Table 6.23Cohort studies on the association between smoking and periodontitis

Bolin et al. 1986170 men and179 women
Aged 18–65 years at baseline
10Loss of interproximal alveolar boneMean bone loss (% of root length) by baseline smoking status and cigarettes smoked/day, standardized for plaque level
   1–9 cigarettes/day5.1
   10–20 cigarettes/day5.5
   >20 cigarettes/day5.6
Unclear if nonsmokers included former smokers
Feldman et al. 1987483 men from the Veterans Administration Normative Aging Study
United States(Boston)
66-year change in mean PPD*, tooth mobility, and radiographic alveolar bone lossMean change in PPD by baseline smoking status
Mean change in tooth mobility
Mean change in alveolar bone level
Ismail et al. 1990167 adults
Aged 5–60 years at baseline
United States(Michigan)
28Change in mean LPA ≥2 mmOR = 14.2 (95% CI§, 4.1–48.7) for smoking (assessed at baseline); this multiple logistic regression model also included year of birth and amount of tooth mobility
Bolin et al. 1993170 men and179 women
Aged 18–65 years at baseline
10Loss of interproximal alveolar boneMean bone loss (% of bone height/root length) by baseline and follow- up smoking status and by baseline cigarettes/day
   1–9 cigarettes/day5.2
   10–20 cigarettes/day6.0
   >20 cigarettes/day6.3
 Former smokers(stopped smoking during the 10-year period)4.4
Brown et al. 1994611 community- dwelling persons
Aged ≥65 years at baseline
United States(North Carolina)
1.52 or more sites with incident LPA≥3 mmOR = 3.4 (95% CI, 1.6–7.5) among white adults who smoked cigarettes regularly; this logistic regression model included levels of Porphyromonas gingivalis, most recent medical care, and feelings of depression
McGuire and Nunn 1996100 treated periodontal patients
Aged 22–71 years at baseline
United States(Texas)
55-category clinical prognosis scoreOR = 1.9 (95% CI, 1.2–3.1) for smoking and a worsening prognosis
Beck et al. 1997540 persons
Aged ≥65 years at baseline
United States(North Carolina)
5At least 1 periodontal site with LPA ≥3 mmRRΔ = 1.6 (95% CI, 1.2–2.0); analysiswas conducted at the level of theperiodontal site; referent groupincluded both never and former smokers; this logistic regression model also included Porphyromonas gingivalis status, number of missing teeth, tooth type, periodontal site type, educational attainment, and most recent dental visit
Machtei et al. 199744 women and35 men with established periodontitis
Aged 25–66 years at baseline
United States(New York)
1Increased periodontal breakdown(mean bone loss exceeding 2 standard deviations based on radiographic examination)OR = 5.41 (95% CI, 1.50–19.5) for smoking and increased periodontal breakdown
Sites that experienced loss of clinical attachment (mean %)
Mean clinical attachment loss (mm)
Mean bone height loss (mm)
Sites with bone height loss (mean %)
Elter et al. 1999697 community- dwelling persons
Aged ≥65 years at baseline
United States(North Carolina)
7At least 1 site with incident LPA≥3 mmRR = 1.4 (95% CI, 1.1–1.7) among whites and 1.9 (95% CI, 1.6–2.2) among blacks for current smoking; multivariable Poisson regression models included a number of site- level and person-level variables
Machtei et al. 1999415 persons with little or no periodontal disease
Aged 25–75 years at baseline
United States(New York)
2–5Mean LPA ≥1.95 mmMean annual LPA (mm)
Sites experiencing LPA (mean %)
Smoking also was a strong predictor of annual changes in PPD* in multiple linear regression models
Norderyd et al. 1999Population-based sample of 357 persons
Aged 20, 30, 40, 50, and 60 years at baseline
176 or more sites with radiographic alveolar bone loss>20%OR = 12.0 (95% CI, 4.5–32.1) for smoking and bone loss
Faddy et al. 2000456 university staff members
Aged 18–65 years
34 or more sites with PPD ≥4 mmCurrent smokers had a 28% higher rate of disease regression than non- smokers of the same age and gender; used Markov chain models to model transition probabilities of changes in disease state

PPD = Probing pocket depth, measured in millimeters.

LPA = Loss of periodontal attachment.

OR = Odds ratio.


CI = Confidence interval.


RR = Relative risk.

From: 6, Other Effects

Cover of The Health Consequences of Smoking
The Health Consequences of Smoking: A Report of the Surgeon General.
Office of the Surgeon General (US); Office on Smoking and Health (US).

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