Abstract
Periodontal disease is one of the most common diseases of the oral cavity affecting up to 90% of the worldwide population. Smoking has been identified as a major risk factor in the development and progression of periodontal disease. It is essential to assess the influence of smoking on subgingival microflora that is the principal etiological factor of the disease to clarify the contribution of smoking to periodontal disease. Therefore, this article reviews the current research findings regarding the impact of smoking on subgingival microflora and discusses several potential mechanisms. Cultivation-based and targeted molecular approaches yield controversial results in determining the presence or absence of smoking-induced differences in the prevalence or levels of certain periodontal pathogens, such as the “red complex.” However, substantial changes in the subgingival microflora of smokers, regardless of their periodontal condition (clinical health, gingivitis, or periodontitis), have been demonstrated in recent microbiome studies. Available literature suggests that smoking facilitates early acquisition and colonization of periodontal pathogens, resulting in an “at-risk-for-harm” subgingival microbial community in the healthy periodontium. In periodontal diseases, the subgingival microflora in smokers is characterized by a pathogen-enriched community with lower resilience compared to that in non-smokers, which increases the difficulty of treatment. Biological changes in key pathogens, such as Porphyromonas gingivalis, together with the ineffective host immune response for clearance, might contribute to alterations in the subgingival microflora in smokers. Nonetheless, further studies are necessary to provide solid evidence for the underlying mechanisms.
Highlights
Smoking remains a highly prevalent addiction in many populations worldwide despite the increasing awareness of its harmful effects on general health (World Health Organization [WHO], 2018)
This review aims to present current research findings of the impact of smoking on subgingival microflora and discuss possible mechanisms by which smoking interferes with the microflora
Some of them found no difference in the subgingival microflora between smokers and non-smokers with different periodontal conditions, concluding that smoking had insignificant effects on the subgingival microflora (Darby et al, 2000; Bostrom et al, 2001; Van der Velden et al, 2003; Apatzidou et al, 2005; Natto et al, 2005; Salvi et al, 2005)
Summary
Smoking remains a highly prevalent addiction in many populations worldwide despite the increasing awareness of its harmful effects on general health (World Health Organization [WHO], 2018). As one of the five leading risk factors for the global burden of the disease, smoking is responsible for various diseases, including cancer, cardiovascular. Periodontal disease, known as gum disease, comprises a range of polymicrobial infectious disorders (such as gingivitis and periodontitis) that affect the tooth-supporting tissues (the gingiva, alveolar bone, and periodontal ligament). It is the most common cause of tooth loss and contributes to systemic diseases. Smoking has been recognized as a major risk factor for periodontal disease, affecting the prevalence, severity, progression, and treatment response of the disease, second only to the dental plaque. Smoking exerts an adverse influence on the clinical treatment outcomes of non-surgical and surgical therapies as well as the long-term success of implant placement (Heasman et al, 2006; Patel et al, 2012)
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