Purpose: To investigate the relationship between water pipe and cigarette smoking and the prevalence and severity of vertical periodontal bone defects. Material and Methods: A study sample of 355 individuals in the age range 17 to 60 years was recruited from Jeddah, Saudi Arabia. Full sets of intra-oral radiographs for each individual were assessed with regard to the presence or absence of vertical bone defects. A vertical defect was defined as an angular resorption of the interdental marginal bone of 2 mm or more at either the mesial or distal aspect of the root. Results: The overall prevalence of vertical defects was 39%, with a specific prevalence of 47% in water pipe smokers, 54% in cigarette smokers, and 23% in non-smokers. The prevalence was significantly elevated in both types of smokers compared with non-smokers (p < 0.001). Expressed as the proportion of sites with vertical defects per person, the severity was 2.6% for water pipe smokers, 2.8% for cigarette smokers, and 1.3% for non-smokers. The association between smoking and severity of vertical defects was statistically significant (p < 0.001). The severity of vertical defects was significantly greater in heavy exposure compared to light exposure smokers in water pipe as well as cigarette smokers (p < 0.001). The relative risk associated with water pipe and cigarette smoking was 2.9-fold and 6.6-fold increased, respectively, compared to non-smoking. Conclusion: The present observations suggest that prevalence and severity of vertical periodontal bone defects are increased in tobacco smokers. The association of vertical bone loss with water pipe smoking is comparable to the association with cigarette smoking.
Keywords: angular bone loss, cigarette smoking, periodontal disease, Saudi Arabia, tobacco smoking, vertical bone defect, water pipe smoking