Cigarette smoking is associated with increased prevalence and severity of destructive periodontal disease in terms of periodontal pocketing, periodontal bone loss, and tooth loss. The smoking destructive effect on periodontal bone may be of even "horizontal" and vertical "angular" pattern. The vertical bone loss or the "vertical defect" is a sign of progressive periodontal breakdown that involves the periodontal bone. Water pipe smoking has a sharp rise by the popularity in the recent years by

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... en and women in Middle East countries. The general objective of this thesis was to investigate the relationship between tobacco smoking and vertical periodontal bone loss cross-sectionally and longitudinally. This thesis is based on two study populations, Swedish musicians and a Saudi Arabian population. All participants had a full set of intra-oral radiographs including 16 periapical and 4 bitewing projections that were assessed with regard to presence or absence of vertical defects. In Study I, the number of defects per person increased with age. Vertical defects were more common in the posterior as compared to the anterior region of the dentition and the distribution of defects within the maxilla as well as the mandible typically revealed a right-left hand side symmetry. Cigarette smoking was significantly associated with the prevalence and severity of vertical bone defects (Studies II and III). The relative risk associated with cigarette smoking was 2 to 3-fold increased. The impact of water pipe smoking was of the same magnitude as that of cigarette smoking and the relative risk associated with water pipe smoking was 6-fold increased compared to non-smoking. In addition, the risk of vertical defects increased with increased exposure in cigarette smokers as well as water pipe smokers (Study III). In Study IV, the proportion of vertical defects increased over a 10-year period and the increase over time was significantly associated with smoking. Moreover, the 10-year vertical bone loss was significantly greater in heavy exposure smokers than in light exposure smokers suggesting an exposure-response effect of smoking. Compared to non-smokers the 10-year relative risk was 2.4-fold increased in light exposure smokers and 5.8-fold increased in heavy exposure smokers. In conclusion, the present observations indicate that there is a significant relationship between tobacco smoking and vertical periodontal bone loss. Tobacco smoking should be considered a risk factor for periodontal vertical bone loss.