The 2017 Classification scheme wasspecifically designed to allow for an individualised treatment approach, taking into account the specifics of every case, including severity, extent, progression rates and local and systemic complicating factors. Therefore, the logical next step was to develop clinical guidelines based on the Classification.
The European Federation of Periodontology (EFP) spearheaded this development, choosing the highest quality level for guideline development, the S3 format, that takes into account both a systematic appraisal of the published evidence as well as the clinical experience of a large group of stakeholders.
The development of the guideline was finalised in a workshop in November 2019 and published in May 2020. Many of the BSP were involved in the systematic reviews and participated as Chairs or Working Group members.
The European document entitled, “Treatment of Stage I-III Periodontitis – The EFP S3 Level Clinical Practice Guideline”, on periodontal therapy, takes into account a systematic appraisal of the published evidence, as well as the clinical experience of a large group of stakeholders.
As the guideline document is, by definition, international, to ensure a broad dissemination and general applicability, it was recommended by the EFP that national member societies adopt the document or adapt it to their own healthcare system.
The BSP immediately reviewed the guidelines, by involving Public Health England/NHS England and other important stakeholders, to ensure that the guidance could be used easily and effectively by oral health practitioners in the UK. The Society worked with the moderator of the EFP guidelines, Professor Ina Kopp, to ensure the correct processes were followed. The German and Spanish Periodontal Societies performed the same process ahead of us.
To help the dental community implement the guidelines in UK practice, the BSP has put considerable effort into creating a wide range of educational resources and we suggest dental care professionals in the UK use the “BSP Implementation of Treatment of Stage I-III Periodontitis –The EFP S3 Level Clinical Practice Guideline” in their clinical practice (see Professional Information and Resources).
The BSP rapidly reviewedthe European document and developed a UKversion of the Guidelines, whichwere suitable for the UK healthcare system. This was done using the GRADE ADOLOPMENT framework.
“Adolop” simply means that we discussed the guidelines and adopted, modified or developed them as we saw fit, to ensure they were appropriate for us to share with UK dental professionals (dentists, hygienists, therapists), patients and the public.
Led by Prof. Nicola West and Prof. Moritz Kebschull, the BSP held Working Group meetings during lockdown and worked incredibly hard to review the EFP’s Evidenced-based Treatment Guidelines.
We were delighted to engage the services of Professor Ina Kopp, who kindly agreed to moderate the whole of this process for the BSP. Ina has extensive experience in leading, strengthening and supporting international collaborations in guideline development. Her excellent moderation skills and lovely manner ensured that the discussions at every meeting were relevant and useful. The BSP is extremely grateful for her contributions to the discussions, which made our collaboration with dental professionals, medical experts, stakeholders and BSP Patient Forum members run smoothly.
The meetings were held online during June and July and Prof.West remarked on the speed and success of the project,
“We were keen to involve several stakeholders in this project, from a variety of organisations, to gain a broader insight and include different perspectives when reviewing the clinical recommendations. I was delighted to have such fantastic working groups comprised of dental professionals, medical experts, stakeholders and BSP Patient Forum who were all committed to rapidly review the European guidelines.
Together, we achieved an enormous task in a very short time, and I am extremely proud to have led this initiative with Moritz. I greatly appreciate the tremendous support of all participants and would like to thank them for their time, dedication and valuable contributions which helped make this project a huge success.”
Prof.Kebschull echoed the same sentiments and added,
“It was a pleasure to work with the BSP on this important project. The BSP UK version of the guidelines will be an important document, as the recommendations provide evidence-based support for specialists, dentists, dental hygienists and dental therapists.”
The authors and workshop participants of the UK adolopment project are listed below. The list includes dental professionals, medical experts, stakeholders and BSP Patient Forum members,all of whom dedicated a considerable amount of time to this project. Their support in reviewing the guideline documentand contributing to the workshop discussions helped to make this project a hugesuccess.
