According to a recent poll, 1 in 10 smokers try to hide the fact from their physician. Most say they do this to avoid getting get lectured about their habit. And that’s understandable. After all, most smokers know they should quit. Many have tried. But the pleasures, rituals and effects (physical and mental) – and so, the addiction – often win out.
Since so much of tobacco’s damage isn’t readily visible in a routine medical visit, hiding the habit may be fairly easy – especially if you’re a light smoker, as the poll says many hiders are. Hiding it from a dentist, though, is tougher. Yes, you can mask bad breath for a while. Yes, you can diligently whiten your teeth. But you can’t mask things like bleeding gums, bone and tooth loss or cancerous lesions.
While most Americans have some degree of gum disease, the problem, as noted before, is much worse among smokers. According to research published in the Journal of Periodontology, over half of all cases may be due to smoking, and smokers are four times more likely to develop it. Why? Among other reasons, they “may be more than 10 times more likely than nonsmokers to harbor the bacteria that cause periodontal disease and are also more likely to have advanced periodontal disease.”
And no, it’s not just about cigarettes. You don’t get a free pass just because you smoke cigars or a pipe. The effect is similar. And the more you smoke, the greater the risk. Chewing tobacco carries its own oral health risks.
While gum disease can lead to bone and tooth loss, it’s not a necessary cause. Smoking alone is enough of a trigger, and its effects persist even after decades of living smoke-free. While we can try to spur new bone growth or at least slow the rate of loss, there’s currently no sure-fire fix.
Because of tobacco’s pernicious effects on both the hard and soft oral tissues, an increasing number of periodontists refuse to treat smokers until they kick the habit. Smokers may be surprised, frustrated, hurt or even offended by this. Obviously, they care enough about their oral health to consult with a specialist. But that care needs to motivate a successful quit, as well. After all, would you start repairing a flooded home while water was still gushing in? Or a fire-damaged home while flames are still raging?
For while periodontal treatment may help in the short term, long-term prognosis for smokers is poor. This is borne out both clinically and through research.
Among the latest research is a study just published in the American Journal of Medical Sciences. For it, the authors reviewed over 40 years of research on the impact of smoking on perio surgery outcomes. Of the two dozen studies that met their criteria, 2/3
showed that reductions in probing depth and gains in clinical attachment levels were compromised in smokers in comparison with nonsmokers. Three studies showed residual recession after periodontal surgical interventions to be significantly higher in smokers compared with nonsmokers. Three case reports showed periodontal healing to be uneventful in smokers.
But this can be new incentive to quit. No one wants to waste money on treatments not likely to help much or last long. So the choice becomes one of continued tobacco use and worsening oral health or quitting and getting help to regain periodontal health and keep as many natural teeth as long as possible. (After all, replacing teeth isn’t cheap either: a single implant can cost several thousand dollars!) For the good news is that although the risk of tooth loss persists, the effects of smoking on gum tissue are reversible. You can undo a lot of damage.
You just have to quit the cigs first.
Image by Marko Miloševic, via Flickr