• 6/30/2004
  • Washington DC
  • By Craig Palmer
  • The American Dental Association

A new U.S. Surgeon General’s report on smoking and health expands the list of illness and disease linked to cigarette smoking to include periodontal disease.

The report released at a May 27 National Press Club news conference and posted online at the Office of the Surgeon General and Centers for Disease Control and Prevention Web sites is the 28th dating from the landmark 1964 report of Surgeon General Luther Terry, which cited cigarette smoking as a definite cause of cancers of the lung and larynx in men and chronic bronchitis in men and women. It is also the first in the series to report specifically on dental effects of cigarette smoking, although oral cancer and related premalignant lesions have been addressed in previous reports and the topic is addressed in Oral Health in America: A Report of the Surgeon General issued in the year 2000 and available at the surgeon general’s Web site.

American Dental Association tobacco policy is posted online at ADA.org.

The dental section of the 960-page printed report of the U.S. Surgeon General reviews the epidemiologic evidence for smoking as a causal factor for the most common forms of nonmalignant oral disease. Its major conclusions:

* the evidence is sufficient to infer a causal relationship between smoking and periodontitis;
* the evidence is inadequate to infer the presence or absence of a causal relationship between smoking and coronal dental caries;
* the evidence is suggestive but not sufficient to infer a causal relationship between smoking and root-surface caries.

A 1982 Surgeon General’s report found that cigarette smoking is a major cause of cancers of the oral cavity in the United States. The 2004 report updates that finding to conclude, “The evidence is sufficient to infer a causal relationship between smoking and cancers of the oral cavity and pharynx.”

“We’ve known for decades that smoking is bad for your health, but this report shows it’s even worse,” said Surgeon General Richard Carmona, M.D. “The toxins from cigarette smoke go everywhere the blood flows. I’m hoping this new information will help motivate people to quit smoking and convince young people not to start in the first place.”

In addition to periodontitis, the new illnesses and conditions linked to cigarette smoking include cataracts, pneumonia, acute myeloid leukemia, abdominal aortic aneurysm and cancers of the cervix, kidney, pancreas and stomach. Smoking even contributes to wound infections following surgery and complications from diabetes, the surgeon general said. It harms nearly every major organ of the body, often in profound ways, causing many diseases and significantly diminishing the health of smokers in general. The report concludes that quitting smoking has benefits immediate, “within minutes and hours after smokers inhale that last cigarette,” and long-term and at any age.

Research on smoking and dental disease has been hampered by lack of consensus on case definitions for some diseases; difficulty in measuring oral conditions and consequent use of indices of questionable validity; some incorrect assumptions about disease etiology, pathogenesis, distribution and natural history; and limited capacity for epidemiologic investigations within the dental research community, the report said.

Through an interactive database of more than 1,600 key articles, the surgeon general’s office is aiming to have the latest and most comprehensive information on smoking available to all. The Health Consequences of Smoking Database is available through the surgeon general’s Web site. The database provides detailed information on the specific health effects of smoking and the surgeon general says it will be continually updated as new critical studies are published. Dr. Carmona said, “Using this technology, once a threshold of danger is met, we can quickly alert the American people of new information related to smoking.”

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