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
The Lowdown on Gum Disease
Dentistry has surely shifted its focus from cavity control, thanks to fluoride and early dental care. Now we are learning more about periodontal disease, and for good reason. These days, tooth loss is the likely result of gum disease.
Q. I used to come in twice a year for cleanings. Now the dental hygienist says I need more attention, more often. My insurer limits coverage to six-month visits. What's up?
A. First, we know more about diagnosing the disease and have come upon some very dangerous systemic relationships to other conditions. That is, if you have heart problems, diabetes, or you're expecting a baby, we'll have to watch you closer than the next patient. Ongoing treatment for advanced mouth disease (periodontitis), too, should be scheduled more often.
Q. OK. What will periodontal treatment cost? I want to keep all the teeth I have.
A. You'll have to contact your periodontist's office for specific pricing but to treat a light case of gingivitis - the very first stages of disease - is the least expensive. Deep pockets around teeth and apparent bone loss - a complex case - will cost more. Periodontitis that requires surgery, and maybe the services of a specialist, costs much, much more. A good argument for early gum disease treatment and prevention.
Q. When you're done with me, am I cured?
A. Periodontal and gum disease prevention is the best defense because nobody walks away from it. Unfortunately, periodontal disease is incurable. But with your help, we can keep it under control. So much of your tissue health depends on how much work you're willing to put in. There's nothing magical about brushing and flossing. You just have to do it.
+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.