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Smoking and periodontal disease – what’s the connection?

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Periodontal disease is a very common problem, which most people will suffer from at some point in their lives. Although dental hygiene is a must in order to avoid periodontal disease, there are some factors that increase the risk. Among these is smoking. Some studies suggest that the risk of developing periodontal disease is up to 11 times higher for smokers than for non-smokers. But why is it so?

Smoking and your gums

One reason that smoking is a risk factor for developing periodontal disease is that nicotine makes the blood vessels in the gum tissue constrict, which reduces the amount of oxygen in the area. Without oxygen for the cells, the body’s ability to defend itself against bacterial infection is reduced.

Nicotine and cytokines


Another effect of nicotine is that it triggers an over-production of immune factors called cytokines, which can be harmful to cells and tissue. When nicotine is combined with certain oral bacteria, the cytokines multiply and become even more harmful to the oral tissues.

Makes periodontal disease ‘invisible’

Another tricky thing about smoking and periodontal disease is that the effect of nicotine can make the periodontal disease ‘invisible’. The constriction of the blood vessels results in less bleeding from the gums. Since bleeding gums are normally an indicator for periodontal disease, the disease might not be discovered as easily. It is therefore vital that your dentist makes a thorough examination of your gums and measures your gingival pockets regularly in order to get an exact idea of your periodontal status.

Other kinds of smoking

The impact of cigar, pipe and waterpipe smoking is largely the same as that of cigarette smoking. Passive smoking is also thought to increase the risk of periodontal disease, although not by as much as ‘active’ smoking. Since nicotine gum also constricts the blood vessels in the mouth, there has been speculations that nicotine gum might also be a risk factor in developing periodontal disease. No studies have confirmed these speculations yet, though.

Effect on treatment prognosis

Apart from being a risk factor for developing periodontal disease, smoking also negatively affects the prognosis of treating periodontal disease. Because of the effect of the nicotine, the gum tissues do not heal as well for smoker as for non-smokers. Many dentists and dental hygienists will therefore offer advice on how to quit smoking as part of their treatment plan for periodontal disease.

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