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Smoking and Gum Disease

The systemic risks of tobacco use are well known. Tobacco use can increase the risk for cancer, lung disease, and heart disease. But whether you smoke, dip, or chew tobacco, it also affects the oral cavity in a variety of ways. It contributes to oral cancer, stains the teeth, and contributes to tartar deposits, bad breath, and a loss of taste and smell.

Tobacco use causes inflammation of the soft tissues of the mouth, ulcers, recession, and other oral lesions. Tobacco users are two times more likely to develop periodontitis, and ten times more likely to develop acute necrotizing ulcerative gingivitis (ANUG). They also are more likely to lose teeth than those who don't smoke. Smoking is the number one most significant risk factor in the development and progression of periodontal disease.

Tobacco smoking causes periodontal bone loss that is not related to the amount of gum inflammation or plaque accumulation. Although the periodontal disease may be advanced, the classical signs of gum inflammation (redness, bleeding gums, etc.) are not usually as evident in tobacco smokers. Thus, prevention and early detection are more difficult.

Tobacco smoking has a direct effect on the oral tissues and it can alter the immune response. Although smokers do benefit from periodontal treatment, the healing is often delayed and the results are less predictable. In addition, the success rates of periodontal and implant treatment are reduced in people who use tobacco products. The amount of complications is related to the amount of daily tobacco exposure, and the number of years the person has been exposed.

The use of tobacco products can increase the risk of periodontal disease:

1. It weakens the immune system: Tobacco products suppress the body's ability to fight infection. Carbon monoxide (a major byproduct of cigarette smoke) reduces oxygen concentration and inhibits the movement of white blood cells. This reduces the capacity of the white blood cells to fight bacteria (including the bacteria that cause periodontal disease), and delays healing.

2. It masks signs of infection: Tobacco reduces the ability of blood vessels to carry infection fighting cells, nutrients, and oxygen to the tissues. As a result, the typical signs of periodontal disease (redness, swelling, and bleeding of the gums) are masked. People who smoke may have periodontal disease that is harder to diagnose.

3. It increases calculus formation: Smoking can cause more calculus (tartar) accumulation that if not removed promptly can lead to more plaque build-up and periodontal disease.

4. It reduces healing: Nicotine and other chemicals can be absorbed directly by the root surfaces of the teeth and reduce the ability of cells to reattach to the root surface during healing.

Besides the obvious health benefits of discontinuing tobacco use, quitting can also reduce the risk of oral cancer and the detrimental effects of tobacco on the gums and bone that support the teeth. In addition, another incentive to stop smoking is that former smokers respond similarly to never smokers to periodontal treatment.

Because there is a physical and psychological addiction to tobacco, quitting can be very difficult. But millions of Americans quit smoking every year. There are aids available that reduce the craving for tobacco. These include the use of systemic medications, the nicotine patch, the nicotine gum, the nicotine inhaler, and the nasal spray. See your dentist or physician for aid in stopping tobacco use.

By Laura Minsk, DMD

Periodontitis and Gum Disease Treatment

It's natural to want to lump people together in some Big Category. Natural, but wrong. Like, "Baby Boomer." President Clinton and home run slugger Mark McGwire are both "Boomers." But are these two guys exactly alike?

It's the same in health and dental care. Your oral chemistry is as unique as your thumbprint. Yet magazine stories claim "you" need only one dental appointment a year to stay healthy. They don't know you. They're referring to an "average" patient. Dental insurance plans also tend to believe in this mythical "average patient" and may not pay for more than a biannual visit.

Sure, two visits are fine for many patients, even most. But some mouths build up more tartar than others. Others are naturally decay-prone. Still others - and this is critical - may be showing signs of periodontal (gum) disease.

Bleeding gums need to be taken seriously. They're signs of an infection that can be a significant risk factor for heart disease, and, in fact, many serious illnesses. If you had a bleeding sore on your hand that didn't heal you'd get to a doctor for a checkup, right? Type I periodontitis (gingivitis) consists of tender gums and a little bacteria-filled pocket between your tooth and gum. It's easily treatable at this point. But if the infected pockets are allowed to enlarge and you get swollen gums, that inflammation can extend to the bone beneath and erode it.

Your periodontist's concern is for your health and your teeth, not whether you've made the standard number of appointments for this year. He or she wants the chemistry to be right in your mouth... and between the two of you.

+Jim Du Molin is a leading Internet search expert helping individuals and families connect with the right dentist in their area. Visit his author page.