The influence of smoking on periodontal health: A case–control study in Afghanistan
Authors: Ehsan Hedayatullah 
Published: February 2025

Background

Periodontal disease, a prevalent oral health condition, is exacerbated by smoking, which accelerates tissue destruction and complicates disease management. This study investigates the association between smoking and periodontal health by comparing key periodontal indicators between smokers and nonsmokers in Afghanistan, where smoking prevalence is rising.

Methods

A case–control study was conducted at Ghalib University Hospital in Kabul, Afghanistan, involving male participants aged 15–50 years. Smokers with stage II or III periodontitis, as defined by the clinical attachment loss (CAL) and probing pocket depth (PPD) criteria, were included in the case group, while nonsmokers without signs of periodontitis were assigned to the control group. Periodontal assessments included PPD, CAL, and bleeding on probing (BOP). The data were analyzed to evaluate differences in periodontal health indicators between the two groups and to assess the association between smoking duration and periodontal severity.

Results

Smokers exhibited significantly worse periodontal health compared to nonsmokers. Mean PPD was 3.8 mm in smokers versus 2.5 mm in nonsmokers, and mean CAL was 2.9 mm in smokers compared to 1.7 mm in nonsmokers (p < 0.001 for both measures). Additionally, smokers showed a reduced BOP score, with bleeding observed in only 45% of sites among smokers versus 78% among nonsmokers, indicating a masking effect of nicotine on gingival inflammation. Longer smoking duration was associated with more severe periodontal damage, with increased PPD and CAL values.

Conclusion

This study underscores the negative impact of smoking on periodontal health, particularly in populations with limited access to dental care. The findings support the need for integrating smoking cessation programs into oral healthcare strategies to mitigate periodontal disease progression among smokers. Public health initiatives should prioritize smoking prevention and cessation, particularly in underserved regions with high smoking prevalence.

Plain Language Summary

Smoking has a major impact on oral health, specifically by worsening periodontal (gum) disease. This study aimed to understand how smoking affects gum health by comparing smokers and nonsmokers in Afghanistan. Periodontal disease is a common condition in which the structures that support the teeth become inflamed and, if untreated, can lead to tooth loss. This study involved examining the gums of 122 participants, some of whom smoked while others did not. Several indicators of gum health were measured, such as probing depth, clinical attachment loss, and bleeding on probing.

The findings revealed that smokers showed significantly worse gum health than nonsmokers. Smokers had deeper pockets around their teeth, more attachment loss, and less gum bleeding, which can make it harder to detect early signs of disease. These results confirm that smoking is a serious risk factor for periodontal disease, suggesting that quitting smoking could be key to improving oral health. This research highlights the importance of public health programs focusing on smoking prevention and cessation to reduce periodontal disease risk in communities where smoking rates are high.