Cigarette smoking is one of the most preventable sources of morbidity and premature death worldwide. In the United States, smoking is responsible for approximately one in five deaths. Smoking prevalence has been on the decline in recent years. In 1963, the per capita consumption was 4,354 cigarettes compared to an estimated 1,979 in 2002, a lower level not seen since the 1940s. However, with the steady decline, smoking still costs the economy more than $150 billion in annual health-care costs and lost productivity, including $75.5 billion in excess medical expenditures. These expenditures include dental costs, since smoking increases the disease progression and complicates the treatment of periodontal diseases.