Alveolar bone loss and tooth loss in male cigar and pipe smokers

Background. While cigarette smoking is recognized as being detrimental to o ral health, eht effects of cigar and pipe smoking on tooth-loss risk, alveo lar bone loss and periodontal disease are not known. The authors conducted this study to determine whether cigar and pipe smokers were at greater risk of experiencing tooth loss and alveolar bone loss than were nonsmokers. Methods the authors studied 690 dentate men who participate in the Veterans Affairs Dental Longitudinal Study. Subjects are not VA patients, and they receive medical and dental care in the private sector. A board-certified pe riodontist conducted clinical examinations triennially for 23 years. These examinations included the number of teeth remaining, number of decayed and filled surfaces per tooth, and indicator scores for plaque, calculus, pocke t probing depth, gingival bleeding and tooth mobility. Alveolar bone loss w as assessed at each examination on intraoral periapical radiographs using t he Schei ruler method, which measures loss of bone height in 20 percent inc rements. Multivariate analyses of tooth-loss rates and alveolar bone loss c ontrolled for demographic and oral hygiene measures. Results. the relative risk, or RR, of tooth loss compared with that of non smokers was significantly elevated in cigar smokers (RR = 1.3, 95 percent c onfidence interval, or CI, = 1.2, 1.5), pipe smokers (RR = 1.6, 95 percent CI = 1.4, 1.9) and cigarette smokers (RR = 1.6, 95 percent CI = 1.5, 1.7). The percentages of mesial and distal sites with moderate-to-severe progress ion of alveolar bone loss ( a change of 40 percent or more from baseline) w ere 8 +/- 1 percent (mean +/- standard error) in nonsmokers, 16 +/- 3 perce nt in cigar smokers (P < .05), 13 +/- 4 percent in pipe smokers (P = 1.7), and 16 +/- 3 percent in cigarette smokers (P < .001). Pipe and cigar smoker s did not differ significantly from nonsmokers with respect to the percenta ge of sites at baseline with moderate-to-severe scores for calculus, pocket probing depth, gingival bleeding or tooth mobility. Pipe smokers had fewer sites with moderate-to-severe plaque accumulation than did nonsmokers (7 /- 11 vs. 13 +/- 17, P < .05). Conclusions. The authors found that men who smoke cigars or pipes were at i ncreased risk of experiencing tooth loss. cigar smokers also were at increa sed risk of experiencing alveolar bone loss. These elevations in risk are s imilar in magnitude to those observed in cigarette smokers. Clinical Implications. The increases in risk related to cigar and pipe smok ing provide a strong rationale for targeting smoking prevention and smoking cessation programs to smokers of all tobacco products.