[The effect of smoking on the spread and frequency of periodontal disease].

In recent years substantial data accumulated in the literature supporting the direct detrimental effect of tobacco smoking on periodontal health. The significantly inferior periodontal condition of smokers cannot be solely attributed to poor oral hygiene, increased calculus formation and altered subgingival microflora. Smoking imposes a direct threat to the periodontal tissues. Smokers with excellent oral hygiene show significantly less periodontal bone height and attachment level than matches non-smokers. Smoking entails a 2.5 to 3.5 risk ratio for severe periodontal attachment loss. Smoking also interferes with the outcome of nonsurgical and surgical periodontal treatment and impairs periodontal regeneration. The pathomechanism of the tobacco smoking related periodontal destruction is just partly understood. Tobacco products can alter normal host responses to neutralize infections and can also stimulate pathologic mechanisms to destroy the surrounding tissues. Tobacco products can directly impair polymorphonuclear leukocyte functions. Smokers have less salivary IgA and decreased serum IgG concentration as well as depressed number of helper T lymphocytes. Consequently smoking today is considered as one of the major risk factors for destructive periodontitis. Periodontitis is also considered as a decisive risk factor for systemic diseases especially for cardiovascular disorders. A strong association has been shown between periodontal disease and coronary heart diseases, as well as between periodontal disease and cerebrovascular diseases (stroke). The subgingival microflora and the continuous latent bacteremia and endotoxemia originated from the periodontal pockets might be responsible for the damage of the vascular endothelial integrity, platelet functions and blood coagulation. Modern periodontal epidemiology rediscovered the old ide of "focal infections" and indicated that the general health has a crucial impact on the periodontal health and periodontal disease has also a major impact on the general health status of the patient.