Workshop Participants:
Neil Almond, Marie Anderson, Raimondo Ascione, Martin Ashley, Paul Baker, Leon Bassi, Sanjeev Bhanderi, Elena Calciolari, Nigel Carter, Antonio Ceriello, Iain Chapple, Marilou Ciantar, Dominic Clark-Roberton, Nick Claydon, David Cottam, Shauna Culshaw, Andrew Cundy, Francesco D'Aiuto, Thomas Dietrich, Nikos Donos, Ian Dunn, Ken Eaton, Gillian Flett, Chris Fox, Mandeep Ghuman, Jenny Godson, Gareth Griffiths, Stephen Hancocks, Peter Heasman, Debbie Hemington, Penny Hodge, Mark Ide, Matt Jerreat, Roshni Karia, Moritz Kebschull, Gerry Linden, Matt Locke, Isobel Madden, Phil Marsh, Matthew Garrett, Giles McCracken, William McLaughlin, Imogen Midwood, Mike Milward, Aidan Moran, Federico Moreno, Madeleine Murray, Rajan Nansi, Ian Needleman, Luigi Nibali, Sarifa Patel, Divyash Patel, Vipul Patel, Michael Paterson, Alexander Pollard, Philip Preshaw, Devan Raindi, Raj Rattan, Anthony Roberts, Shazad Saleem, Ross Scales (observer), Joon Seong, Praveen Sharma, Andrew Smith, Susan Smith, Jeanie Suvan, Manoj Tank, Richard Tucker, Aru Tugnait, Wendy Turner, Bobby Varghese, Jenny Walker, Nicola West, Paul Weston, Roger Yates.
Methodological Consultant:
Professor Ina Kopp
Workshop Organisation:
British Society of Periodontology and Implant Dentistry –
Professor Nicola West & Professor Moritz Kebschull
Scientific societies involved in the guideline development process:
Association of Clinical Oral Microbiologists
British Association of Dental Therapists
British Endodontic Society
British Society of Dental Hygiene and Therapy
British Society of Periodontology and Implant Dentistry
British Society of Restorative Dentistry
Restorative Dentistry UK
Other organisations involved in the guideline development process:
British Dental Association
BSP Patient Forum
Oral Health Foundation
Dental Protection
Faculty of General Dental Practice (UK)
General Dental Council (Observer)
Office of the Chief Dental Officer (OCDO) England
Public Health England
Royal College of Surgeons of England
Scottish Antimicrobial Prescribing Group
(A list of Clinical Experts/Representatives from each organisation can be viewed HERE.)
The BSP UK version of the S3 Treatment Guidelines for Periodontitis paper is now available online in the Journal of Dentistry, with open access: https://authors.elsevier.com/sd/article/S0300-5712(20)30310-9
The Guidelines communicate in a very transparent way the evidence behind all the treatment interventions that we do in dealing with a case of periodontitis (gum disease).
This isan important document, as the recommendations provide evidence-based support for specialists, dentists, dental hygienists and dental therapists. The BSP has therfore arranged to publish the paper with open access to all.
We believe that this is an incredibly important project. Poor gum health can lead to tooth loss and affect other systemic health issues, so it was wonderful that European experts came together to look at the 4 main phases of periodontal disease management with a view to creating clear guidelines for all.
Within each of the four sections below, the experts looked at specific questions within each category and systematically reviewed the literature in order to provide evidence-based answers:
- Self-care (oral hygiene) & behaviour modification (risk factor control)
- Non-surgical treatments
- Surgical therapy
- Supportive care/maintenance
As a result, the BSP UK S3 Guideline isthe “go-to” document for professionals who need clarification on clinical questions and for patients keen to manage their periodontal disease.
The BSP has created a Glossary of the periodontal terminology used in the BSP Implementation of the S3 Treatment Guidelines for Periodontitis and professional flowchart resource. We hope that you find this document helpful.
We intend to treattheGlossary as a working document, so please contact the Society if there are other terms you feel need explaining.
Click HEREto download resource.
Toassist members and the wider dental community in interpreting the guidelines, the BSP carefully planned and created educational resources to support the profession.
Theseries of four educational webinars followedthe publication of the paper. The webinars may now be viewed below, without CPD. We hope that you enjoy the series:
Webinar Series 2021
10 February - Step 1: Prof. Moritz Kebschull, sponsored by GSK
24 February - Step 2: Prof. Iain Chapple, sponsored by Acteon
10 March - Step 3: Prof. Nikos Donos
24 March - Step 4: Prof. Nicola West, sponsored by Oral-B
Webinar Series 2022
20 January - Prof. Iain Chapple,Time to take periodontitis seriously
10 February - Dr Shazad Saleem, Avoidance of Doubt, sponsored by Acteon
In addition, the BSP has been kindly supported by GSK on this project. We have worked together torecord several educational videos and produce a flowchart resourceto help dental care professionals implement the guidelines in clinical practice. The flowchart QR code will link to a short, informative video, guiding you through the four steps, which you can VIEW HERE.
