Smoking and Periodontal Diseases 30 CHAPTER 2: SMOKING AS A MAJOR RISK FACTOR FOR ADULT PERIODONTITIS 2.1 SMOKING—A MAJOR RISK FACTOR FOR PERIODONTAL DISEASES

30 CHAPTER 2: SMOKING AS A MAJOR RISK FACTOR FOR ADULT PERIODONTITIS 2.1 SMOKING—A MAJOR RISK FACTOR FOR PERIODONTAL DISEASES Tobacco use is a potent risk factor for many human diseases and conditions including cancer, cardiovascular and pulmonary diseases and it has a major deleterious effect on population health. Also, tobacco smoking appears to be one of the single most significant environmental factors in the initiation and progression of destructive periodontal disease (Solomon, Priore & Bross, 1968; Haber, 1994; Bergström & Preber, 1994; Grossi et al., 1994; 1995; Kamoi, 1996; Krall et al., 1997; AAP Position Paper, 1996b; 1999). Smoking can affect pathogenesis of the disease in an individual, change periodontal disease patterns in the population and affect periodontal therapy outcomes. A number of studies, mostly from industrialised countries, have confirmed the detrimental effects of tobacco use on periodontal health and disease. The mechanism by which tobacco exerts its influence on oral health has not been fully understood or explained by experiments. Moreover, the temporal sequence of the process is always extremely difficult to explore. However, evidence obtained from cross-sectional risk assessment studies and several longitudinal studies have suggested the causal role of tobacco smoking is the initiation and progression of periodontitis in humans.