The role of smoking habits in periodontal health and disease: A cross-sectional study

INTRODUCTION: Smoking is a major environmental factor in oral and periodontal tissue deterioration. The aim of this study was to investigate the association of cigarette smoking with periodontal health and disease severity. METHODS: The Periodontology Clinic at Bolu Abant İzzet Baysal University conducted a cross-sectional study from 2024 to 2026. Participants (aged ≥18 years) without systemic diseases and with no periodontal treatment within 6 months, were eligible. Antibiotic and anti-inflammatory drug users, pregnant or breastfeeding women, diabetics, waterpipe smokers, and chemotherapy and radiotherapy patients were excluded. Pack-years were computed by multiplying daily cigarette use by smoking years. Current periodontal status was determined using the 2017 World Workshop classification and 2023 EFP criteria. Statistical analyses were performed using SPSS 27.0 with t-tests, chi-squared tests, and logistic regression, with significance set at p<0.05. RESULTS: A total of 484 participants (242 current smokers and 242 non-smokers) attended the Periodontology Clinic of Bolu Abant İzzet Baysal University. While the overall distribution of periodontal diagnoses did not differ significantly (p=0.449), smokers exhibited more rapid progression of periodontitis (Grade C: 40.4% vs 11.5% in non-smokers, p<0.05). Smokers presented with significantly higher plaque index (PI) (p=0.024) and lower bleeding on probing values (p=0.028). Furthermore, longer smoking duration and higher pack-years were strongly associated with periodontitis severity (p=0.001). Multivariable logistic regression analysis revealed that female gender (AOR=2.51; 95% CI: 1.70-3.98, p=0.001) gingival recession (AOR=1.76; 95% CI: 1.05-2.94, p=0.001) were the strongest independent factors associated with smoking status, while each unit increase in PI was associated with 42% lower odds (AOR=0.58; 95% CI: 0.37-0.90, p=0.015). CONCLUSIONS: Smoking was associated with periodontal status and differences in disease severity and grade distribution. Additionally, tobacco exposure accelerated plaque and periodontal problems. These findings underscore the need to cease smoking for periodontal care.