We have workedwith GSK to distribute the flowcharts to UK dental practices. The flowchart will be coated in N9 Pure Silver, which is designed to provide anti-microbial performance and is the safe and natural way to protect the printed surface.
By creating a series of short video clips, which we have shared via social media and our website, we aim to helpspread the important educational message to the wider dental profession, patients and the public.
We are often asked similar questions via our website, during lectures and on social media. Dr Viren Vithlani & Dr Ian Dunn have,therefore, collated the frequently asked questions with the BSP answers:
Q: What does S3 mean? I thought there were four main steps in the treatment guidance.
A: The new treatment guidance is based on a ‘stepwise’ approach to treatment. The guidance has been developed with the highest quality level for guidance development (S3 format) which considers both a systematic appraisal of the published evidence as well as clinical experience. S3 simply refers to the highest level of guideline production.
Q: Why did we need a new set of guidelines for the treatment of periodontitis?
A: Following the publication of the new classification, guidance was developed to support treatment of patients, to allow for an individualised treatment approach. The guidelines are there to support clinicians when treating periodontal disease, helping them make up to date evidence based treatment decisions and focus on personalised patient education. This in turn should empower patients to take more responsibility for their health, ultimately improving outcomes.
Q: The guidelines published by the European Federation of Periodontology aredifferent to the BSP version? Why are we using a different version to the European document?
A: Internationally produced guidelines are not always transferable to each country’s working systems. After the guidance was published in May 2020, the BSP moved rapidly to take the European document and develop a British version of the guidelines, making sure they were suitable for our UK healthcare system. This was something that all EFP societies were encouraged to do and it was done using the ‘grade adolopment’ framework. For each of the individual recommendations, an adolopment process was carried out. ‘Adolop’ simply means that the guidelines are accepted unchanged, adopted, modified, or developed in line with the evidence, to ensure they were appropriate for dental professionals and patients in the UK healthcare system.
Q: What does PMPR mean and why have we got new terminology?
A: PMPR stands for ‘Professional Mechanical Plaque Removal’ and it can be supragingival or subgingival. We have all used different ways of describing what we have done in the past and it is important that we use universal professional language. It replaces ALL previous terminology. Subgingival PMPR is an umbrella term and replaces root surface debridement or root planing. It does not mean that what we did before was wrong or unreasonable and it does not change what we use practically. It does mean the death of the term ‘scale and polish’ which can be misleading to a patient with periodontitis. We are doing much more than just that!
Q: What is the difference between PMPR in step 1 and PMPR in step 2? In Step 1, it mentions Supra and Subgingival PMPR of the clinical crown. I thought we did not go subgingival in Step 1.
A: In Step 1, PMPR includes the removal of plaque and calculus supra and subgingivally. This acknowledges that at this step you are not attempting to do any root surface management but are looking to remove visible or detectable subgingival deposits located on the crown of the tooth, part of which may be subgingival either due to false pocketing or the disease being mild. Essentially you are creating an environment for the patient to clean better. In Step 2, you are carrying out subgingival instrumentation (root surface debridement or PMPR) on the root surface. What you use (hand / powered or a combination) does not matter. It is important to consider patient needs, site level needs and preferences. The quality of the instrumentation is important.
Q: Do we have to write PMPR in our notes or can we still describe what we did i.e., subgingival debridement with hand instruments?
A: The BSP accepts that it will take time for new terminology and language to be adopted universally in the UK but practitioners should make the effort to familiarise themselves with the new terminology. You can still describe and provide more detail on what has actually been carried out, for example subgingival instrumentation with ultrasonic and hand instruments.
Q: Engaged and Non-engaged patients - if a patient fails to hit the required scores to be classed as an engaged patient, can we withhold Step 2 forever? Is that medico-legally robust?
A: The idea is to take each step at a time, to give patients more responsibility. A non-engaging patient could be held at step 1 and not move to step 2 until they are demonstrating that they can improve their plaque control. Of course, this is only true if we have educated our patients on the importance of oral hygiene and demonstrated how to do it. This is medico-legally robust as long as we have followed the steps and are documenting the patient’s oral hygiene routines, the treatment carried out and the reasons why they are not able to move to step 2. Having an objective way of measuring our patient’s plaque control using a plaque score is a great way of demonstrating this.
