A Literature Review on the Effects of Smoking on Tertiary Dentin Formation

PURPOSE. The tooth is a complex structure composed of two anatomical regions, a crown and root. Each region is comprised of two, highly mineralized tissue layers that surround and protect the vital pulp chamber. The crown is visible in the oral cavity and covered externally with enamel. The outer layer of the root is covered in cementum. Dentin is the hard tissue that makes up the bulk of the tooth and gives structural support to the overlying enamel and cementum. Dentin also provides protection to the cellular and neurovascular elements in the pulp chamber. Dental trauma and carious lesions can induce the deposition of tertiary dentin as a protective response to localized sites of injury. The extent of injury and the cellular response of the pulp determines whether a reparative or reactionary type of tertiary dentin will be deposited. Smoking is considered a contributing factor to several oral diseases; however, little is known about the effect of smoking on the reparative process of the pulp chamber. The purpose of this review is to investigate the impact of smoking on tertiary dentin formation. METHODS. A literature review on tertiary dentin and the effect of smoking was performed. Peer reviewed research articles, published between 1994 through 2016, were obtained through PubMed. RESULTS. This review includes information on tertiary dentin formation and the proposed mechanisms that initiate this process. The effect of smoking on teeth and gingiva is also discussed to demonstrate the impact of smoking on the formation of tertiary dentin. SIGNIFICANCE. Demonstrating a relationship between smoking and tertiary dentin formation could have a significant impact on the treatment of patients. Documentation of the effect of smoking on the inhibition of tertiary dentin formation could lead to the development of new treatment plans and ultimately preventive measures resulting in improved oral health.