Dose-dependent effect of smoking and smoking cessation on periodontitis-related tooth loss during 10 – 47 years periodontal maintenance — a retrospective study in compliant cohort.

We retrospectively explored effects of smoking on tooth loss due to periodontitis (TLP) in long-term compliant patients.
Chart data were collected from 258 patients undergoing post-non-surgical periodontal treatment (mean 2.24 visits/year) for 10 – 47.5 (mean 24.2) years. Patients were categorized as: 1) never-smokers, 2) former smokers, 3) current light smokers (<10 cigarettes/day), and 4) current heavy smokers (≥10 cigarettes/day).
Of 6,590 teeth present at baseline (mean 25.6 teeth/patient), 264 teeth were lost due to periodontitis, corresponding to 0.03, 0.05, 0.08, and 0.11 TLP annually among never-smokers, former-smokers, current light-smokers, and current heavy-smokers, respectively. A tooth from a current heavy smoker had 4.4-fold, 2.7-fold, and 2.6-fold greater risk of TLP than a tooth from a never-smoker, a current light-smoker, and a former-smoker, respectively. Both heavy- and light-former-smokers needed washout periods of approximately 15 years to reach the TLP risk level of never-smokers. The TLP risk decreased by 6%/year of smoking cessation.
It took almost 15 years of smoking cessation for the risk of TLP among former smokers to reach the level of never-smokers. Hence, the 2018 periodontitis grading system should consider the impact of the “wash-out” period on former smokers.

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