Sigara ve Periodontal Hastalıklar: Epidemiyoloji, Biyolojik Mekanizmalar ve Klinik Sonuçlar
Özet
Sigara kullanımı, periodontitis için en önemli ve en tutarlı biçimde gösterilmiş modifiye edilebilir risk faktörlerinden biri olarak kabul edilmektedir. Epidemiyolojik kanıtlar, sigara içen bireylerde periodontal hastalık prevalansının ve şiddetinin anlamlı derecede daha yüksek olduğunu; klinik ataşman kaybı, periodontal cep derinliği, alveoler kemik kaybı ve diş kaybı gibi olumsuz klinik sonlanımların daha sık görüldüğünü ortaya koymaktadır. Çok sayıda gözlemsel ve uzunlamasına çalışma, sigara kullanım süresi ve günlük tüketim miktarı arttıkça periodontal doku yıkımının risk ve şiddetinin arttığını gösteren belirgin bir doz–yanıt ilişkisini desteklemektedir. Sigaranın periodontal dokular üzerindeki etkileri yalnızca mikrobiyal birikim ile sınırlı değildir. Tütün dumanına maruziyet, subgingival ekosistemi değiştirerek mikrobiyal disbiyozisi teşvik etmekte ve Porphyromonas gingivalis, Tannerella forsythia ve Treponema denticola gibi periodontal patojenlerin kolonizasyonunu kolaylaştırmaktadır. Bunun yanı sıra sigara, nötrofil fonksiyonlarının bozulması, doku yıkıcı enzimlerin salınımının artması ve proinflamatuvar sitokin düzeylerinin yükselmesi gibi mekanizmalar aracılığıyla konak immün ve inflamatuvar yanıtı da modüle etmektedir. RANKL/OPG dengesindeki değişiklikler ise osteoklastik aktivitenin artmasına ve alveoler kemik rezorpsiyonunun hızlanmasına katkıda bulunmaktadır. Klinik açıdan değerlendirildiğinde, sigara içen bireylerde periodontal hastalığın daha agresif bir seyir gösterdiği ve hem cerrahi olmayan hem de cerrahi periodontal tedavilere verilen yanıtın daha sınırlı olduğu bildirilmektedir. Buna karşılık sigara bırakmanın periodontal hastalık riskini azaltabildiği ve tedavi sonuçlarını iyileştirebildiği gösterilmiştir. Bu nedenle sigara bırakma danışmanlığının periodontal tedavi planlamasına entegre edilmesi, uzun dönem periodontal sağlık ve tedavi başarısının artırılması açısından kritik önem taşımaktadır.
Smoking is widely recognized as one of the most significant and consistently demonstrated modifiable risk factors for periodontitis. Epidemiological evidence indicates that individuals who smoke exhibit a markedly higher prevalence and severity of periodontal disease, including increased clinical attachment loss, periodontal pocket depth, alveolar bone loss, and tooth loss. Numerous observational and longitudinal studies have demonstrated a clear dose–response relationship, showing that the risk and severity of periodontal destruction increase with both the duration and intensity of tobacco consumption. The impact of smoking on periodontal tissues extends beyond microbial accumulation. Tobacco exposure alters the subgingival ecosystem by promoting dysbiosis and facilitating the colonization of pathogenic bacteria such as Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. In addition, smoking modifies host immune and inflammatory responses through impaired neutrophil function, increased release of tissue-destructive enzymes, and elevated levels of pro-inflammatory cytokines. Alterations in the RANKL/OPG balance further contribute to enhanced osteoclastic activity and alveolar bone resorption. Clinically, smokers tend to present with more aggressive disease progression and reduced response to both non-surgical and surgical periodontal therapies. Conversely, smoking cessation has been shown to reduce periodontal risk and improve treatment outcomes. Therefore, integrating smoking cessation counseling into periodontal management is essential for improving long-term periodontal health and treatment success.
Referanslar
Zee KY. Smoking and periodontal disease. Aust Dent J. 2009;54 Suppl 1:S44-50.
Nociti FH Jr, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000. 2015;67:187-210.
Jacob P. Smoking as a risk factor for periodontitis: a literature review. Rev Odonto Cienc. 2010;25(4):406-11.
Obeid P, Bercy P. Effects of smoking on periodontal health: a review. Adv Ther. 2000;17(5):230-7.
Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol. 2004;75(2):196-209.
Bergström J. Tobacco smoking and risk for periodontal disease. J Clin Periodontol. 2003;30(2):107-13.
Linden GJ, Mullally BH. Cigarette smoking and periodontal destruction in young adults. J Periodontol. 1994;65(8):718-23.
Haber J. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol. 1993;64(1):16-23.
Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol. 2001;28(4):283-95.
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.
