By Julie D. Sutton, RDH, MS
It has happened to us all. Walking in or outside an airport, in a car, on a bus, in a restaurant; we’ve all noticed the permeation of smoke from a cigarette lit by someone else. Inherently, it’s unpleasant, and can’t be beneficial, but have you ever wondered what it could do to a non-smoker’s periodontal health?
For years studies have mounted providing impetus to the notion that active smoking causes periodontitis;(1, 2) beyond that, we know that details associated with the behavior can modify the manifestation of disease, such as the number of cigarettes smoked and for how long.(3) But are you at risk as a non-smoker? If so, is it dependent on how exposed you are? That question became the study aim for my thesis.
In 2001, researchers at the University of North Carolina used representative data from the National Health and Nutrition Examination Survey to determine that among adults with self-reported exposure to environmental tobacco smoke, the risk for periodontitis was 1.6 times higher.(4) My thesis pursuits allowed the findings of that study to be expanded, evaluating not only subjective self-reported exposure, but also exposure that the participants might not have been aware of, by the use of an objective biomarker: serum cotinine. Cotinine is a metabolite specific only to nicotine,(5) making it an ideal way to isolate cigarette smoke exposure in the body.(6)
We found that the adjusted odds of periodontitis were 89% higher in those with high exposure, when compared with negligible exposure. One could draw from these two studies that periodontitis is roughly twice as likely in those heavily exposed to environmental tobacco smoke. Non-smokers are at risk, and the risk goes up with exposure.
Another interesting finding from our study was that among a verbally and physiologically confirmed non-smoking adult population, nearly half of the participants were being exposed to environmental tobacco smoke (40.5%). That begs questions for further investigation about how protective our tobacco control legislation was during the study period, and is now, and how knowledgeable non-smokers are regarding the dangers of environmental tobacco smoke.
In dental hygiene, we are a collection of people dedicated to seeking optimal oral health for our patients. Of late, we’ve seen the focus expand to include systemic health as medical and dental professionals agree that health is holistic. When it comes to second-hand smoke, systemic and oral health is at stake.
1. Do LG, Slade GD, Roberts-Thomson KF, Sanders AE. Smoking-attributable periodontal disease in the Australian adult population. J Clin Periodontol 2008;35(5):398-404.
2. United States. Public Health Service. Office of the Surgeon General., National Center for Chronic Disease Prevention and Health Promotion (U.S.). The health consequences of smoking a report of the Surgeon General. [Atlanta, Ga.]: U.S. Public Health Service, National Center for Chronic Disease Prevention and Health Promotion; 2004.
3. Calsina G, Ramon JM, Echeverria JJ. Effects of smoking on periodontal tissues. J Clin Periodontol 2002;29(8):771-6.
4. Arbes SJ, Jr., Agustsdottir H, Slade GD. Environmental tobacco smoke and periodontal disease in the United States. Am J Public Health 2001;91(2):253-7.
5. Benowitz NL. Biomarkers of environmental tobacco smoke exposure. Environ Health Perspect 1999;107 Suppl 2:349-55.
6. Benowitz NL. Cotinine as a biomarker of environmental tobacco smoke exposure. Epidemiol Rev 1996;18(2):188-204.
AHA. Health effects of secondhand smoke. www.americanheart.org/presenter.jhtml and www.heart.org/HEARTORG/Advocate/IssuesandCampaigns/Prevention/Environmental-Secondhand-Tobacco-Smoke_UCM_318940_Article.jsp.
Julie Sutton, RDH, MS, graduated from UNC-Chapel Hill (2011), and is currently pursuing an academic career in dental hygiene education.