Personalized periodontal treatment for the tobacco- and alcohol-using patient

Abstract

The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco-cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco-using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e-cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco-cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.

Fig. 1

Clinical views of two heavy smokers with a moderate (top) and severe (bottom) chronic periodontitis. In both of these clinical examples there is considerable accumulation of plaque, calculus and tobacco stain. As often seen in heavy smokers, the gingiva generally appears enlarged and fibrotic, with loss of surface stippling, and with the exception of a few areas, with a less overt margin-papillary erythema when compared to similar levels of inflammatory periodontal diseases in non-smokers. There also often less of a tendency for bleeding on probing when compared to non-smokers. (Special thanks to Stacey Lee and Iman Mohammadi)

Fig. 2

Stages of Change Model Related to Tobacco Cessation

Fig. 3

In evaluating, counseling, and treating the tobacco-using periodontal patient, the dental care provider should consider personalized factors, such as patient values, nicotine dependence, and microbiology, to develop appropriately tailored therapies.