please visit the AAP’s Web site and take a free risk assessment test. A referral to a periodontist in your area and brochure samples including one titled Tobacco & Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

“In this study we investigated the relationship between tobacco smoking and the inflammatory response in smokers who consumed 10 to 20 cigarettes per day,” said Michael P. Rethman, D.D.S., M.S., and president of the American Academy of Periodontology (AAP). “What we found in tobacco smokers is that the body’s defense mechanism was weakened, whereas the defense mechanism in non-smokers promoted a more favorable healing response.”

Research also shows that tobacco smoking releases enzymes that could increase the development of periodontitis, a bacterial infection of the gums, bone and attachment fibers that support the teeth and hold them in the jaw. Once smokers quit, oral health begins to improve.

“Patients who want to quit smoking are urged to increase brushing and flossing their teeth and gums,” said Rethman. “It’s suggested that the fresh clean feeling a person feels in the mouth after brushing and flossing may curb the urge to smoke. Ironically, these simple tips also help to prevent periodontal diseases.”

In conjunction with the Great American Smokeout in November, the AAP has launched a special section on its Web site at www.perio.org to educate people about tobacco’s effects on periodontal health.

A referral to a periodontist in your area and free brochure samples including one titled Tobacco and Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

After six to 10 periodontal appointments in which the goal was to reduce inflammation and probing depths (the amount of space between the teeth and gums), nearly 43 percent of smokers in the study required further periodontal treatment, while only about 11 percent of nonsmokers did. The study included 35 smokers and 35 nonsmokers with periodontal disease. Study Abstract *

“Smoking impairs the body’s defense mechanisms and interferes with the healing process,” explained Robert Genco, D.D.S., Ph.D., editor-in-chief of the Journal of Periodontology. “Smokers should understand that they are at increased risk for treatment failure, treatment complications and increased time to treat periodontal disease. Periodontal treatment of smokers should include serious attempts at smoking cessation.”

“The good news is your oral health will begin to improve once you quit smoking,” said Jack Caton, D.D.S., M.S., president of the American Academy of Periodontology (AAP). “In addition to reducing such serious threats as heart disease and cancer, quitting will help ensure you keep your teeth for a lifetime.”

In conjunction with the Great American Smokeout in November, the AAP has launched a special section on its Web site at www.perio.org to educate people about tobacco’s effects on periodontal health. The smoking section provides information on how tobacco use affects oral health and provides links to the following:

• Other AAP news releases on smoking and periodontal disease
• Research studies on tobacco use and oral health
• Web sites with smoking cessation information

A referral to a periodontist in your area and free brochure samples including one titled Tobacco and Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

Researchers studied rats that were induced with periodontal disease. One group was not exposed to any cigarette smoke while the other two groups were exposed to either 30 days of smoke inhalation produced by non-light cigarettes (cigarettes containing higher tar, nicotine and carbon monoxide levels) or light cigarettes (cigarettes containing lower tar, nicotine and carbon monoxide levels). Results showed that bone loss was greater in the subjects exposed to secondhand smoke regardless of if it was smoke from light or non-light cigarettes than those who were exposed to no smoke at all.

“Previous clinical research has proven a strong positive correlation between smoking and gum disease. However, this study is unique in that it evaluated the impact of secondhand smoke on periodontitis,” explained study author Getulio da R. Nogueira-Filho, D.D.S.

“This study really drives home the fact that even if you don’t smoke the effects of secondhand smoke can be devastating. Part of maintaining a healthy lifestyle should include avoiding smoke-filled places such as night clubs, bars and even some restaurants,” said Dr. Preston D. Miller, DDS, and AAP president. “The Academy applauds the cities that are taking steps to make their hospitality industries smoke-free so all patrons can enjoy not only a good time but also good overall health.”

Cigarette smoking may well be the major preventable risk factor for periodontal disease. To find out if you are at risk for periodontal diseases, please visit the AAP’s Web site and take a free risk assessment test. A referral to a periodontist in your area and brochure samples including one titled Tobacco & Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

In general, do you believe your patients who smoke have less attractive smiles than your nonsmoking patients do? Right-click to download a TIFF version of graphic for print media.

Of the 244 periodontists polled, 90 percent said they routinely ask patients about tobacco use, and 96 percent record information in patients’ charts about tobacco use. The vast majority of periodontists take the next step by routinely (79 percent) or most of the time (14 percent) advising patients to quit. And, 20 percent offer smoking cessation clinics, workshops or support groups at or through their practices.