Q: What happens if a patient declines treatment or is not-engaging at all?
A: These patients can be entered into ‘palliative care’ for their gum disease with step 1 repeated regularly. It is also important that we do not write patients off, you never know when a patient may change their behaviour and engage. Always consider whether we are engaging them enough? Do we need to change our approach or maybe they will engage more with another member of your dental team?
Q: Should subgingival PMPR in Step 2 be carried out using local anaesthesia?
A: There is no significant evidence base that addresses this question. Successful periodontal treatment relies on high quality non-surgical treatment and if you can achieve this without local anaesthetic then it is not required. If you cannot, then it is. This will vary from patient to patient and is something that should be discussed with the patient prior to treatment.
Q: At Step 3, the guidance talks about referring patients to a level 2 or 3 practitioner if required, for non-responding or residual deep sites. What happens if a referral is not possible?
A: There may be instances where a specialist or level 2 practitioner is not available in the area, or the patient cannot travel or cannot afford treatment. In these cases, the onus is on the practitioner or dental professionals within their team to continue with some form of therapy i.e., repeating subgingival PMPR or providing regular supportive periodontal care that includes subgingival PMPR. If a patient refuses or cannot access specialist of level 2 care they should be made aware of the consequences of their decisions i.e., that the disease may progress and teeth may be lost.
Q: Is it important that every patient has step 4 (supportive periodontal care)?
A: Supportive periodontal care (maintenance) should be encouraged strongly to all patients. Several long-term studies show that it is crucial to long term stability. It allows oral hygiene to be reviewed, reinforced, targeted and it allows monitoring of the disease situation together with PMPR. Oral hygiene is not a one-off event in Step 1, it needs to be practiced throughout all the steps. Maintenance is a crucial part of periodontal therapy and it is the most cost-effective thing patients can do to keep their teeth!
Q: The guidance only talks about treating Stage 1-3 disease, what about Stage 4?
A: The current set of guidance reviewed Stages 1, 2 and 3 disease and guidance for Stage 4 is currently being evaluated and will be published separately. You can read more about the BSP UK Clinical Practice Guidelines for the Treatment of Periodontitis and view other resources by visiting: www.bsperio.org.uk/S3-Guidelines
The BSP has also created a lay version of the guidelines for the public and patients, which conveys the importance of gum health in a simplified, informative way.It was extremely important to the BSP to involve patients, who could present their important viewpoints in the Workshops. They have also been involved in the process of creating a lay version of the guidelines.
This lay version will allow patients to empower themselves with evidence-based information to both take responsibility for aspects of their disease management and know that they are being offered appropriate, contemporary, evidence-based treatment.
Our aim in creating resources for patients and the public include:
- Help the public understand what gum disease is
- Raise awareness of how you can look after your gums and maintain good oral health
- Reduce the stigma associated with gum disease (as highlighted in “The Sound of Periodontitis” video) by identifying the many causes including smoking, diabetes etc.
- Highlight that more can be done to aid gum health in addition to brushing your teeth
- Encourage the patient to take ownership of their disease and highlight the ways they can do this
FAQs
How many cigarettes per day does the BSP advise increases the risk of developing periodontists by 50 %? ›
Therefore, patients should be advised that even smoking 1-4 cigarettes a day increases their risk of developing periodontitis by almost 50%.
What are S3 guidelines? ›The guidance has been developed with the highest quality level for guidance development (S3 format) which considers both a systematic appraisal of the published evidence as well as clinical experience. S3 simply refers to the highest level of guideline production.
How many steps of care are there in the new S3 guidelines for the treatment of periodontitis? ›The guideline, recommends four sequential steps to periodontal therapy: Good oral hygiene and a healthy lifestyle to reduce inflammation is the foundation for an optimal response to treatment and long-term control of the disease.
What factors should a periodontal treatment plan include? ›...
(a) Plaque control and patient education:
- Diet control (in patients with rampant caries)
- Removal of calculus and root planing.
- Correction of restorative and prosthetic irritation factors.
Whilst a full mouth plaque score of 20% and a full mouth bleeding score of 10% are the accepted standard with periodontal academics and specialists, these are mainly mentioned for patients post therapy in the maintenance phase following periodontal treatment.
How does smoking affect periodontal healing? ›Results indicate that current smokers have less healing and reduction in subgingival Bacteroides forsythus and Porphyromonas gingivalis after treatment compared to former and nonsmokers, suggesting that smoking impairs periodontal healing.
