diabetes and smoking Flashcards
why is diabetes a risk factor for periodontal disease?
poorly controlled diabetes causes an increase of glucose molecules within the blood- which reduces circulation of blood to tissues including the periodontium. This causes an impaired host response meaning poorer resistance to infection and therefore increased levels of disease aswell as poor wound healing. Poorly controlled diabetes leads to poorly controlled periodontitis and vice versa.
what should the HBA1C levels be?
48mmol/mol
what are the clinical signs of smoker?
- increased plaque levels
- increased calculus (due to increased salivary flow rate in response to irritants found within cigarettes)
- more staining
- lack of BOP (due to reduced inflammatory response)
- deeper periodontal pockets
- more furcation involvement
- more mobility
- more tooth loss
- more radiographic bone loss
- keratinised tissue in response to irritants found in cigarettes which mask periodontitis symptoms
- refractory response to periodontal therapy
- increased risk of cancer
- increased risk of NG
- xerostomia
how does smoking affect the periodontium?
nicotine is a vasoconstrictor and smokers have a reduced inflammatory response- this means
- reduced vasodilation
- reduced vascularity of tissues ( less larger blood vessels- accounts for lack of BOP)
- reduced GCF- less flushing of bacteria within pocket and less immune cells within GCF to address bacteria
- reduced no. of neutrophils and reduced motility of neutrophils
- reduced fibroblasts and collagen due to increase of collegensases meaning poor wound healing
- more pathogenic bacteria due to reduced inflammatory response
what is pack years?
estimated measure of lifetime exposure to tobacco
how is pack years measured?
no of cigs per day/20 x no of years smoked
for my case 5 cigs/20 x 25 yrs= 6.25 years
what is the relevance of pack years?
high no of pack years means:
- increased risk of PD
- more severe PD
- poorer the response of NSPT
- higher the risk of progression of periodontal disease.
what smoking cessation was used?
patient expressed she would be keen to quit and was therefore contemplative so followed 5 As- ask, advise, assess, assist, arrange.
- using brief interventions- relating to situation less than 5 mins avoid feeling of judgment/lecture
how did you assist your patient to reduce/quit smoking?
- advised of help from local pharmacy or gp
- nrt/nnrt
what are nrt examples?
- nicotine patches
- nicotine lozanges
- nicotine gum
- e-cigarettes
what are examples of nnrt?
- diet and exercise
- therapy
- dummy cigarettes
- champix (prescribed- very good but side effects include mood swings/sleep disturbances)
- hypnosis
if someone was pre-contemplative, what would you follow?
- 5 R, relevance, risks, rewards, roadblocks, repetition.
what are examples of tobacco use?
smoking tobacco use- including cigarettes, cigars, pipes, e-cigarettes
smokeless tobacco use- snuff (powered tobacco inhaled or placed on gums), chewing tobacco, betel quid (placed in gum), moist snuff or snus placed in gums.
why would we not recommend e-cigarettes?
although e-cigarettes can be a very effective form of smoking cessation- they should not be recommended to patients and if already using such as my restorative patient- the patient should be praised for stopping but encouraged to discontinue the use. This is because :
- there are no long term studies on the long term effects of e-cigarettes
- their use can induce xerostomia
- chemicals found within e-cigarettes can cause irritation and potential damage of oral tissues.
- liquids and flavourings used can cause staining.
- studies have shown e- cigarettes can damage fibroblasts, others have shown they cause direct damage to lung cells.
- diacetyl (die-uh-see-til) commonly added to enhance the flavour of e-cigarettes- but studies have shown to be damaging to the bronchioles known as popcorn lung which makes breathing more difficult- though many studies dispute this.
- short term studies are difficult as they often find increased BOP in e-cigarette users-however most of the individuals in the studies had quit smoking and this increased BOP may have resulted as the masking effects of smoking had stopped therefore results may be due to tobacco effects and not the effects of e-cigs- harder to interpret findings.
Evidence so far shows e-cig use is far less harmful than tobacco use- but they are not risk free and we will likely see long term oral health problems from the use of e-cig though these well likely be less detrimental than the effects of tobaccos smoking.
