CSA effects of smoking on periodontium

Question 1

Why do people keep smoking?

Answer 1

nicotine dependence

Question 2

What are smoking related diseases?

Answer 2

• Cancers >Lung, mouth, pharynx, larynx,
• Fatal conditions > Ischemic/respiratory heart disease, (bronchitis), stroke, pneumonia,
• Non-fatal > perio disease, low birth weight babies

Question 3

What does passive smoking increase?

Answer 3

Risk of lung cancer

Question 4

What is tobacco smoking related to ?

Answer 4

o Chronic periodontitis
o Periodontitis that is “stubborn” to treatment
o NUG

Question 5

WHAT is Pan related to

Answer 5

o Localised recession – attachment loss
o Increased oral cancer risk
o Severe active perio disease

Question 6

What do smokers have ?

Answer 6

o Greater bone loss & attachment loss

o Increased number of deeper pockets

Question 7

What is the clinical appearance of smokers?

Answer 7

• 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

Question 8

What does vertical bitewing show ?

Answer 8

shows bone loss

Question 9

What is perio disease clinical characteristics?

Answer 9

• 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

Question 10

smokers more susceptible to NUG?

Answer 10

• 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

Question 11

What are risk factors for NUG>

Answer 11

• Stress
• Immune suppression HIV
• Smoking
• Malnutrition
• Poor oral hygiene
• Pre-existing gingivitis
• Tissue trauma

Question 12

What particles in smoke?

Answer 12

o Nicotine
o Benzene
o Benzo(a)pyrene

Question 13

What do free radicals in smoke react with ?

Answer 13

cholesterol – lead to atheroma on artery walls

Question 14

How does smoking cause disease?

Answer 14

• 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

Question 15

What is smokers blood vessels like?

Answer 15

o higher prop. of smaller blood vessels compared to larger vessels – blood flow not as good

Question 16

What does a reduction in ICAM-1 expression mean?

Answer 16

affect neutrophil emigration from vessels

o smoking causes suppressive effect on vasculature rather than just vasoconstrictive

Question 17

What does decreased vascularity mean?

Answer 17

• Less gingival bleeding
• Less BOP
• Fewer vessels clinically & histologically
• Healing response affected
• In smokers, less BOP

Question 18

What doe smokers have more of ?

Answer 18

subgingival plaque

Question 19

What do smokers respond less well to ?

Answer 19

perio therapy (surgical & non-surgical) 
o Due to local, systemic & microbiological effect

Question 20

What are the use of local antimicrobials ?

Answer 20

• l in assisting scaling & RSD

* Perio chip good example

Question 21

What is smoking cessation ?

Answer 21

• 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,

Question 22

What changes after smoking cessation ?

Answer 22

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)

Question 23

What to suggest for smoking cessation ?

Answer 23

•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