César Neto JB, Rosa EF, Pannuti CM, Romito GA. Smoking and periodontal tissues: a review. Braz Oral Res. 2012;26 Suppl 1:25-31.
Patel RA, Wilson RF, Palmer RM. The effect of smoking on periodontal bone regeneration: a systematic review and meta-analysis. J Periodontol. 2012;83(2):143-55.
Bergström J. Periodontitis and smoking: an evidence-based appraisal. J Evid Based Dent Pract. 2006;6(1):33-41.
Madi M, Smith S, Alshehri S, Zakaria O, Almas K. Influence of smoking on periodontal and implant therapy: a narrative review. Int J Environ Res Public Health. 2023;20:5368.
Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol. 2006;33(4):241-53.
Zhang J, Yu J, Dou J, Hu P, Guo Q. The impact of smoking on subgingival plaque and the development of periodontitis. Front Oral Health. 2021;2:751099.
Wu J, Peters BA, Dominianni C, Pei Z, Yang L, Purdue MP, et al. Cigarette smoking and the oral microbiome in a large study of American adults. ISME J. 2016;10(10):2435-46.
Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors—tobacco smoking. J Clin Periodontol. 2005;32 Suppl 6:180-95.
Buduneli N, Biyikoglu B, Sherrabeh S, Lappin DF. Saliva concentrations of RANKL and osteoprotegerin in smoker versus non-smoker chronic periodontitis patients. J Clin Periodontol. 2008;35(10):846-52.
Iho S, Tanaka Y, Takauji R, Kawano Y, Saito T, Yamada H, et al. Nicotine induces human neutrophils to produce IL-8. J Leukoc Biol. 2003;74(6):942-9.
Petropoulos G, McKay IJ, Hughes FJ. The association between neutrophil numbers and IL-1α in smokers with periodontal disease. J Clin Periodontol. 2004;31(5):390-6.
Pabst MJ, Pabst KM, Collier JA, et al. Inhibition of neutrophil and monocyte defensive functions by nicotine. J Periodontol. 1996;67(10):1047-55.
Pauletto NC, Liede K, Nieminen A, Larjava H, Uitto VJ. Effect of cigarette smoking on oral elastase activity in adult periodontitis patients. J Periodontol. 2000;71(1):58-62.
Boström L, Linder LE, Bergström J. Smoking and GCF levels of IL-1β and IL-1ra in periodontal disease. J Clin Periodontol. 2000;27(4):250-5.
Offenbacher S, Odle BM, Van Dyke TE. The use of crevicular fluid PGE2 levels as a predictor of periodontal attachment loss. J Periodontal Res. 1986;21(1):101-12.
Bergström J, Persson L, Preber H. Influence of cigarette smoking on vascular reaction during experimental gingivitis. Scand J Dent Res. 1988;96(1):34-9.
Tarbiah N, Todd I, Tighe PJ, Fairclough LC. Cigarette smoking differentially affects immunoglobulin class levels in serum and saliva. Basic Clin Pharmacol Toxicol. 2019;125(6):474-83.
Sørensen LT, Nielsen HB, Kharazmi A, Gottrup F. Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes. Surgery. 2004;136(5):1047-55.
Chapple IL. Reactive oxygen species and antioxidants in inflammatory diseases. J Clin Periodontol. 1997;24(5):287-96.
Aminoshariae A, Kulild J, Gutmann J. The association between smoking and periapical periodontitis: a systematic review. Clin Oral Investig. 2020;24(2):533-45.
Walter C, Rodriguez FR, Taner B, Weiger R. Association of tobacco use and periapical pathosis: a systematic review. Int Endod J. 2012;45(12):1065-73.
Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. J Periodontol. 2000;71(5):743-51.
Hill AB. The environment and disease: association or causation? Proc R Soc Med. 1965;58:295-300.
Morabia A. On the origin of Hill’s causal criteria. Epidemiology. 1991;2(5):367-9.
Albandar JM. Epidemiology and risk factors of periodontal diseases. Dent Clin North Am. 2005;49(3):517-32.
Javed F, Warnakulasuriya S. Is there a relationship between electronic cigarette use and periodontal disease? J Periodontol. 2016;87(12):1464-71.
Referanslar
Zee KY. Smoking and periodontal disease. Aust Dent J. 2009;54 Suppl 1:S44-50.
Nociti FH Jr, Casati MZ, Duarte PM. Current perspective of the impact of smoking on the progression and treatment of periodontitis. Periodontol 2000. 2015;67:187-210.
Jacob P. Smoking as a risk factor for periodontitis: a literature review. Rev Odonto Cienc. 2010;25(4):406-11.
Obeid P, Bercy P. Effects of smoking on periodontal health: a review. Adv Ther. 2000;17(5):230-7.
Johnson GK, Hill M. Cigarette smoking and the periodontal patient. J Periodontol. 2004;75(2):196-209.
