Smoking Cessation Flashcards
Smoking cessation - other affects?
Chronic bronchitis Emphysema COPD Pneumonia Worsen asthma Respiratory tract infections
Smoking cessation - 10 year scenario
- condensate sticks and irritated airways and alveolar tissue
- reduces o2 levels (exercise)
- promotes sedentary lifestyle
- implicated in development if abnormal enlargement of right side if the heart as a result of lung or pulmonary blood disease
Smoking cessation - CVD?
Increases risk:
- coronary heart disease
- MI
- stroke
- peripheral vasc and cerverovasc disease
By:
- release of adrenaline
- oxidasrion if cholesterol in blood stream
- poor endothelial lining repair and function
- risk of thrombosis
- reduction in oxygenation and ability to exercise
Compounded:
- hypertension, hypercholesterolenia and diabetes
Most preventable cause from smoking
Nictonine and CO:
- adversely alter the myocardial oxygen supply to demand ratio and produce endothelial injury, leading to the development of atherosclerotic plaque
Smoking cessation - accelerates aging?
- due to vasoconstriction and free radicals
- leading to reduced oxygen in the skin, which slows down crucial collagen formation
- reduces absorb of Vit C and store of Vit A
- increases collagenases in the CT
- interferes with skins natural defences against free radicals (skin breakdown)
- skin cancers
Smoking and periodontal health? Overview?
- greater alveolar loss
- increases number of deep pockets especially anterior maxillary palatal
- increased rate of disease progression
- increases calculusnformation
- less clinically apparent gingival inflammation
Smoking cessation - dose response?
- years of exposure to tobacco as risk factors for periodontal disease
- 42% of periodontitis
- 1-4 a day increases perio risk at 50%
- more smoking greater degree of periodontal disease experience
1 cig - 1g pipe 3 cigs to 1 small cigar and 5 cigs per 1 cigar
Smoking cessation - calculating pack years?
- number of cigarettes per day / 20 x number of years smoking = pack years
- e.g. 15/20 x 51 = 38.25
- morenthan 15 pack years is considered to be potentially clinically significant
Smoking cessation - hard tissue effects? OH and plaque scores?
- extrinsic/exogenous staining
- thick tar condensate
- causes a PRF
- anaesthetic
- related to intended care
OH: PI - smokers tend to have lower levels of intended care- raised plaque scores (not direct from smoking)
Smoking cessation - pathogenic microflora?
- Higher number of B forsythius and T denticola (96/98) in the subgingival flora (not due to perio disease)
- no recent studies suggest an adverse change to periodontal tissues by altering composition of plaque
- however, possibility to impair host response
Smoking cessation - effect on calculus?
- increased
- increased salivary flow due to irritation
- increased parotid flow with increased pH and Ca conc leading to precipitation of CaPO4
- increases PRFs, promoting the growth of bacteria, and toxic due to absorption of alkaline on the surface directing in contact with tissues
Smoking cessation - necrotizing disease?
- very saw
- sluff on teeth
- RSD painful
- smoking cessation integral part of treatment
Smoking cessation - effect on the host response?
- vasoconstriction of the microcirculaton, reduces the amount of neutrophils, macrophages and lymphocytes
- also with vasoconstriction, less GCF is produced and less saliva also
- inflammatory response is non-existent or delayed and reduced inflammation so less healing
Smoking cessation - microcirculation (BF?)
- nicotine is a vasoconstrictior to reduce BF and reduced BOP
- smoking impaires the vasc of microcirc, less large BVs and more smaller vessels in smokers
- smokers inflammatory repsonse is lesser
- can be seen as less inflammation, redness and BOP
Smoking cessation - effect of nicotine on inflammatory response - neutrophils? Macrophages?
Neutrophils:
- deleterious effect in variety of neutrophils functions leading to less function and reduced number
- reducing in motility and chemotaxis and reduction in oxidative burst
- chemotaxis and obagocytosis of neutrophils adhesion and diaphysis impaired which in turn impairs recruitment of host cells during inflammation
Macrophages:
- reduction in antigen presenting attributes therefore leading to a reduction of both and humoral and cell mediated
Cytokines:
- smoking associated with local production of increased quantities of pro inflamm cytokines and acute phase proteins
- leading to more severe destruction in the periodontal tissues
- plasma response to smokers during LPS stimulation differed from no smokers higher levels of TNFa and IL6
Ig:
- reduced salivary IgA and serum IgG prod
- reduced titres of P. Intermedia and F.nucleatum
Smoking cessation - GCF responses - what is it? Function? Response to nicotine.
