CSA effects of smoking on periodontium Flashcards
Why do people keep smoking?
nicotine dependence
What are smoking related diseases?
- Cancers >Lung, mouth, pharynx, larynx,
- Fatal conditions > Ischemic/respiratory heart disease, (bronchitis), stroke, pneumonia,
- Non-fatal > perio disease, low birth weight babies
What does passive smoking increase?
Risk of lung cancer
What is tobacco smoking related to ?
o Chronic periodontitis
o Periodontitis that is “stubborn” to treatment
o NUG
WHAT is Pan related to
o Localised recession – attachment loss
o Increased oral cancer risk
o Severe active perio disease
What do smokers have ?
o Greater bone loss & attachment loss
o Increased number of deeper pockets
What is the clinical appearance of smokers?
- Fibrotic “tight” gingiva with rolled margins
- Less gingival redness & bleeding
- anterior, maxilla & palate worse affected
- Recession seen at front of mouth
- Open embrasures between anterior teeth – black triangle formation
- Nicotine staining & calculus
- Drifting due to chronic periodontists
What does vertical bitewing show ?
shows bone loss
What is perio disease clinical characteristics?
- earlier onset & show rapid progression
- poorer response to non-surgical therapy
- Recurrence of disease within year of surgery –avoid surgery in smokers
- incr. prop. of patients don’t respond as well to treatment
smokers more susceptible to NUG?
- Painful mouth, interdental necrosis & bleeding gingiva
- Necrotic ulcers affect interdental papilla
- Papilla show punched out appearance
- Ulcers painful & covered by grey slough
- Gingival bleeding spontaneously
- Possible halitosis/ lymph nodes involvement
What are risk factors for NUG>
- Stress
- Immune suppression HIV
- Smoking
- Malnutrition
- Poor oral hygiene
- Pre-existing gingivitis
- Tissue trauma
What particles in smoke?
o Nicotine
o Benzene
o Benzo(a)pyrene
What do free radicals in smoke react with ?
cholesterol – lead to atheroma on artery walls
How does smoking cause disease?
- local & systemic effects –
- Inhibition of phagocytosis of neutrophils
- Reduction chemotaxis & migration of PMNs due to nicotine
- Nicotine affects neutrophils respiratory burst
- Nicotine affects fibroblast function & penetrates oral epithelium
- reduced antibody production
- Alerts T cell ratio
- Reduces bone mineralisation
- Affects micro circulation & blood flow
- vasoconstriction of gingival capillaries
- chronic hypoxia (deficiency in oxygen) in tissues
- Fewer gingival vessels in smokers
What is smokers blood vessels like?
o higher prop. of smaller blood vessels compared to larger vessels – blood flow not as good
What does a reduction in ICAM-1 expression mean?
affect neutrophil emigration from vessels
o smoking causes suppressive effect on vasculature rather than just vasoconstrictive
What does decreased vascularity mean?
- Less gingival bleeding
- Less BOP
- Fewer vessels clinically & histologically
- Healing response affected
- In smokers, less BOP
What doe smokers have more of ?
subgingival plaque
What do smokers respond less well to ?
perio therapy (surgical & non-surgical) o Due to local, systemic & microbiological effect
What are the use of local antimicrobials ?
- l in assisting scaling & RSD
* Perio chip good example
What is smoking cessation ?
- Record giving advice on patient’s notes – good for medico – legal reasons
- Explain poorer response to periodontal therapy
- Give smoking cessation counselling
- After smoking cessation,
What changes after smoking cessation ?
o Recovery of inflammation leads to momentary increased bleeding (for 6 months) – tell patient not to worry about that
o May return to normal mouth architecture (Approx. 12 months)
What to suggest for smoking cessation ?
•Suggest o NHS smoking helpline o Nicotine replacement therapy / E – cigs o Medication – Zyban & Champix Use the 5 A’s/ 3 A’s o Ask, Advise, Assess, Assist, Arrange
