EFFECTS OF SMOKING ON PERIO HEALTH

Question 1

a. Explain the differences between smoker and non-smoker in terms of periodontal clinical condition

Answer 1

 Less MGI, greater loss of attachment, reduces bleeding, more calculus, staining

Question 2

b. Tobacco will affect which part in the oral cavity the most (2marks)?

Answer 2

 Upper Palatal lower anterior lingual

Question 3

2. Smoking and its effect on periodontal health

Answer 3

 Smoking will make the host more susceptible to severe periodontal disease as there will be a decrease in PMNs function, a decrease in fibroblast activity in producing collagen fibres, a decrease in blood supply to the periodontium and an increase in calculus deposition. Also, chemicals in cigarettes enhance the action of matrix metalloproteinase. As a result, smokers will have a decreased chance of recovery.

Question 4

3. C/O discomfort. Crown done many years ago by pt’s husband, a dental technician. A smoker. Given: PAN, // PA (Summative, 2005)
   a. What are the effects of smoking on the periodontal condition? Describe the mechanisms leading to the above effects.

Answer 4

• Nicotine
  
  • Locally inhibit tissue perfusion and cell proliferation and metabolism
  • Systemically cause immunosuppression, impair soft tissue and bone metabolism
• Host defence inhibition
  
  • Decrease salivary IgA, IgG
  • Decrease ratio of CD4+/CD8+
  • Impair PMN function (chemotaxis, phagocytosis)
• Destruction of ECM and bone
  
  • Upregulate pro inflammatory cytokines and inflammatory mediators (IL 1, TNF a, PGE2)
  • Increase matrix metalloproteinase activity
• Compromise wound healing
  
  • Decrease revascularization
  • Negative bone metabolism
• Thus advance periodontal disease progression and poor treatment response

Question 5

A middle aged gentleman complaining pain arose from 36, difficulty with chewing for 10 days, bleeding on brushing recently, an irregular dental attender, had some restorations before, smokes 1 pack of cigarettes per day

Panoramic radiograph: 36 crown fractured, with apical radiolucency, multiple missing teeth and tooth wear, generalized horizontal bone loss

a. What are the detrimental effects of smoking on periodontal condition? (4)

Answer 5

• Nicotine
  
  • Locally inhibit tissue perfusion and cell proliferation and metabolism
  • Systemically cause immunosuppression, impair soft tissue and bone metabolism
• Host defence inhibition
  
  • Decrease salivary IgA, IgG
  • Decrease ratio of CD4+/CD8+
  • Impair PMN function (chemotaxis, phagocytosis)
• Destruction of ECM and bone
  
  • Upregulate pro inflammatory cytokines and inflammatory mediators (IL 1, TNF a, PGE2)
  • Increase matrix metalloproteinase activity
• Compromise wound healing
  
  • Decrease revascularization
  • Negative bone metabolism
• Thus advance periodontal disease progression and poor treatment response

Question 6

5. OR and Perio (Formative, 2009)

5 findings from the pan. (5)

How does smoking affect periodontal health? (5)

Answer 6

 Nicotine triggers sympathetic discharge (produce catecholamines) and stimulates peripheral vasoconstriction directly (reduce oxygen and nutrient supply, maybe less gingival bleeding but attribute to heavier keratinization)

 Nicotine impairs fibroblast activity by inhibiting attachment and growth of PDL fibroblasts affecting wound healing (collagen synthesis)

 Tar exerts direct irritating effect on gingiva

 Increased salivary flow rates (maybe from nicotine) makes calculus formation more abundant

 Host defense: PMN morbility depressed; immune response impaired, smokers have higher PMN counts but chemotaxis of PMN suppressed ; reduce ratio of CD4+/ CD8+

 Destruction of ECM and inflammatory mediators and increase MMP