Passive smoking and periodontal disease- little evidence currently available of a link


The strong association between smoking and periodontal disease is known (Dental Elf 20th June 2014). However as non-smoking individuals exposed to environmental tobacco smoke (passive or second- hand smoking) are also know to be at risk of disease this review aimed to assess the association between environmental tobacco smoke (ETS) and periodontal disease.

Searches were conducted the Medline and Google scholar databases and reference lists of identified studies also searched.   Clinical and laboratory based investigations that considered clinical periodontal parameters and biomarkers in saliva and gingival cervicular fluid (GCF) of individuals exposed to ETS and controls (non-smokers unexposed to ETS) were included. Only English language studies were considered.

  • 13 studies were included (9 clinical; 4 in-vitro)
  • All the clinical studies were cross-sectional with sample sizes ranging from 45-6611.
    • 5 studies reported the odds ratios for periodontal disease to be significantly higher among individuals exposed to ETS than controls
    • 2 studies, salivary aspartate aminotransferase, lactoferrin and albumin levels were reported to be significantly higher in individuals exposed to ETS than controls.
    • In one study, levels of salivary interleukin-1β were reported to be significantly higher in individuals exposed to ETS than controls.
  • The in-vitro studies reported ETS exposure inhibits the growth of gingival epithelial cells, impairs the morphology and function of gingival fibroblasts and increases the expression of proinflammatory proteins in gingival tissues

The authors concluded

The association between ETS and periodontal disease remains debatable and requires further investigations.


This review was restricted to only two databases and English language studies so it likely that some studies could have been missed. It is not clear whether the study selection and data abstraction was conducted independently and no quality assessment of the included studies has been reported.


Javed F, Bashir Ahmed H, Romanos GE. Association between environmental tobacco smoke and periodontal disease: A systematic review. Environ Res. 2014 Jun 10;133C:117-122. doi: 10.1016/j.envres.2014.05.008. [Epub ahead of print] Review. PubMed PMID: 2492691

Dental Elf 20th June 2014 – Longitudinal study provides strong evidence that chronic smoking is a risk factor for periodontitis

Dental Elf 10th Feb2014 – Possible association between second hand smoke and caries ADA-EBD critical


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