Levels of cigarette consumption and response to periodontal therapy
Initially the authors provide the reader with background information on the topic and make notations in the literature to support their comments. They state that there is increasing evidence that cigarette smoking is a risk factor for periodontitis. It also has been reported that the severity of periodontal destruction is directly related to the quantity of cigarette consumption. The authors note that the response to periodontal therapy is less favorable in current cigarette smokers as compared with nonsmokers. In addition they cite several studies which indicate the poorer response of smokers to surgical and nonsurgical therapy and also note that a large percentage of individuals with infractory periodontitis are predominately smokers.
Seventy-four patients with moderate to advanced periodontitis were classified by cigarette consumption at the initial exam: heavy smokers > 20 cigarettes per day (n = 31); light smokers < 19 cigarettes per day (n = 15), past smokers who had a history but by the first exam were smoking no more (n = 10), and nonsmokers (n = 18). Patients were treated with four modalities of periodontal therapy followed by supportive periodontal treatment (SPT) for a period of up to seven years. Clinical data included measurements of probing depth (PD), clinical attachment level (CAL), recession (REC), presence of bleeding on probing (BOP), and supragingival plaque (PL). Evaluation included six sites around each tooth. In molar furcation areas, horizontal depths of furcation involvement were noted. Data were collected at the baseline exam, four weeks post-nonsurgical therapy, 10 weeks postsurgical therapy, and yearly during SPT. Heavy smokers and light smokers demonstrated less pocket depth reduction and less clinical attachment-level gain than past smokers and nonsmokers following active treatment and throughout SPT. Following active treatment, horizontal probing attachment levels in furcation sites were similar for all groups, but during the seven years of SPT, smokers experienced a greater loss of horizontal furcation attachment. No significant differences in bleeding on probing were noted between the four groups. Heavy smokers had greater deposits of supragingival plaque deposits.
In conclusion, the authors stated that smokers respond less favorably to therapy than do nonsmokers. A past history of smoking was not deleterious to the response to therapy. [I.S.]
Kaldahl, W.B., G.K. Johnson, K.D. Patil, and K.L. Kalkwarf Periodont, 67:675,1996