All Forms of Smoking Harm Gum Health, Study Finds

This study explored how different forms of smoking—including traditional cigarettes, electronic cigarettes (vaping), and heated tobacco products—relate to periodontal health and tooth loss in employed Japanese adults. Researchers surveyed 512 participants across 20 workplaces, performing dental exams and collecting questionnaire data on smoking habits, oral hygiene practices, and health behaviors. After excluding those without enough teeth or with missing data, 473 adults remained in the analysis.

Using the Community Periodontal Index and measurements of attachment loss, they assessed indicators of gum disease (such as probing depths ≥ 4 mm and attachment loss ≥ 4 mm). The results were striking: compared to nonsmokers, cigarette smokers had on average 1.38 fewer teeth, and smokers (of any type) had significantly higher percentages of teeth showing deeper pockets and attachment loss. For example, cigarette smokers showed about 15.4% more teeth with probing depth ≥ 4 mm, while users of heated or electronic cigarettes had 17.9% higher proportions. Attachment loss followed similar trends.

In structural equation modeling, smoking (especially cigarettes), low interest in oral health, and poor hygiene behaviors combined to predict worse periodontal status and fewer remaining teeth. The model fit indices indicated a good match between the hypothesized relationships and observed data.

The authors interpret these findings as evidence that all forms of smoking—not just traditional cigarettes—are harmful to periodontal tissues and contribute to tooth loss. They note, however, that the cross-sectional design limits causal conclusions: we cannot definitively say smoking caused the periodontal deterioration, only that they are strongly associated in this sample.

They suggest that workplace health programs should include smoking cessation support, and that dental professionals play a more proactive role in counseling patients on quitting. Encouraging stronger interest in oral health, promoting regular hygiene habits, and reaching users of newer tobacco products may help mitigate damage in adult populations.

Original Article Info

Title: Associations among smoking status, including the use of cigarettes, electronic cigarettes, and heated cigarettes, periodontal condition, and tooth loss in employed Japanese adults: a cross-sectional study

Journal: BMC Oral Health (2025)

DOI: 10.1186/s12903-025-07003-0