What is S3 level clinical practice guideline? ›The guidance has been developed with the highest quality level for guidance development (S3 format) which considers both a systematic appraisal of the published evidence as well as clinical experience. S3 simply refers to the highest level of guideline production.
What are the different phases of periodontal therapy? ›Principally the comprehensive periodontal therapy can be divided into four main phases: phase I. initial or cause related therapy, phase II. surgical therapy, phase III. periodontal reconstruction, and phase IV.
What is S2K guideline? ›The S2k Guideline on “Variations of Sex Characteristics” is a medical guideline which has been in place since 2016. The guideline will be reassessed after five years. This will therefore happen again in 2021. When something is classified as S2K, this means that it is a consensus-based guideline.
What is supportive periodontal therapy? ›Periodontal maintenance procedures (also known as supportive periodontal therapy) are designed to minimize the recurrence and progression of periodontal disease in patients that have been previously treated for periodontal problems. This is an ongoing prevention program of periodontal cleanings and evaluations.
What can be done about periodontal disease? ›
Try these measures to reduce or prevent periodontitis: Brush your teeth twice a day or, better yet, after every meal or snack. Use a soft toothbrush and replace it at least every three months. Consider using an electric toothbrush, which may be more effective at removing plaque and tartar.
What does PmPr mean in dentistry? ›Periodontitis by. Professional. mechanical Plaque. removal (PmPr) Guidance for dentist and dental HyGienist.
What are three non surgical periodontal treatments? ›- Scaling and Root Planing. ...
- Localized placement of medications under the gum line to combat “gum” disease. ...
- Systemic Antimicrobials. ...
- Laser Therapy.
The initial-first phase in the treatment of periodontal disease typically involves Sanative Therapy ; a meticulous below the gum line cleaning that may include scaling, root planning, soft tissue curettage and dental prophylaxis.
What is periodontal coverage? ›Dental insurance can cover some treatments for periodontal disease. People should enroll into periodontal insurance, which is dental insurance that covers periodontal care (“Periodontal Insurance”). They may have to pay their deductible before receiving coverage for this care (“Laser Gum Treatment & Cost”).
How do you check your plaque score? ›The GREAT Plaque Index Score - YouTube
What is full mouth plaque score? ›The full mouth plaque and bleeding score is commonly used because it records the mesial, distal, buccal, and palatal/lingual surfaces of all the teeth present ( Figure 1.1) in a dichotomous score (plaque present/absent).
How do you calculate plaque score? ›Simply multiply the number of teeth by four to calculate the number of interproximal surfaces, or by six for the total number of surfaces measured. Patients with periodontal disease often start with scores of 25/100 to 85/140 or more. The numbers drop dramatically after therapy.
Does alcohol affect periodontal disease? ›A study in the Journal of Periodontology done by Brazilian researchers has found that alcohol can contribute to periodontal disease, commonly known as gum disease. According to the study, drinking can heighten risk factors for periodontitis and make your symptoms far worse for those who already have it.
Can you smoke after periodontal cleaning? ›If you are a smoker, make sure you avoid smoking for at least 72 hours after your deep cleaning procedure. Quitting altogether, of course, is the best thing to do since smoking can cause gum disease to return again and again.
Do gums grow back after quitting smoking? ›
Unfortunately, even quitting won't bring back your lost gum tissue.
What are the stages of gingivitis? ›- First Signs. In the very early stages of gum disease, your teeth will seem basically healthy. ...
- Gingivitis. ...
- Early Periodontitis. ...
- Moderate Periodontitis. ...
- Advanced Periodontitis.
In addition, Ramfjord recommended the assessment of six 'index teeth' that soon became known as the 'Ramfjord teeth' These teeth (with the notation of the Fédération Dentaire Internationale) were: maxillary right first molar (tooth 16), maxillary left central incisor (tooth 11), maxillary left first bicuspid (tooth 24) ...
Is gum disease gingivitis? ›Overview. Gingivitis is a common and mild form of gum disease (periodontal disease) that causes irritation, redness and swelling (inflammation) of your gingiva, the part of your gum around the base of your teeth.
What is treatment plan? ›In both mental and general healthcare settings, a treatment plan is a documented guide or outline for a patient's therapeutic treatment. Treatment plans are used by professionals such as psychologists, psychiatrists, behavioral health professionals, and other healthcare practitioners as a way to: Design. Blueprint.
