Question:
Smoking may be responsible for more than half of the cases of
periodontal disease among adults in the United States, according to a
study published in the Journal of Periodontology. The study found that
current smokers are about four times more likely than people who have
never smoked to have advanced periodontal disease. The researchers
stated that the high "periodontal cost" of smoking has been calculated
as 27 years of disease progression. For example, a 29 year-old smoker
has similar bone loss as a 56 year-old non-smoker.
Answer:
Studies have found that:
1. Poor people have more peridontal disease than the general
population.
2. Poor people smoke more than the general population.
This is an example of a confounding factor, which causes both
variables.
Next, they'll say smoking causes attendance at NASCR races and
professional wrestling, because studies found those fans smoke more
than average.
If the study had been honest, it would have reported the coefficient
of regression it used to eliminate socioeconomic status as a
confounder.
What makes you think the study didn't report that data? No study was
referenced in the column so it's pretty tough to say one way or the other.
Isn't it? Or are you just making broad brush assumptions based on a
newspaper column?
You're right, I should have gone to a primary source i.e. the
published report. But the rhetoric is so familiar, I know it'll say
nothing about confounders.
Periodontal disease is caused by poor hygene -- failing to brush
teeth after meals. Microbes live in the food particles, causing plaque
and then gum damage. Smoke doesn't contain any microbe nutrition. The
study would be more credible if it had provided an explanation, not
just statistical correlation.
It's much more plausible that smoking and failing to brush teeth are
two expressions of poor self-care.
"Tobacco use reduces the delivery of oxygen and nutrients to gingival
tissue."
"Smoking impairs the body's defense mechanisms, making
smokers more susceptible to an infection like periodontal disease."
http://www.perio.org/consumer/smoking_info.htm#2
Opinion noted. I would not beging to argue that improper brushing is a
prime cause of Periodontal disease but the research on this issue is pretty
clear -- smoking makes Periodontal disease worse:
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"Smoking increases our risk of periodontal disease two to seven-fold."
In addition, nicotine can cause blood vessels to constrict, which may mask
the signs that you have gum and bone disease. You stop smoking, and the
vessels dilate and bleed more! You think that you've developed gum disease
by stopping smoking, but you've only unmasked the signs of it.
Smoking-associated periodontitis is not simply a reflection of oral
cleanliness. Smoking extends a favorable habitat for bacteria such as P.
gingivalis, P. intermedia, and A.actinomycetemcomitans to shallow sites.
Molecular byproducts of smoking interfere with mechanisms that normally
contain growth of damaging bacteria at the surface of the oral mucosa in
gingival crevices. In this way, smoking can promote early development of
periodontal lesions.*
Cigar and pipe smoking have similar adverse effects on periodontal health
and tooth loss as cigarette smoking. Smoking cessation efforts should be
considered as a means of improving periodontal health and reducing tooth
loss in heavy smokers of cigarettes, cigars, and pipes with periodontal
disease.**
http://www.dentalgentlecare.com/periodontal_disease.htm
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"Most of these differences can be attributed to less favourable
toothbrushing habits, particularly evident in male smokers. However, smoking
is associated with a decreased flow of saliva, which may explain the
increased tendency to form dental calculus.
Smoking and gingivitis:
Heavy smokers often present with a thickened, fibrotic appearance of their
gingival tissues. Studies following the protocol of the experimental
gingivitis in man studies (Theilade et al, 1965), in which all oral hygiene
is withdrawn over a period of up to four weeks and the development of
gingivitis is observed, have found that the development of gingivitis is
delayed among smokers. The rate of plaque accumulation is similar in smokers
and non-smokers; however, smokers show less gingival inflammatory change,
with less gingival bleeding, gingival redness and gingival fluid flow.
(Bergstrom and Preber, 1986). Hence, it appears that smoking may suppress
the normal immune response to the accumulation of plaque. The major clinical
implication of these findings is that the masking of gingival bleeding in
smokers may lead to a failure to recognise the presence of periodontal
diseases.
Acute necrotizing ulcerative ginffivitis occurs more frequently in smokers.
Possible mechanisms for this increased susceptibili b ty include
vasoconstriction of gingival blood vessels, reduced activity of leukocytes,
and proliferation of anaerobic, fuso-spirochaetal micro-organisms, These
factors interact with the other factors implicated in the aetiology of ANUG,
namely poor oral hygiene and mental stress."
http://www.adelaide.edu.au/spdent/dperu/cpep/smoking.htm
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"Smoking is the single major preventable risk factor for periodontal
disease, and can cause bone loss and gum recession even in the absence of
periodontal disease."
http://adam.about.com/reports/000024_3.htm
"Modeling with multiple logistic regression revealed that current
smokers were about 4 times as likely as persons who had never smoked
to have periodontitis (prevalence odds ratio [ORP] = 3.97; 95% CI,
3.20- 4.93), after adjusting for age, gender, race/ethnicity,
education, and income:poverty ratio."
