Periodontitis (inflammation of periodontal tissues) is a multifactorial disease. Smoking is one of the main risk factors for the appearance and development of periodontitis. Smoking also significantly alters the response of periodontal tissues to both surgical and non-surgical treatments.
In dentistry, tobacco is responsible, among other adverse effects, for periodontal disease and oral cancer. The first effects of tobacco on periodontal tissues are gingival recession and epithelial hyperplasia. Smoking is associated with an increased susceptibility to periodontal disease because it favors smokers to have higher levels of pathogenic bacteria in periodontal tissues, while the gingival response to bacterial attack is diminished.
Gingival recession is caused by a decrease in blood flow to the periodontal tissues. In patients who smoke, it is common to observe whiter gums or gums that do not bleed, due to the vasoconstrictor effect of nicotine. This fact makes one of the main warning signs of the presence of periodontitis disappear and, therefore, the diagnosis of periodontal disease is made later, thus reducing the chances of successful dental treatment.
Another effect of smoking is bone loss at the oral level, diagnosed after the pertinent intraoral X-rays, which leads to gum recession and tooth mobility, even leading to tooth loss if these bone defects are significant.
Leukoplakia are white precancerous lesions in the oral mucosa, which do not detach when scraped, and are up to 6 times more frequent in patients who smoke. Once the patient stops smoking, they usually remit in a period of time. They are caused by the increase of several inflammatory mediators (interleukin-1 and prostaglandin E2).
Smoking also has a negative effect on healing after surgical treatment, and the clinical response obtained after periodontal treatment in patients who smoke is lower than in non-smoking patients (including scaling and root planing, antimicrobial therapy, periodontal surgery and periodontal maintenance).
The main objective is for the smoking patient to give up smoking. It has been demonstrated that after quitting smoking, in approximately 4 to 6 weeks, gum revascularization recovers, the response to periodontal treatments improves and the appearance of other associated problems progressively decreases.
In patients who smoke, we should insist on the importance of performing more frequent gum check-ups, advising them to brush their teeth three times a day and to use dental floss frequently to eliminate bacterial plaque. We have the obligation to inform patients who smoke of all the risks that smoking entails and to warn them of the reduced effectiveness of periodontal treatments.
