2e - RFOP - Smoking

Question 1

primary risk factors of periodontitis?

Answer 1

accumulation of dental plaque

Question 2

common modifiable risk factors of periodontitis

Answer 2

Question 3

smoking stats NEED TO KNOW???
- how many people smoke world wide
- how many people smoke in the uk?
- how does smoking use effect lifespan?

Answer 3

• 1.3 billion people smoke
• 7.6 million in the UK
  (ONS.gov.uk)
• Tobacco kills half its lifetime
  users
• A lifetime user loose on
  average 15 years of life (WHO
  2011)

Question 4

how does smoking affect periodontal disease?

Answer 4

• plaque had a greater effect on bone loss in smokers than in nonsmokers
• Smoking contributes to formation of dysbiotic biofilm – affects bacterial acquisition, colonization, aggregation, and results in higher levels of key pathogen colonization
• increases odds ratio for the patient to have periodontal disease (ranges 2.5-6)
• Patients who smoke are more likely to develop Periodontitis than non-smokers (2.5-6x more likely)

EXTRA
Odds ratio = the odds that an outcome will occur given a particular exposure, compared to the odds of the outcome occurring in the absence of that exposure

Question 5

how does tobacco effect the body? (what are smokers exposed to?)

Answer 5

• at least 4,000 chemicals - directly in the oral cavity
• direct cytotoxins and free radicals, carbon monoxide

*psycho- and vasoactive chemicals

*chemicals influencing cellular activity:
–tissue turnover (biological
homeostasis)
–healing and wound repair
–immunological activity
–inflammatory cell activity

Question 6

how does smoking affect cells in periodontal tissues?

Answer 6

NEUTROPHILS
- reduce numbers in area and capacity to phagocyte and kill extracellular pathogen

VASOCONSTRICTION (nicotine causes)
- results in less bleeding than smokers

IMPAIRED HEALING
- due to effect on inflamm and vascular response, affects healing on healing after NSPT + surgical PT

Question 7

Clinical features seen in smokers

Answer 7

1. Increased keratinisation of the gingiva
2. Less bleeding on probing
3. Less gingival inflammation
4. Increased probing depths
5. Increased loss of attachment
6. Increased bone loss
   - Longitudinal studies 10yr
   smoking, a predictor of
   future bone loss and at risk of
   attachment loss
   - Acute necrotizing ulcerative gingivitis (ANUG) more prevalent in smokers due to less vascularisation in tissues

Question 8

Considerations when treating smoker

Answer 8

• explain to patient why stopping or reducing smoking is important

Question 9

how does quitting smoking impact periodontitis?

Answer 9

• Quitting smoking was associated with a significant reduction in the odds ratio (OR) for periodontitis
• Each year that passes there is a decrease on the likelihood of having periodontitis
• It takes an average of 13 years for a former smoker to have the same odd ratio a non-smoker has

Question 10

SUMMARY

Answer 10