Carranza’s Clinical Periodontology, 12th Ed, Chapter 10

Table 10-4: Effects of smoking on response to periodontal therapy

INSIGHT: As oral healthcare providers we need to re-ignite our attention toward addressing tobacco use with our patients.  Since the percentage of US smokers has dropped to 16.8%, it is easy to get complacent.  However, based upon the breakdown by age below, we see that in the age group that is often requesting implants (25-44 years), the percentage is 20%.  Looking at Tile 1, the focus of the caption is on the tobacco stain on hard tissue, but one only has to look at the character of the soft tissue depicted here to be reminded of the significant deleterious effects on the periodontium

  • Nearly 17 of every 100 adults aged 18–24 years (16.7%)
  • 20 of every 100 adults aged 25–44 years (20.0%)
  • 18 of every 100 adults aged 45–64 years (18.0%)
  • Nearly 9 of every 100 adults aged 65 years and older (8.5%) 1

In addition to the impacts of tobacco on periodontal tissues seen in the table in Tile 2, we must remain vigilant about the risks of head and neck cancer. The percentages of tobacco smokers listed above does not take into account those smoking marijuana since it is fully legal in 4 states and the District of Columbia with the remaining states having an array of laws regarding medical usage and most states having decriminalized possession.

There is also a concerning upward global trend for tobacco use via waterpipe smoking.2 This increased usage includes the Western world, where there is often the perception that waterpipe smoking creates less harms that other smoking methods. An excellent systematic review in JADA reports that waterpipe smoking is associated with a variety of systemic disorders (lung and bladder cancer, COPD and other respiratory diseases, coronary artery disease and low birth weight).  Head and neck effects include periodontal diseases, precancerous and other oral lesions, squamous cell carcinoma and keratoacanthoma of the lip, and oral candidiasis.3

ALL healthcare providers, according to the CDC and reported by the ADA, ‘need to ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)-approved pharmacotherapy for cessation to adults who use tobacco’ .4-5        The take-home message for clinicians to know and to convey to our patients is that research over time has shown that for most habitual tobacco users, a combination of behavioral counseling and pharmacoptherapy improves rates of smoking cessation among the general population.6

  1.  Accessed January 10, 2016.
  2. Maziak W.  The global epidemic of waterpipe smoking. Addict Behav. 2011; 36:1-5.
  3.  Munshi, T,Heckman CJ, Darlow S.  Association between tobacco waterpipe smoking and head and neck conditions-A systematic review. JADA 2015;146:760-66.
  4. Accessed January 9, 2016.
  5. January 9, 2016.
  6. Patnode CD, Henderson JT, Thompson JH, Senger CA, Fortmann SP, Whitlock EP.  Behavioral counseling and pharmacotherapy interventions for tobacco cessation in adults, including pregnant women:  A review of reviews for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 163:608-21.