Bergström J. Tobacco smoking and risk for periodontal disease. J Clin Periodontol. 2003;30(2):107-13.
Linden GJ, Mullally BH. Cigarette smoking and periodontal destruction in young adults. J Periodontol. 1994;65(8):718-23.
Haber J. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol. 1993;64(1):16-23.
Haffajee AD, Socransky SS. Relationship of cigarette smoking to attachment level profiles. J Clin Periodontol. 2001;28(4):283-95.
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.
César Neto JB, Rosa EF, Pannuti CM, Romito GA. Smoking and periodontal tissues: a review. Braz Oral Res. 2012;26 Suppl 1:25-31.
Patel RA, Wilson RF, Palmer RM. The effect of smoking on periodontal bone regeneration: a systematic review and meta-analysis. J Periodontol. 2012;83(2):143-55.
Bergström J. Periodontitis and smoking: an evidence-based appraisal. J Evid Based Dent Pract. 2006;6(1):33-41.
Madi M, Smith S, Alshehri S, Zakaria O, Almas K. Influence of smoking on periodontal and implant therapy: a narrative review. Int J Environ Res Public Health. 2023;20:5368.
Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heasman PA. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol. 2006;33(4):241-53.
Zhang J, Yu J, Dou J, Hu P, Guo Q. The impact of smoking on subgingival plaque and the development of periodontitis. Front Oral Health. 2021;2:751099.
Wu J, Peters BA, Dominianni C, Pei Z, Yang L, Purdue MP, et al. Cigarette smoking and the oral microbiome in a large study of American adults. ISME J. 2016;10(10):2435-46.
Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors—tobacco smoking. J Clin Periodontol. 2005;32 Suppl 6:180-95.
Buduneli N, Biyikoglu B, Sherrabeh S, Lappin DF. Saliva concentrations of RANKL and osteoprotegerin in smoker versus non-smoker chronic periodontitis patients. J Clin Periodontol. 2008;35(10):846-52.
Iho S, Tanaka Y, Takauji R, Kawano Y, Saito T, Yamada H, et al. Nicotine induces human neutrophils to produce IL-8. J Leukoc Biol. 2003;74(6):942-9.
Petropoulos G, McKay IJ, Hughes FJ. The association between neutrophil numbers and IL-1α in smokers with periodontal disease. J Clin Periodontol. 2004;31(5):390-6.
Pabst MJ, Pabst KM, Collier JA, et al. Inhibition of neutrophil and monocyte defensive functions by nicotine. J Periodontol. 1996;67(10):1047-55.
Pauletto NC, Liede K, Nieminen A, Larjava H, Uitto VJ. Effect of cigarette smoking on oral elastase activity in adult periodontitis patients. J Periodontol. 2000;71(1):58-62.
Boström L, Linder LE, Bergström J. Smoking and GCF levels of IL-1β and IL-1ra in periodontal disease. J Clin Periodontol. 2000;27(4):250-5.
Offenbacher S, Odle BM, Van Dyke TE. The use of crevicular fluid PGE2 levels as a predictor of periodontal attachment loss. J Periodontal Res. 1986;21(1):101-12.
Bergström J, Persson L, Preber H. Influence of cigarette smoking on vascular reaction during experimental gingivitis. Scand J Dent Res. 1988;96(1):34-9.
Tarbiah N, Todd I, Tighe PJ, Fairclough LC. Cigarette smoking differentially affects immunoglobulin class levels in serum and saliva. Basic Clin Pharmacol Toxicol. 2019;125(6):474-83.
Sørensen LT, Nielsen HB, Kharazmi A, Gottrup F. Effect of smoking and abstention on oxidative burst and reactivity of neutrophils and monocytes. Surgery. 2004;136(5):1047-55.
Chapple IL. Reactive oxygen species and antioxidants in inflammatory diseases. J Clin Periodontol. 1997;24(5):287-96.
Aminoshariae A, Kulild J, Gutmann J. The association between smoking and periapical periodontitis: a systematic review. Clin Oral Investig. 2020;24(2):533-45.
Walter C, Rodriguez FR, Taner B, Weiger R. Association of tobacco use and periapical pathosis: a systematic review. Int Endod J. 2012;45(12):1065-73.
Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. J Periodontol. 2000;71(5):743-51.
Hill AB. The environment and disease: association or causation? Proc R Soc Med. 1965;58:295-300.
Morabia A. On the origin of Hill’s causal criteria. Epidemiology. 1991;2(5):367-9.
Albandar JM. Epidemiology and risk factors of periodontal diseases. Dent Clin North Am. 2005;49(3):517-32.
Javed F, Warnakulasuriya S. Is there a relationship between electronic cigarette use and periodontal disease? J Periodontol. 2016;87(12):1464-71.
