Investigation of periodontal destruction patterns in smokers and non-smokers

Background: Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease. Objective: To test the hypothesis that smokers have more disease in the upper anterior region. Methods: A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>= 20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels. Results: The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3 +/- 25.5%, non-smokers: 48.3 +/- 31.2%, p < 0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3 +/- 6.8%, non-smokers: 9.8 +/- 8.8%; p=0.050). Conclusion: The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.