Smoking-a true periodontal hazard

It is now well established that tobacco use in general and cigarette smoking in particular, is a major risk factor in the incidence and severity of several forms of periodontal diseases.A large number of studies have been published in the dental literature regarding this possible role. Much of the literature has also indicated that smokers affected with periodontitis respond less favourably to periodontal treatment be it non-surgical, surgical or regenerative. Numerous studies of the potential mechanisms whereby smoking tobacco may predispose to periodontal disease have been conducted, and it appears that smoking may affect the vasculature, the humoral immune system, and the cellular immune and inflammatory systems, and have effects throughout the cytokine and adhesion molecule network. The aim of this review is to consider the evidence for the association between smoking and periodontal diseases and to highlight the biological mechanisms whereby smoking may affect the periodontium.