• Complete survey results

“I’m pleased that periodontists realize they can play a role in motivating patients to quit smoking,” said Jack Caton, D.D.S., M.S., president of the AAP. “The medical community is being encouraged to do more to help their patients stop smoking, and I think this survey shows periodontists are moving in the right direction.”

Patients seem to want the guidance. A recent study published in the Journal of the American Dental Association found that almost 60 percent of dental patients believed that dental offices should provide tobacco cessation services. Sometimes the effort pays off. Sixty-three percent of respondents to the AAP poll thought their efforts made an impact at least some of the time, while 13 percent thought they did most or nearly all of the time.

“Because there is an established link between smoking and periodontitis, peridontists have a professional responsibility to clearly state that smoking is one of the causes of periodontitis and that the patient should stop smoking,” said one respondent. “I find that sometimes my blunt statement that smoking is a cause of periodontal disease is enough to make the patient make the effort to quit.”

Other respondents said they warn patients that continued smoking makes people three times more likely to loose teeth, means periodontal treatments won’t be as effective, and lowers the success rate of dental implants.

A referral to a periodontist in your area and free brochure samples including one titled Tobacco and Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

Researchers analyzed 705 individuals ranging in age from 21 to 92 years old, and found that 17.6 percent of current or former cigar or pipe smokers had moderate to severe periodontitis – nearly three times the percent of non-smokers. In addition, they averaged four missing teeth. For each given tobacco product, current smokers were defined as individuals who smoke daily. Former heavy smokers were defined as individuals who had smoked daily for 10 or more years, but had quit smoking. The non-smokers group included individuals who had quit smoking cigarettes after smoking for less than 10 years and those with no history of smoking.

“Cigarette, cigar and pipe smokers all had a much higher prevalence of moderate and severe periodontitis compared to former smokers and non-smokers,” explained Jasim Albandar, D.D.S., Ph.D., professor of periodontology at Temple University School of Dentistry and lead researcher of the study. “Research also indicated that there was a correlation with the number of missing teeth with the current, former and non-smokers having 5.1, 3.9 and 2.8 missing teeth, respectively.”

Cigar smokers are at a higher risk of alveolar bone loss than non-smokers. “This increase in risk is similar in magnitude to that of cigarette smokers,” explained Albandar.

“Smoking cessation efforts should be considered a way of improving periodontal health and protecting against tooth loss in cigarette, cigar and pipe smokers,” said Michael McGuire, D.D.S., president of the American Academy of Periodontology (AAP). “My patients who smoke understand the health consequences, so I like to remind them of another possible outcome – a toothless smile.”

The AAP has a section titled Tobacco Use and Periodontal Disease on its Web site at www.perio.org to educate people about tobacco’s effects on periodontal health. A referral to a periodontist in your area and free brochure samples including one titled Tobacco & Gum Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

Researchers found that the impact of water pipe smoking is largely the same magnitude as that of cigarette smoking. The prevalence of periodontal diseases was 30 percent in water pipe smokers, 24 percent in cigarette smokers and eight percent in non-smokers.

“Research from this study shows that the relative risk for periodontal disease increased by 5-fold in water pipe and 3.8-fold in cigarette smokers compared to non-smokers,” said Kenneth A. Krebs DMD and AAP president. “Even though the smoke is filtered out by water, inhalation of toxic substances is similar to or even greater than that of cigarette smoking.”

“Many people are mislead in believing that water filters out the toxins and that nicotine is reduced in water pipe smoking,” Krebs continued. “Not only does water pipe smoking include the same substances as cigarette smoke such as carbon monoxide and tar, tobacco used for water pipe smoking contains two to four percent nicotine verses one to three percent for cigarettes.”

Researchers found increased levels of nicotine and cotinine in plasma, saliva and urine, supporting that water pipe smoking affects the periodontal tissues in the same way as cigarette smoking. “This study provides convincing evidence supporting the role of tobacco smoking as a risk factor for periodontal disease,” said Krebs.

“Although the precise mechanisms of action of tobacco smoke are not well understood, it seems highly likely that the periodontal bone is one of the most susceptible tissues,” commented Krebs. “This hypothesis will be further tested by investigating the periodontal bone height levels of various tobacco smokers in the presently studied population.”

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for