Dr. Britten is highly concerned about his patients who smoke. The likelihood of developing advanced periodontal disease or gum disease can be up to six times higher in smokers. Periodontal disease is an extremely serious condition affecting not only the gums, but also the membranes and ligaments and bone supporting the teeth.

Many studies on smoking and periodontal disease have concluded that smokers have:

• Deeper probing depths and a larger number of deep pockets in the gums.
• More attachment loss including more gingival recession
• More alveolar boneloss & tooth loss
• Less gingivitis and less bleeding on probing
• One of the major problems with smoking is that it tends to mask the damage being caused to teeth and gums. This damage can be difficult to detect, producing very few early warning signs of advanced periodontal disease.
• For years it was thought that nicotine being a vasoconstrictor was causing less blood flow to the gums, causing less infection-fighting white blood cells to reach the area. Newer studies are showing that smoking appears to have a long-term effect on the inflammatory lesions, or diseased gums of smokers, which have less blood vessels in them than in non-smokers.
• More teeth with furcation involvement (where the bone levels have been destroyed below the area where the roots of the teeth meet, leaving this area exposed, making it prone to further destruction as well as decay.
• Additionally, nicotine affects saliva, causing it to become thicker so it is less able to wash away acid created after eating. As a result, heavy smokers can be more likely to suffer from tooth decay than non-smokers, even though they may practice good oral hygiene.
• Smoking has a profound effect on the immune and inflammatory system. Smokers have more infection-fighting cells in their body, but fewer of these helpful cells make it into the gingival pocket. Studies also show that these good cells have a decreased ability to accomplish their function, which is to destroy harmful periodontal bacteria.
• Adhesion molecules are found within smoker’s tissues, in the white blood cells, in the inflammatory lesions, and even in the supporting gingival tissues. Studies have shown impairment in defensive functions of other defensive blood cells, even those using smokeless tobacco due to the high concentrations of nicotine.
• Smoking also impairs the healing of dental implants and even in the healing from all other aspects of periodontal treatment including non-surgical treatments (including scaling and root planing or “deep cleaning”), surgical treatment, bone grafting and tissue grafting.
• Studies have shown that tobacco smoke and nicotine affect blood vessels in the gums, healthy bone-building cells, connective tissue matrix, the jaw bone and even the root surface itself. Tooth root surfaces in smokers have actually been shown to be contaminated by products of smoking such as nicotine, cotinine, acrolein and acetaldehyde, which may inhibit the gum tissue from healing around the roots of teeth as they should.
• Smoking has been shown to affect human bone, and is a risk factor for osteoporosis, which is also a risk factor for periodontal disease.

As a periodontist, Dr. Britten is a specialist in treating advanced periodontal disease and is able to provide patients with the very latest techniques and treatments to help slow down this condition. Where teeth are lost then one option is to replace them with dental implants, but smoking is not advisable during this treatment because it does slow down healing.

If you do currently smoke and value your smile, it’s worth thinking about quitting.