THE EFFECT OF SMOKING ON PERIODONTAL HEALTH

Background: Tobacco use is a well-established modifiable risk factor for periodontitis, yet its consequences for disease onset, treatment and implant therapy are scattered across many reports. This review gathers them for dental clinicians. Methods: Narrative review of PubMed/MEDLINE records from 2010 to 2026 in English, with bibliographic details checked in Crossref; 29 sources were grouped by theme. Results: A meta-analysis of prospective studies gave a risk ratio of 1.85 for periodontitis onset or progression in smokers, and observational studies describe a gradient with pack-years. Suggested mechanisms are a blunted gingival vascular response that masks bleeding, a different cytokine response after therapy and subgingival dysbiosis. After non-surgical therapy smokers achieved 0.33 mm less probing-depth reduction, and implants in smokers failed more often (odds ratio 2.40). Quitting brought the risk close to that of never-smokers, although tooth-loss risk needed about 15 years to converge. Electronic cigarettes, heated tobacco and waterpipe are not demonstrably safe for the periodontium. Conclusions: Smoking history should be recorded as a graded exposure, and cessation support belongs in periodontal care.