Smoking and stress Flashcards
What are smoking related diseases?
Cancer: lung mouth pharynx bladder oesophagus Ischaemic heart disease Obstructive lung disease Stroke Aortic aneurysm Periodontal disease
Why is it related to periodontitis?
Less easy to treat - refractory
Necrotising periodontal diseases
In studies, what did smokers have?
Higher levels of perio disease
Poorer oral hygiene - linked to higher disease levels smoking indirectly affects periodontium
In cross sectional and longitudinal studies what was shown?
Smoking is a risk factor for periodontal disease
Smokers have:
Greater bone and attachment loss
Increased number of deep(er) pockets than non smokers with similar plaque levels
Does the number of cigarettes you have a day influence odds of having periodontal disease?
Yes, increases with more a day
What is the speed of onset in smokers?
Earlier onset, rapid disease progression, smoking has detrimental effect on incidence and progression
What is the clinical appearance in smokers?
Fibrotic tight gingiva Rolled margins Less gingival redness and bleeding More severe widespread disease than same age control Anterior, maxilla, palate worst affected Anterior recession Open embrasures Staining
What is necrotising gingivitis?
Rapid onset Painful interdental necrosis Bleeding gingivae Necrotic ulcers, grey slough coverage Punched out appearance Gingival bleeding, little provocation Halitosis Lymph node involvement Most people with NPD are smokers
what are the toxic substances in cigarettes?
Nicotine, benzene
gases - HCN, CO, NH4, formaldehyde, dimethylnitrosamine
Free radicals (react with cholesterol forming atherosclerosis)
What is the pathogenesis of smoking and periodontal disease?
Inhibition of phagocytosis of neutrophils (PMN’s)
Reduction of oral PMN’s, chemotaxis and migration exposed to nicotine
Nicotine affects PMN’s respiratory burst
Nicotine affects fibroblast function and penetrates oral epithelium
Reduced antibody production, IgG2
Altered peripheral blood immunoregulatory T cell subset ratio in some studies
Reduced bone mineralisation
Cytotoxic constituents
Adverse effects on micro-circulation, gingival circulation
Chronic hypoxia - low levels of oxygen - affects healing
High proportion of small blood vessels, fewer gingival vessels in smokers
Why doesn’t the normal increase in vascularity occur with smoking?
Reduction in ICAM-1 expression affecting neutrophil emigration from vessels
Suppressive effect on vasculature rather than vasoconstriction
What is the microbial differences in smokers and non smokers?
No biological differences in some studies
Others found smokers harbour more potential periodontal pathogens
Difference in prevalence and abundance of disease and health compatible organisms
How long does it take to recover the inflammatory response?
6 months
What can you advise your patient?
VBA - ask, advise, act
Buproprion (zyban)
Nicotine replacement therapy
What is seen in quitters?
More pocket depth reduction
