How does tobacco impact periodontal disease? (Episode 6 show notes)

tobacco and periodontal disease

In episode 6 of Dental Digest Podcast, Dr. Manali Vora discusses her study, which was published in the Journal of the American Dental Association, in which she looks at the relationship between tobacco and periodontal disease. The outcomes she focused on were the diagnosis and treatment of gum disease and the diagnosis of precancerous lesions. Gum disease, or periodontal disease, includes bone loss and eventually tooth loss. Participants were asked to report their tobacco usage to include products such as: cigarettes, pipes, e-cigarettes, hookah, cigars, smokeless tobacco, or a combination of 2 or more, as well as if they had ever been diagnosed by a clinician with periodontal disease or a precancerous lesion.

Dr. Seibert (Host): What makes this study unique?

Dr. Vora: There have been numerous studies on traditional cigarette use and periodontal disease, but few studies evaluating other tobacco products and gum disease. 

Dr. Seibert: What were the main findings of the study?

Dr. Vora: All patterns of tobacco use had higher reports of gum disease diagnosis and treatment compared to non users, with the exception of exclusively using hookah and exclusively using smokeless tobacco. Gum disease was highest among current e-cigarette users and multiple tobacco users. Multiple tobacco users are considered participants who use 2 or more different types of tobacco products, for example someone who uses both e-cigarettes and cigars. Pre-cancerous lesion reporting was highest among smokeless tobacco users and recent quitters.    

Dr. Seibert: What are your thoughts on the dangers of e-cigarettes and periodontal health?

Dr. Vora: People who report continuously using e-cigarettes are at higher chance of having gum disease and bone loss around teeth than non users. Although, we still need more time and cross sectional studies to directly correlate the two. 

Dr. Seibert: What should we be doing as practitioners?

Dr. Vora: It is important to warn all patients who use tobacco products about periodontal disease, not just those who smoke cigarettes. Dentists are well versed in the correlation between cigarettes and periodontal disease, but we must not forget to ask our patients about all forms of tobacco use, especially as the prevalence of new tobacco use continues to increase. 

Dr. Seibert: What should dentists tell tobacco users who want implants?

Dr. Vora: The dentist should find out what tobacco products the patient uses, how much, and if he/she is interested in quitting. Most importantly, dentists must warn the patient that the implant is less likely to be successful if the tobacco use and smoking is continued. 

Dr. Seibert: Was there any findings from your study that surprised you?

Dr. Vora: Smokeless tobacco use was not associated with generalized periodontal disease. This could possibly be because smokeless tobacco is placed in a certain area of the oral cavity, unlike smoke which passes through the entire mouth. Although, smokeless tobacco users reported more oral lesions. 

Dr. Seibert: Were there any limitations in your study or things you would have changed?

Dr. Vora: The biggest limitation was the self reporting. Participants were asked if they had EVER been diagnosed with gum disease, therefore we are relying on their truthfulness and memory. The assumption with self reported compared to clinically reported studies is that the numbers might be underreported. 

If you would like to read the full study, you can visit the May 2019 issue of the Journal of the American Dental Association (JADA). 

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Hannah Wilken

This summary was written by Hannah Wilken. Click here to read more about her!

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