Smoking as an environmental hazard to the periodontal and peri-implant tissues: A brief review

Abstract

While dental plaque is considered the etiological factor for the development of periodontal and peri-implant diseases, many studies from recent years point to smoking as the most significant environmental factor contributing to disease severity. This effect is evident at the epidemiological level as well as on our understanding of the biological mechanisms involved. The present review presents abundant scientific evidence showing that smoking negatively affects the local blood supply, interferes with the reaction of the immune system to bacterial insult, is toxic to gingival and periodontal ligament cells, impedes the response of the periodontal attachment apparatus to treatment, and is linked to dental implant failure. Over the past 30 years, more than 200 million people have died as a result of smoking tobacco use. There are more than 1 billion current smokers worldwide and these numbers are likely to increase over the coming years. And yet, the effect of smoking on periodontal and peri-implant health has been a controversial issue. It was argued, that it is difficult to prove such an effect due to poor adherence of smokers to oral hygiene, which creates a confounding factor inseparable from the effect of the smoking itself. Unfortunately, even some of the more recent publications cast doubt as for the importance of smoking cessation on peri-implant health, as a prerequisite for a successful treatment. The aim of the present review was to question the validity of these reports by presenting multiple evidence to support the quiet widely accepted common knowledge that is the numerous hazards to the oral biology which are the result of a heavy and prolonged smoking habit.