Smokers more often than not present with clinical characteristics that set them apart as a distinct group. They usually present with relatively severe and widespread disease without much bleeding and suppuration, which can mask the severity of inflammation. Gingival pocketing tends to be proportionately greater in the anterior segments and maxillary lingual sites. The marginal gingiva tends to be thickened and fibrotic with a rolled margin. There is usually no association between periodontal status and plaque and calculus scores.
Smokers also respond differently when treated.
They exhibit minimal resolution of pockets after scaling and root planing. Repocketing one year after surgery is common. Smoking cessation on the other hand shows us that there is some clinical benefit if the patient stops smoking. Haber and Kent, Haber et al., and Bergstrom et al. showed that the periodontal condition of former smokers was between that of smokers and nonsmokers. About one year after smoking cessation, the gingiva loses the fibrotic, thickened appearance and assumes a normal anatomy.