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Short Communication
Effect of smoking on oral pigmentation and its relationship with
periodontal status
Jyothi Tadakamadla1, Santhosh Kumar2, Anand Nagori3, HarishTibdewal4, Prabu Duraiswamy5, Suhas Kulkarni6
1
Departments of Maxillofacial Surgery and Diagnostic Sciences, 2Preventive Dental Sciences, College of Dentistry, Jazan University, Jazan, Kingdom
of Saudi Arabia, 3Department of Preventive and Community Dentistry, Darshan Dental College and Hospital, Udaipur, 4Department of Public Health
Dentistry, Vidarbha Youth Welfare Society's Dental College, Amravati, Maharashtra, 5Department of Public Health Dentistry, Sri Ramachandra Dental
College, Chennai, 6Department of Public Health Dentistry, Panineeyamahavidyaliaya Institute of Dental Sciences, Hyderabad, Andhra Pradesh, India
ABSTRACT
Background: To assess the effect of smoking on lip and gingival pigmentation and also to assess
the relationship of pigmentation with periodontal parameters.
Materials and Methods: 109 smokers and an equal number of control subjects who were
nonsmokers in the age range of 35 44 years comprised the study sample. All the participants
Received: May 2012 were assessed for pigmentation on lip and gingiva and a total periodontal status examination was
Accepted: September 2012 done with measurements on gingival bleeding, probing depth and loss of attachment at six points
in each tooth.
Address for correspondence:
Dr.Santhosh Kumar
Results: Melanin pigmentation on lips and gingiva was observed in all the smokers except for
Tadakamadla, one who did not exhibit gingival pigmentation. Significantly greater number of smokers exhibited
Department of Preventive pigmentation than nonsmokers. Gingival bleeding on probing, probing depth and loss of attachment
Dental Sciences, College of differed significantly in relation to gingival and lip pigmentation.
Dentistry, Jazan Unviersity,
Jazan, Kingdom of Saudi
Conclusions: Oral pigmentation was widespread and more commonly observed in smokers than
Arabia. nonsmokers and there was a relationship between pigmentation and periodontal deterioration.
Email:santosh_dentist@
yahoo.com Key Words: Oral mucosa, pigmentation, smoking, periodontium
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112 Dental Research Journal / Dec 2012 / Vol 9 / Issue 7 (Supplement Issue 1)
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Tadakamadla, et al.: Effect of smoking on oral pigmentation
Table1: Mean scores of periodontal parameters according to levels of lip and gingival pigmentation
Periodontal Lip pigmentation Gingival pigmentation
parameter Upper lip Lower lip Maxilla Mandible
Absent Present Absent Present Absent Grade Grade Absent Grade Grade
12 34 12 34
Bleeding 0.330.24* 0.090.11 0.350.25* 0.150.18 0.420.23 0.210.22 0.100.10 0.410.23 0.230.23 0.090.09
Probing depth 1.140.34* 1.610.57 1.320.46* 1.590.61 1.250.52 1.370.50 1.770.53 1.200.41 1.400.53 1.770.55
Loss of attachment 0.050.13* 0.410.38 0.160.31* 0.420.36 0.200.42 0.190.26 0.560.39 0.070.19 0.250.34 0.550.37
*Mann: Whitney U test, Kruskal: Wallis test
attending Darshan Dental College and Hospital, than nonsmokers which could be attributed to
Udaipur, India during the period September to nicotine and benzopyrene in the tobacco smoke
November 2008. Consequently, 109 smokers and an that stimulate the production of melanin from the
equal number of control subjects(pair matched) who melanocytes.[8] Nearly twothirds(31.2%) and 73.4%
were nonsmokers in the age range of 3544years nonsmokers exhibited lip and gingival pigmentation,
were selected as the final sample. Mean age of the respectively(not presented in tables), which might be
subjects was 39.5years. Individuals suffering from due to ethnic pigmentation. This is in accordance with
nutritional deficiencies, systemic disorders, and oral the fact that oral pigmentation was reported among
mucosal disorders that would cause oral pigmentation 96% of the Indian population, whereas it was reported
were excluded from the study. Inclusion criteria for to be 15% among Europeans.[9] However, among the
control subjects constituted those who were not using population of Turkey(Eurasia), it was found to be
any form of tobacco and had not undergone any form 37%.[10]
of periodontal therapy.
DISCUSSION
The methodology for the present study has been
adopted from a previous report;[6] clinical examination Table1 depicts that gingival bleeding on probing,
was conducted by a single examiner and each subject probing depth, and loss of attachment differed
was assessed for lip[6] and gingival pigmentation[7] significantly in relation to gingival and lip
(Score 0: No pigmentation; score 1:1 or 2 solitary pigmentation. Gingival bleeding was inversely related
unit(s) of pigmentation on papillary gingiva; to lip and gingival pigmentation, in accordance to
Score 2: >3 units of pigmentation on papillary gingiva; an earlier study in Turkey.[10] On the other hand,
Score 3: One or more short continuous ribbons of measurements of periodontal probing depth and loss
pigmentation on papillary gingiva; Score 4: One of gingival attachment were seen highest in subjects
continuous ribbon including the entire area between with pigmented lips and in those who had grade34
canines) besides periodontal assessment(gingival of gingival pigmentation. The observed relationship
bleeding, probing depth, and loss of attachment between pigmentation and periodontal deterioration
in each tooth at six sites). Gingival bleeding was could be attributed to the indirect relationship between
assessed as the presence or absence of bleeding, and these two entities which have a common etiological
thus the mean percentage of sites with bleeding was agent, smoking.
calculated for each individual. Statistical differences in
periodontal parameters in relation to grades of lip and CONCLUSION
gingival pigmentation in maxillary and mandibular
gingiva were assessed using the MannWhitney U Oral pigmentation was widespread and more
and KruskalWallis tests, respectively. commonly observed in smokers than nonsmokers and
there was a relationship between pigmentation and
RESULTS periodontal deterioration.
Melanin pigmentation on lips and gingiva was REFERENCES
observed in all the smokers except for one who did
not exhibit gingival pigmentation. Significantly, a 1. TannerAC, Kent RJ, Van Dyke T, Sonis ST, Murray LA.
greater number of smokers exhibited pigmentation Clinical and other risk indicators for early periodontitis in adults.
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Tadakamadla, et al.: Effect of smoking on oral pigmentation
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