Smoking Flashcards
How do you calculate pack years?
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)
What does more than 15 pack years signify?
- Considered to be potentially clinically significant
What is deemed heavy cigarette usage?
- 10 cigarettes
How can you measure tobacco smoke exposure in the body?
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
What cancers are associated with smoking?
Lung cancer: Causes 90% cases
Also causes:
- Mouth
- Lip
- Larynx
- Liver
- Kidney
What’s the relationship between smoking and CVD?
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
What effect does smoking have on the skin?
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
What are the general effects of smoking on Periodontal health?
- 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)
When probing pocket depths of smokers, how can they throw you off?
- Due to vasoconstriction, we wouldn’t expect blooding to occur on probing - can throw us off when grading
What are the effects on hard tissue?
- Unaesthetic
- Thick tar condensate (staining and physical deposit)
- Exogenous staining
What’s the effect of smoking on calculus?
- Increases calculus
- Stimulates salivary flow (chemical irritation) from the Parotid gland with increased concentrations of calcium = precipitation of calcium phosphate
What are the long term smoking affects on saliva?
- Long term dry mouth
Is there a link between smoking and necrotising disease?
YES
- Association between smoking and Necrotising gingivitis
- Have to debride areas affected
What’s the effect of smoking on the host response within the periodontium?
- 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
What’s Nicotines effect on blood flow?
- Potent vasoconstictor - reduces blood flow and reduces bleeding on probing
- Impairs the vasculature
What effect does smoking have on Neutrophils?
- Reduces the number of fully functional neutrophils
- Reduction in motility/chemotaxis/in oxidative burst
- Impairs recruitment of host cells during inflammation
What effect does nicotine have on the inflammatory response?
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
What’s the healing response in those who have stopped smoking?
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
What are the therapy outcomes in smokers?
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
How should you treat smokers?
- 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
What happens to the oral mucosa when people smoke?
- Lose stippling
- No knife edges around the teeth
- Gingival shrinkage
- Hyperkeratinised salivary glands
Oral conditions associated with smoking: What’s Oral Leukoplakia?
- 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
Oral conditions associated with smoking: What are Erythematous areas?
- 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
E-Cigarettes and Immune cells: What’s the effect?
- 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
Treatment: What’s NRT?
- 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
