Smoking and Periodontal Disease Flashcards
What does the current etiopathogenesis model of periodontitis look like in clinical health?
In clinical health:
Health promoting biofilm is formed with a proportionate host response and acute resolution of inflammation in the gingiva.
How common is smoking?
30% of the population smoke on average
Men 35% and women 24%
Who typically smokes?
Most smokers are between 20 - 24 years of age
Low socio-economic status
What are the toxic substances found in tobacco smoke?
Nicotine (Raises BP, increases HR and Resp Rate, reduces skin T)
Tar
Carbon monoxide
Oxidative gases
What does smoking do to bacteria levels in people with periodontitis?
More bacteria associated with periodontitis are seen in smokers than in non-smokers. Particularly in the maxillary teeth and incisor regions.
What are the effects of smoking on the gingiva?
Temperature and gases are affected
Vasoconstriction
Microvasculature
Fibroblast function
Neutrophils
Cytokines
IgG reduced
Adhesion molecules
How does smoking increase periodontal disease on the local level?
Causes peripheral vasoconstriction causing local ischaemia and increased pathogenic organisms (P. gingivalis, and t. forsythia) which lead to periodontal disease
How does smoking increase periodontal disease on the systemic level?
Decreased immunity.
Specific immunity: IgG and IgA.
Nonspecific immunity: Decreased PMNs chemotaxis and phagocytisus
Decreased immunity leads to increased oxidant stress and activation of NF-κB
This leads to activation of inflammatory cascade TNF-alpha, IL-1beta, and IL-6
This leads to periodontal disease
What periodontal conditions are associated most commonly with smoking?
ANUG
Considered main risk factor for periodontitis (2.8x more likely to develop severe perio)
Clear dose-response effect
Level of risk relates to the number of pack years (Packs smoked daily multiplied by the number of years smoked)
What kind of effect does smoking have on periodontitis?
A dose-response relationship: Stopping smoking reduces the risk of periodontitis but this should be for more than 10 years.
The more you smoke the worse the periodontitis.
What is the relationship between smoking and periodontal health?
Smokers have:
Increased amounts of plaque and calculus
Less bleeding on probing and gingivitis
Deeper probing depths and icnreased number of sites with deeper probing depths
More attachment loss and recession
More alveolar bone loss
More tooth loss
More furcation involved teeth
What are the features of the smokers periodontium that can be examined clinically?
Fibrotic ‘tight’ gingiva with rolled margins
Less gingival redness and bleeding despite increased calculus and plaque
More severe, widespread disease than same age non-smoking control
Anterior, maxilla, palate are worst areas affected
Anterior recession, open embrasures
Nicotine staining
Calculus
What are the features of progression of periodontitis in smokers?
Relatively earlier onset of periodontitis
Rapid disease progression
Greater severity and extent of disease (pockets, clinical attachment loss, bone loss)
More tooth loss
How do smokers respond to surgical and non-surgical therapy?
Poorer response to non-surgical therapy
Recurrence within 1 year of surgery
Increased % are refractory to treatment
Why is there less BOP and gingivitis in smokers? How does this make the composition of the gingiva different in smokers vs non-smokers?
Due to the vasoconstriction and reduced number of blood vessels in the gingiva of smokers.
Gingiva is more fibrotic with less oedema
How does smoking affect alveolar bone loss?
The mean attachment loss is larger in a dose-dependent fashion with increased loss with more pack-years
How does type of smoking affect periodontal health?
Cigar smokers and cigarette smokers have more sites of alveolar bone loss >40% compared to pipe smokers.
Does smoking affect treatment outcomes?
Yep leads to decreased clinical response to scaling and root planing.
Decreased reduction in pocket depth
Decreased gain in clinical attachment levels
Decreased negative impact of smoking with increased level of plaque control
How does smoking affect implant therapy?
Strong evidence links smoking as a risk factor to adverse implant outcomes.
Increased risk of peri-implantitis.
Radiographic marginal bone loss. (more than non-smokers)
Is smoking a contraindication for implant therapy?
No, however, patients must be notified and informed.
Does smoking cessation help?
2 days: Sense of taste and smell improve
1 month: Skin is clearer and more hydrated
3 months: Improved breathing, no cough or wheeze. Improved lung function, risk of mouth and throat cancer reduced.
6 months: Most smoking-related oral white patches will have disappeared
1 year: Gingival circulation improved
10 years: Risk of heart attack reduced to half that of a smoker
15 years: Risk of lung cancer reduced by half and risk of heart attack same as never smoker.
What are the 5 steps to be followed as a dental professional to assist patients with quitting smoking?
Ask about tobacco use at every visit
Advise all smokers to quit
Assess readiness to quit
Assist with a quit plan
Arrange follow up visits
What are the 3 steps to stop smoking?
Preparing to stop: Set quit date, list and re-read benefits of stopping
Stopping: Aim to get through the first day without smoking
Staying stopped: Be aware that most people need several attempts to stop. Should not give up trying to quit.
Some arguments to tell patients that smoke:
Quitting smoking means no longer causing harm to others through passive smoking especially babies/children.
Children of non-smokers are much less likely to be smokers than children of smokers (3x less)
Lots of money can be saved from not buying cigarettes
Unborn baby can be harmed severely by smoking
What are the 5 forms of nicotine replacement therapy?
Patches
Gum
Lozenge
Inhaler
Sub-lingual tablet
What medications can be used for quitting nicotinein combination with NRT?
Bupropion is a non-nicotine medication that canbe combined with NRT to help with quitting
Vereniclin (champix)
What are some other methods to quit smoking?
Telephone helplines
Hypnosis
Acupuncture
Allen Carr’s book
