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Oral Biology > Smoking > Flashcards

Smoking Flashcards

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1
Q

How do you calculate pack years?

A

No. of cigarettes per day / 20 * number of years smoking = NUMBER OF PACK YEARS

E.g. 65yr old smokes 15 cigarettes per day and they started smoking at 14 (51yrs smoking)

15 / 20 * 51 = 38.25 (round up to 40)

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2
Q

What does more than 15 pack years signify?

A
  • Considered to be potentially clinically significant
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3
Q

What is deemed heavy cigarette usage?

A
  • 10 cigarettes
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4
Q

How can you measure tobacco smoke exposure in the body?

A

Continine (metabolite of nicotine)

  • Can be measured in the serum/plasma and saliva and is a better measure of tobacco smoke exposure as it has a longer half-life than nicotine
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5
Q

What cancers are associated with smoking?

A

Lung cancer: Causes 90% cases

Also causes:

  • Mouth
  • Lip
  • Larynx
  • Liver
  • Kidney
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6
Q

What’s the relationship between smoking and CVD?

A

Increases the risk of developing:

  • Coronary heart disease
  • Stroke
  • Myocardial infraction

How does smoking increase the risk of developing these conditions?

  • Can oxidise LDL in the blood stream - cytotoxic and builds up = cell death and build up of atherosclerosis plaque
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7
Q

What effect does smoking have on the skin?

A

Accelerates ageing
- causes vasoconstriction and free radical formation

  • This reduces the amount of oxygen getting to the peripheries which slows down collagen formation
  • Reduces Vit.C absorption & Vit.A storage
  • Increases collagenases in the CT
  • SKIN BREAKS DOWN
  • Also breaks down periodontal ligament
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8
Q

What are the general effects of smoking on Periodontal health?

A
  • Greater alveolar bone loss
  • Increased number of deep pockets especially anterior maxillary - palatal
  • Increased rate of disease progression
  • Increased calculus formation
  • Less clinically apparent gingival inflammation (less gingival bleeding)
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9
Q

When probing pocket depths of smokers, how can they throw you off?

A
  • Due to vasoconstriction, we wouldn’t expect blooding to occur on probing - can throw us off when grading
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10
Q

What are the effects on hard tissue?

A
  • Unaesthetic
  • Thick tar condensate (staining and physical deposit)
  • Exogenous staining
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11
Q

What’s the effect of smoking on calculus?

A
  • Increases calculus
  • Stimulates salivary flow (chemical irritation) from the Parotid gland with increased concentrations of calcium = precipitation of calcium phosphate
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12
Q

What are the long term smoking affects on saliva?

A
  • Long term dry mouth
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13
Q

Is there a link between smoking and necrotising disease?

A

YES

  • Association between smoking and Necrotising gingivitis
  • Have to debride areas affected
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14
Q

What’s the effect of smoking on the host response within the periodontium?

A
  • There’s an influx of Neutrophils into the area and secretion of Lysozymes = increased destruction of periodontal tissue
  • No secondary host response to help clear infection - work synergistically to F.U. up
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15
Q

What’s Nicotines effect on blood flow?

A
  • Potent vasoconstictor - reduces blood flow and reduces bleeding on probing
  • Impairs the vasculature
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16
Q

What effect does smoking have on Neutrophils?

A
  • Reduces the number of fully functional neutrophils
  • Reduction in motility/chemotaxis/in oxidative burst
  • Impairs recruitment of host cells during inflammation
17
Q

What effect does nicotine have on the inflammatory response?

A

Cytokines:
- Smoking is associated with local production of increased quantities of pro-inflammatory cytokines

  • Causes more severe destruction in the Periodontal tissues

Immunoglobulin production:
- Reduction in IgA + IgG

18
Q

What’s the healing response in those who have stopped smoking?

A

Vascular changes:
- Nicotine is no longer have a vasoconstrictive effect on the blood vessels - increase in larger vessels etc and an increase in flow through the vessels

  • Capillary beds open up and causes bleeding which wasn’t present before
  • Poor long term healing of the tissue
  • Fibroblast function is impaired - bind and internalise nicotine = produces defective collagen fibres which impairs gingival tissue support and adaption
19
Q

What are the therapy outcomes in smokers?

A

Conventional therapy:
- Less favourable, smokers respond to it to a lesser degree

NEED TO TELL PATIENTS THAT THERE IS A HIGH RISK OF FAILURE DUE TO THEM SMOKING

20
Q

How should you treat smokers?

A
  • Good daily plaque control and regular+high quality sub+supragingival debridement
  • Monitor diet and caries status of the roots
  • Tend to avoid surgical intervention (implants etc) due to poor healing
21
Q

What happens to the oral mucosa when people smoke?

A
  • Lose stippling
  • No knife edges around the teeth
  • Gingival shrinkage
  • Hyperkeratinised salivary glands
22
Q

Oral conditions associated with smoking: What’s Oral Leukoplakia?

A
  • White speckled patch which is excluded by any other cause
  • Potentially malignant

TESTING:
- Take a mirror and wipe it over the patch - see if it comes off (softly)

  • Take a biopsy
  • SUBLINGUAL SITES ARE AT GREATER RISK
23
Q

Oral conditions associated with smoking: What are Erythematous areas?

A
  • Red velvet patches with asymmetry (look out for this)
  • Potentially malignant
  • Biopsy is needed
  • Need to ask how long they have been aware of it - most cases seem to have progressed to severe dysplasia/malignant
24
Q

E-Cigarettes and Immune cells: What’s the effect?

A
  • Vapours impair the activity of alveolar macrophages (key to immune response in airways)
  • They remove dust/bacteria/allergens that have evaded other mechanical defenses of the respiratory tract
25
Q

Treatment: What’s NRT?

A
  • Evidence based therapy
  • Allows smokers to quit in 2 phases:
    + Behavioural
    + Drug phase
  • Nicotine from NRT is delivered at a lower rate and at lower levels
  • No carcinogens

Oral Biology (33 decks)

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