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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

Gingivitis and Gum Disease Basics

It afflicts as many as nine in ten adults at some point in their lives, as well as teenagers and children as young as five or six years of age. Yet, many suffer from it without even suspecting anything is wrong.

"It" is periodontal disease, or gingivitis - in the minds of most dentists, Public Enemy Number one for teeth.

Only for the last 30 years have researchers understood that gum disease is an infectious disorder, caused by many different species of bacteria. But even today, there is no cure. Fortunately, we have learned a good deal about what periodontal disease is and what can be done about it.

Behind the scenes

The culprits in gum disease are the bacteria that thrive in the crevices between gums and teeth, accumulating in the form of plaque, a hard, colorless film. Plaque produces toxins that not only irritate gums and cause bad breath, but can eventually attack connective tissue, bone and teeth.

These crevices become "pockets" where the bacteria lodge and begin to erode the tissues that connect gums with teeth. If periodontal disease isn't checked, the pockets deepen. The havoc spreads. Eventually, the bone around the teeth and roots is destroyed - and the teeth soon follow.

Sounding the alarm

How can you tell if you have a periodontal problem?

If you have bleeding gums or if you have swollen gums, gingivitis may be the reason why. But mouth disease can strike silently, without any pain or obvious signs.

Any bleeding from your gums should be a tip-off. Make sure you're doing a thorough but gentle job of brushing and flossing every day. If bleeding persists, it's time to see your periodontist. Different people have different levels of susceptibility to periodontal disease, and some forms - including those that affect children and adolescents - can develop quite rapidly.

Not everyone who has gingivitis disease goes on to develop more serious periodontal problems. Some people manage to reverse the disease or stop the progress of chronic gingivitis when it flares up.

Until there's a cure, the fundamentals of gum disease prevention - regular professional care and careful brushing and flossing at home - are still the best line of offense for good dental health.

Ways to fight back

• Periodontal disease can be checked and often reversed with simple preventive measures: brushing, flossing and professional cleaning to remove plaque and stimulate gum circulation.
• If the problem has become more serious, the dentist may do what's called scaling and planing - deep scraping of plaque from under the gum line, and smoothing of root and tooth surfaces so gum tissues have a better chance to reattach.
• Promising new gum disease treatment is already on the horizon: antiseptic or antibiotic drugs placed at the site of infection. And new chlorhexidine mouthwashes that may help prevent the formation of plaque.

+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.