Stubbing out smoking in dental care

There is more than ample evidence, garnered from numerous studies in various populations, to support a conclusion that in adult smokers periodontitis is found some three times more than in non-smokers.

There’s ample evidence smoking affects dental health, increasing rates of periodontitis.

If you just account for the most severely affected patients, the connection between smoking and attachment loss get even stronger.

Smokers exhibit diminished response to periodontal therapy as well as showing about half as much improvement following various non-surgical or surgical therapies.


Implant Failures

Smokers experience twice the failures of non-smokers. The major difference can be found in a higher failure rate in the maxillary arch; changes in microbial and host factors, caused by tobacco use, have clearly been shown to have effects on the periodontium.

Other studies have found that the rate of periodontal disease progression increases in those who smoke, but following tobacco cessation falls to that of a non-smoker.

In patients who are recent non-smokers it has been shown that response to therapy is similar to those who have never smoked.


The Role Of The Dental Practitioner

Most professionals are familiar with the so-called five A’s, but for the sake of clarity they are:

Ask – identify tobacco users.

Advise – advise them to quit.

Assess – evaluate the patient’s readiness to quit.

Assist – offer assistance in cessation.

Arrange – follow up on the patient’s cessation efforts.


Nicotine replacement therapy and bupropion when combined with behavioural therapy has been shown to increase cessation rates. The most widespread of nicotine replacement therapies is the patch, which has been shown to double cessation rates when compared to the use of behavioural therapy on its own.

For those who are heavy smokers, or are smokers who have experienced multiple failed attempts at cessation, use of bupropion combined with nicotine replacement therapy can be particularly helpful.


Smoking has such an affect on post-procedure outcome that the American Academy of Periodontology Parameters of Care includes tobacco cessation as a part of periodontal therapy. Additionally, in the 2000 [US] Surgeon General’s Report on Oral Health in America dental professionals were encouraged to become more active in tobacco cessation counselling.


I believe that by strongly recommending smoking cessation dental practitioners can make far-reaching and positive affects on patients’ oral and general health.

How does smoking affect your daily work? If you’ve got anything to add to this discussion, feel free to leave a comment here or get in touch with me on social media:

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Image courtesyof: Graur Codrin

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