GCF carried all components of serum such as Ig and play role in inflammatory stimulation
Function:
- washes the crevice
- influence epithelial attachment by plasma prots
- lysozymes
- carries PMN and macro
- vol related to underlying periodontal pathology (increased with inflamm)
Nicotine:
- rescued BF, due to vasoconstriciton, reduce and and reduced passage of leukocytes
Smoking cessation - healing response - vasc changes? Pocket reduction? Periodontium?
Changes:
- vasc changes, impairments in the revasc healing lesion
- products of inflamm as part of healing and repair reduced transport to site
Pocket reduction:
- due to reduction in inflamm
- improved tissues resistance
- formation of long JE
- small gain in attachment
Smokers:
- impaired host inflammatory response, pre treatment inflammation may be reduced significantly (not contribute to pocket reduction)
- have deeper pockets work areas for possibility of more patho bacteria
Periodontium:
- reduced fibro, neutrophils and cell function reduced due to vasoconstriction
- longer term healing
- fibro impaired - bound by nicotine and collagen fibres production is defective, affects gingival tissue support and adaption is impaired
- decrease in Col I and fibronectin due to collagenase production from nicotine and fibroblasts
- poor tissue formation resulting in plaque retention
Smoking cessation - conventional therapy?
Conventional therapy:
Less favourable in smokers as they respond to a lesser degree, particularly to deeper pockets
- after treatment smokers still show continiued bone loss
Complex treatment:
- guided tissue regen in intra bony defects displayed less gain in attachment
- allograft placement showed similar results
- similar results after implant placement
Smoking cessation - effect of smokeless tobacco - on the periodontium?
Periodontium:
- relation with oral carcinoma (more local)
- increased CVD
- periodontal disease more towards the placement of the product, and play a role in local attachment loss
- nicotine direct effect on local microcirculation
Smoking cessation - periodontal treatment for smokers? Patient expectations?
Ensure good plaque control and regular and high quality supra- and subgingival debridement work adjucntive local anaesthesia as required
- smokers with gingival recession are at increased risk of developing roots (careful monitoring of the diet and caries status together worh fluoride provisions
- avoid surgical intervention and particular hard or soft tissue
Patient expectations:
- fully aware of effects that smoking will have effect on their periodontal health, response to treatment, risk of relapse and tooth loss
Smoking cessation - surgical implications?
- clinicians not to provide periodontal surgery or implants to compromised patients
- risk benefit
- provision of smoking cessation is recorded in treatment notes
Smoking cessation - oral mucosa effects - clinical signs?
Clinical signs:
- fibrotic rolled gingiva
- anterior gingival shrinkage
- results in changes from keratosis to carcinoma
Smoking cessation - carcinogens in cigarette smoke?
- 300 carcinogens dissolve in the saliva
- main: aromatic hydrocarbon Benz-pyrine and the tobacco specific N-nitrosamines; metylnitrosamino-1-3-(3-pyridyl)-1-butanon (NNK), and N-nitrosonornicotone (NNN)
- carcinhoens are generated when tobacco is burnt
- smokeless tobacco act on the oral mucosa and absorbed and causing damage to many body systems
Smoking cessation - nicotine?
- addiction from nicotine
- readily absorbed across the epithelium of oral mucosa, nose, lungs and skin
- t1/2 2 hours
- meta in the liver, excreted renally
- nictonine binds nicotine receptors in brain
- on binding causes release of dopamine which gives rise to dependence, tolerance and withdrawal symptoms
Smoking cessation - replacement products?
- not removing nicotine but the tobacco, to reduce carcinogens
- chewing gums, oral and nasal sprays, lozenges, transdermal patches and inhalers
Smoking cessation - smokers melanosis?
- melanocytic pigmentation of oral mucosa
- brown discolouration of the mucosa and gingiva
- benign and asymptomatic
- direct effect on tobacco
- nicotine stim melanocytes to produce more melanosomes, resulting in increased deposition of melanin pigment
Smoking cessation - black hairy tongue?
- superficial discolouration/staining in the dorsum of the tongue (filiform papilla elongated)
- benign
- disappears with cessation of habit
Smoking cessation - median rhomboid glossitis?
- dorsum of tongue mid section ant 2/3rds
- atripoc lesion thrombosis in shape caused by a candidal infection
- resist to antifungal
- benign
Smoking cessation - malignancy?
- oral cancer
- early diagnosis is significant
- stage and grade
- location
- unnoticed so present later
- 50% of patients die within 5 years if diagnosis due to metastasis
- metastatic tumours rare to reach the oral region
- lesions can occur in soft and osseous tissues
- mandible most common place for metastases
Smoking cessation - oral leukoplakia?
- white speckled patch which is excluded by other causes
- potentially malignant and may present dyspalstic
- biopsy
- malignant transformation 5-20% over 10 heats
- sublingual greatest risk
Smoking cessation - erythematosus?
- red velvet patch
- malignant potential
- biopsy
- present with severe dysplasia/malignant