What are the phases of treatment plan? ›Treatment plan sequencing
Complex treatment plans often should be sequenced in phases, including an urgent phase, control phase, re-evaluation phase, definitive phase, and maintenance phase.
Of all the products included here, chlorhexidine appears to be the most effective agent for reduction of both plaque and gingivitis, with short-term reductions averaging 60% (29).
Why is supportive periodontal therapy important? ›Following completion of treatment and arrest of inflammation, supportive periodontal therapy (SPT) is employed to reduce the probability of re‐infection and progression of the disease; to maintain teeth without pain, excessive mobility or persistent infection in the long term, and to prevent related oral diseases.
Is periodontal disease and infection? ›What is periodontal disease? Periodontal diseases are mainly the result of infections and inflammation of the gums and bone that surround and support the teeth. In its early stage, called gingivitis, the gums can become swollen and red, and they may bleed.
What is the best antibiotic for periodontal disease? ›Tetracycline antibiotics – Antibiotics which include tetracycline hydrochloride, doxycycline, and minocycline are the primary drugs used in periodontal treatment. They have antibacterial properties, reduce inflammation and block collagenase (a protein which destroys the connective tissue).
Which mouthwash is best for periodontal disease? ›
- TheraBreath Periodontist Recommended Healthy Gums Oral Rinse. ...
- Crest Pro-Health Gum and Breath Purify Mouthwash. ...
- Colgate Peroxyl Antiseptic Mouthwash and Mouth Sore Rinse, 1.5% Hydrogen Peroxide.
Periodontal disease is caused by a buildup of plaque on the teeth and gums, and no matter how diligent you are about cleaning your teeth, plaque will continue to accumulate after your periodontal treatment. Periodontal disease can come back as soon as two to four months after your treatment.
What is a 6 point pocket chart? ›6 Point Pocket Chart (6PPC)
These 6 positions are checked for every tooth in the sextant after initial therapy if there is a BPE of 3, however all teeth in the mouth are checked if there is a BPE of 4. During a 6PPC, much more information regarding the periodontal health is noted.
90% of adults in the UK have some gum disease1, even if only a small amount. Gum disease, however, can be prevented by maintaining a good oral hygiene routine, including regular brushing, check-ups with your dentist, and hygienist appointments.
What does TCA mean in dentistry? ›Introduction: Trichloracetic acid (TCA) is a soft tissue chemical cauterizing agent that is used on gingival margins prior to restoring cervical cavities with resin materials.
When do you use a 6 point pocket chart? ›The BPE suggests that when a code 3 is scored, a 6 point probing pocket chart should be taken for that sextant. It might well be worth recording the whole mouth since it should be examined anyway. Where a code 4 or * is scored, a full mouth periodontal probing chart should be recorded.
How many chemicals are found in tobacco? ›Tobacco smoke contains a deadly mix of more than 7,000 chemicals. Hundreds are toxic. About 70 can cause cancer.
How do you calculate periodontal pocket depth? ›How do We Measure Periodontal Pockets? To measure a periodontal pocket we use a periodontal probe. The probe allows us to measure from the top of the pocket to the bottom of the pocket. The bottom of the pocket is the area where the tissue is connected through ligaments to the tooth's root.
What is full periodontal charting? ›Periodontal charting monitors your gum health by measuring the space between your teeth and the surrounding gum tissue. This information is vital because it can provide insights into the overall health of your teeth, gums, and jaws.
How do you calculate plaque score? ›Simply multiply the number of teeth by four to calculate the number of interproximal surfaces, or by six for the total number of surfaces measured. Patients with periodontal disease often start with scores of 25/100 to 85/140 or more. The numbers drop dramatically after therapy.
What is the healthiest cigarette? ›
Actually, the answer would be - none. There are simply no safe cigarettes. Even “light” and “all natural” might sound attractive and healthier, but they are not. They all contain harmful substances that we have mentioned.
Why do people smoke cigarettes? ›Over time, your body and brain get used to having nicotine in them. About 80–90% of people who smoke regularly are addicted to nicotine. Nicotine reaches your brain within 10 seconds of when it enters your body. It causes the brain to release adrenaline, and that creates a buzz of pleasure and energy.
Are there healthy cigarettes? ›There is no safe smoking option — tobacco is always harmful. Light, low-tar and filtered cigarettes aren't any safer — people usually smoke them more deeply or smoke more of them. The only way to reduce harm is to quit smoking.