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Periodontal findings are mixed: increased gingival recession - particularly at anterior sites corresponding to product placement - appears consistently, whereas links with deeper periodontal destruction are inconsistent and often confounded by oral hygiene and concomitant cigarette smoking

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From the Quality and Outcomes Framework, in 2014/15, it was estimated that over half (52%) of people with a serious mental illness registered with Hull GPs smoked which was statistically significantly higher than England (41%)