CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 14 • Number 3 • Fall 2001

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Cigarette Smoking Linked to Gum Diseases

Cigarette smoking is a major preventable risk factor for gum disease, according to a CDC study that found that current cigarette smokers are 4 times more likely than nonsmokers to develop periodontitis. The study used data gathered by the Third National Health and Nutrition Examination Survey (1988–1994) to examine the relationship between periodontal (gum) disease and cigarette smoking in adults aged 18 years and older. 

An estimated 15 million U.S. adults have periodontal disease. Gingivitis, the mildest form of the disease, causes the gums to redden, swell, and bleed easily. Untreated gingivitis can advance to a more severe infection, periodontitis, characterized by loss of attachment between the root of the tooth and its supporting bone. If not controlled, bone loss can progress until the the tooth itself is eventually lost. According to Oral Health in America, a report released in 2000 by the U.S. Surgeon General, at least half of U.S. adults have gingivitis, and about one in five have the more severe form of destructive gum disease, or periodontitis. 

The study also found that the risk for developing periodontitis increases with the number of cigarettes smoked daily. Moderate smokers who smoke less than half a pack a day are 3 times as likely as nonsmokers to have periodontitis, but people who smoke heavily, more than a pack and a half a day, have almost 6 times the risk of developing serious gum disease. The study was conducted by Scott Tomar, DMD, DrPH, formerly of CDC's Division of Oral Health and now Associate Professor, Division of Public Health Services and Research, University of Florida College of Dentistry, and Samira Asma, DDS, MPH, of CDC's Office on Smoking and Health.

"Data from these surveys clearly demonstrate that smoking plays an important role in periodontal destruction," noted Dr. Asma. "In fact, our study found that smokers with periodontitis are 3 to 4 times more likely than nonsmokers to lose some or all of their teeth. So, this is yet another reason that smoking prevention is important and beneficial to public health." 

The study also found that quitting smoking reduces the chance of developing severe periodontal disease. Former smokers' chances of developing severe periodontitis decline the longer they remain tobacco free. 

Smokers with periodontitis also are less likely to respond favorably to treatment of the infection. "Smoking impairs both the immune system and the healing mechanisms in the mouth," explained Robert E. Mecklenburg, DDS, MPH, coordinator of tobacco and oral health initiatives at the National Institutes for Health's National Cancer Institute. Dr. Mecklenburg noted that a very high percentage of intractable cases of periodontal disease are found among smokers. "We need to recognize that tobacco use adversely affects oral health and treatment prognosis." 

Added William R. Maas, DDS, MPH, Director, Division of Oral Health, CDC, "The results of this study show us that a large proportion of adult periodontitis can be prevented by avoiding cigarette smoking and that oral health care providers should help smokers to quit. Hopefully, this study will stimulate even more dental care providers to get involved with helping their patients quit smoking." 

On the basis of numerous clinical trials, the Public Health Service clinical practice guideline Treating Tobacco Use and Dependence concluded that nonphysician clinicians, including dentists, are effective in helping their patients quit and that results are better if two or more clinicians, or professionals from different disciplines such as the patient's physician and dentist, provide help.

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This page last reviewed August 10, 2004

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