Periodontal disease is one of the leadingcauses of tooth loss, particularly amongolder individuals (1–6). Although den-tal plaque-associated microorganisms arethe primary etiologic agents of periodon-tal diseases, several other factors such aslocal, genetic, systemic, and environmentalfactors play an important role in deter-mining the susceptibility of individuals toperiodontal diseases. Tobacco smoking isone of the most important environmen-tal risk factors for periodontal diseases.Large numbers of studies have been con-ducted to understand the role of smokingin the etiology of periodontal diseases andthe available data show that smoking isassociated with increased prevalence andseverity of periodontal disease, which maybe due to the adverse effects of tobaccosmoke on the physiology, immunology,and microbiology of the oral environment.Unlike smoking, the role of oral smokelesstobacco (SLT) in the etiology of periodon-tal disease has received considerably lessattention.Although traditionally, oral SLT con-sumption has been associated withoral malignant and potentially malignantlesions, emerging data suggest that thesehabits may be associated with poor peri-odontal health also. Besides some casereports mentioning periodontal changesassociated with oral SLT habits (7), initialstudies conducted in the US have shownthat oral SLT habits are associated withincreased incidence of gingival recession(8–11). Studies conducted in Sweden alsohave shown that the consumption of moistsnuff, an oral SLT product, is associatedwithincreased prevalenceof gingivalreces-sion (12–14). However, some studies con-ducted in the US and Sweden have failed toshow any association between SLT habitsand periodontal changes such as gingi-val recession, attachment loss, or boneloss (15–18). Unlike the studies amongthe Swedish and US populations, stud-ies conducted among Asian populationshave shown that oral SLT habits are associ-ated with destructive periodontal disease.Studies conducted in India have reportedthat oral SLT users tend to have higherscores and risk for periodontal disease (19–22). Similar results were reported amongSLT users in Bangladesh and Thailandalso (23,24). A study based on NationalHealth and Nutrition Examination Sur-vey III data conducted in the US alsoshowed strong association between oralSLT use and severe active periodontal dis-ease (25).Very few studies have reported on thepattern of periodontal destruction amongoral SLT users. A study on the patterns oftooth loss among tobacco users in centralIndia showed that mandibular tooth losswas more among oral SLT users suggest-ing that the deleterious effects of SLT use ismanifested more in mandibular teeth (26).Studies reporting the occurrence of gingi-val recession among oral SLT users havereported that these occurred at sites adja-cent to mucosal lesions suggesting that therecession was a result of long-term injurytothegingivaltissuesfromtheSLTproduct(8,10,13, 14). Oral SLT users in a cen-tral Indian population were shown to havean increase in prevalence and severity ofrecession and attachment loss at mandibu-lar teeth, buccal surfaces, anterior teeth,and molars-the surfaces most likely tohave prolonged exposure to SLT productdue to retention of the SLT product atthe mandibular buccal or anterior labialvestibule (21).Oral SLT consumption in various formsis highly prevalent among all populations,particularly in the Asian countries (27–35), and a wide variety of SLT productsare available worldwide (36, 37). The mostcommon SLT products available in the USinclude chewing tobacco and snuff (moistanddry),andinSweden,themostcommonproduct is snus. In Asian countries, suchas India and Bangladesh, a myriad of SLTproducts are available such as betel quidwith tobacco, zarda (prepared by boilingtobacco leaves with water and slaked lime),gutka (mixture of powdered tobacco, arecanut,slakedlime,andcatechu),mawa(arecanut, tobacco, and slaked lime), and khaini(tobacco with slaked lime).Although oral SLT habits are commonamong all populations, strong associationsbetween SLT habits and destructive peri-odontal disease has been observed mainlyamong Asian populations, whereas a sys-tematic review of studies testing the asso-ciation between SLT habits and periodon-tal disease conducted in Sweden and theUS suggested that SLT habits may not berelated to periodontal diseases (38). Suchcontradictory observations may be due toseveral factors such as differences in thetrends of oral SLT practices and the typeof SLT products used by the respectivepopulations.
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Apr 13, 2024
Namrata. N. Nangare + 1
