Smoking Flashcards
What are the mechanisms for effects of smoking on periodontal disease?
- More bone destruction
2. More connective tissue destruction
How does smoking cause more bone destruction?
- Oral environment becomes more anaerobic which alter oral microflora to a more subgingival one with more Gram -ive bacteria
- Activation of neutrophil TLR-4 by Gram –ve Lipopolysaccharide (LPS) upregulated the expression of membrane RANKL → bone resorption
How does smoking cause more connective tissue destruction?
- Affects immune response –> Affects healing capacity of the periodontium
More PMNs but impaired PMNs (chemotaxis, phagocytosis, oxidative burst)
Produce neutrophil collagenase and elastase in GCF –> destruction of connective tissue
Delayed PMN apoptosis –> destruction of connective tissue
Also: there is a reduced salivary immunoglobulin A
- Nicotine leads to decreased tissue blood flow – can mask the disease symptoms (as less bleeding on probing)
o Oxygen to periodontal tissues decrease → inflammation → enzymes that destroy the periodontium → periodontitis - Higher plaque index (tar is sticky + more calculus) –> Affects microbial composition in the subgingival area – shift to periodontal pathogens
Explain the differences between smoker and non-smoker in terms of periodontal clinical condition
- Greater probing depth, bone and attachment loss, furcation involvement
- Gingival recession
- Increased bone loss
- Increased rate of periodontal destruction
- Increased colonization of shallow periodontal pockets, increased tooth loss
- Impaired wound healing
- Paler tissue color
- Compromised immune system
- Minimal erythema relative to extent of disease
What is the Pack Year of this patient and its significance? (2)
1 pack year = 20 cigarettes/day for 1 yr OR 40 cigarrettes/day for 0.5 year (and so on)
(x cigarettes per day)/20 = y pack year
B3) Give 4 questions you will ask the patient to assess his Nicotine Dependency level? (4)
- Have you ever felt a need to Cut down or control your smoking, but had difficulty doing so?
- Do you ever get Annoyed or angry with people who criticize your smoking or tell you that you ought to quit smoking?
- Have you ever felt Guilty about your smoking or about something you did while smoking?
- Do you ever smoke within half an hour of waking up (Eye-opener)?
Anson: CAGE (Cut, Annoyed, Guilt, Eye-opener)
What are the psychological Withdrawal symptoms of smoking?
Psychological:
• a strong desire or craving for nicotine
• irritability or frustration; low mood; difficulty concentrating
• anxiety
• mood swings
What are the physical withdrawal symptoms of smoking?
- headaches////sweating///restlessness////tremors
- difficulty sleeping; waking at night
- increased appetite;
- abdominal cramps; digestive issues, including constipation
- difficulty concentrating
List 5 benefits of smoking cessation (2.5m)
- Lower risk of lung cancer and other cancers
- Lower risk for heart disease
- Reduce periodontal destruction
- Reduced respiratory symptoms such as coughing, wheezing, shortness of breath
- Reduced risk of infertility (women)
What are some practical advice for craving when your Px wants to quit smoking (2.5m)
- Chew gum
- Do something else/distraction
- Go for a walk or jog
- Take slow, deep breaths
List forms of nicotine replacement therapy (2m)
• Nicotine patches, nicotine gum, nicotine inhalers, and nicotine nasal sprays
List 2 services provided by medical care, nursing care and allied team respectively (3m)
- Department of Health Smoking Cessation Services
- Hospital Authority
- Tung Wah Group of Hospitals
- Pok Oi Hospital
Tobacco will affect which part in the oral cavity the most(2marks)?
Upper Palatal, lower anterior lingual
How do you explain the periodontal conditions to the patient?
Plaque, inflammation, bleeding, swelling
