Relationship of cigarette smoking to attachment level profiles

Objectives: The present investigation examined clinical features of periodo ntal disease and patterns of attachment loss in adult periodontitis subject s who were current, past or never smokers. Material and Methods: 289 adult periodontitis subjects ranging in age from 20-86 years with at least 20 teeth and at least 4 sites with pocket depth a nd/or attachment level >4 mm were recruited. Smoking history was obtained u sing a questionnaire. Measures of plaque accumulation, overt gingivitis, bl eeding on probing, suppuration, probing pocket depth and probing attachment level were taken at 6 sites per tooth at all teeth excluding 3rd molars at a baseline visit. Subjects were subset according to smoking history into n ever, past and current smokers and for certain analyses into age categories <41, 41-49, >49. Uni- and multi-variate analyses examined associations bet ween smoking category, age and clinical parameters. Results: Current smokers had significantly more attachment loss, missing te eth, deeper pockets and fewer sites exhibiting bleeding on probing than pas t or never smokers. Current smokers had greater attachment loss than past o r never smokers whether the subjects had mild, moderate or severe initial a ttachment loss. Increasing age and smoking status were independently signif icantly related to mean attachment level and the effect of these parameters was additive. Mean attachment level in non smokers <41 years and current s mokers >49 years was 2.49 and 4.10 mm respectively. Stepwise multiple linea r regression indicated that age, pack years and being a current smoker were strongly associated with mean attachment level. Full mouth attachment leve l profiles indicated that smokers had more attachment loss than never smoke rs particularly at maxillary lingual sites and at lower anterior teeth. Conclusions: In accord with other studies, smokers had evidence of more sev ere periodontal disease than past or never smokers. At all levels of mean a ttachment loss, smokers exhibited more disease than never smokers. Differen ce in mean attachment level between smokers and never smokers at individual sites was not uniform. Significantly more loss was observed at maxillary l ingual sites and lower anterior teeth suggesting the possibility of a local effect of cigarette smoking.