Systemic risk factors Flashcards
when is world no tobacco day
31st may
how many hospital admissions are attributable to smoking?
489000
what trends are found related to smoking
- increase in vapers
- more men smoke than women
higher levels of smokers in younger groups of patients - e cigarettes are used to help quit smoking
no long term effects
what ingredient makes a smoker addicted
nicotine
develop dependance
Somers smoke for the nicotine but die from the tar
list smoking related diseases
cancer; lung, mouth,p[jarynx, lung, bladder,pancreas,kidney,oesophagus,stoamch,kidney,leaukemia
Potentially fatal; ischaemic/respiratory heart disease, obstructive lung disease eg bronchitis, stroke, penuomina, aortic aneurysm, foetal/neonate death
Non fatal; periodontal disease, low brith weight baby
what is tobacco smoking and smokeless tobacco related to?
Tobacco smoking
- periodontitis
-periotntiist that is refractory to treatment
- Necrostiign periodontal disease
Smokeless tobacco
- localised recession manifesting as attachment loss and also increased oral cancer risk
-severe active periodontal disease
what effects does tobacco have on periodntium
- higher levels of pd
- poorer oral hygiene
- hypothesised that poorer OH may be responsible for higher disease levels ie smoking indirectly affected periodontium
- greater bone loss and attachment loss
- increased. number of deeper pockets
what is the clinical appearance of smokers pd
- fibrotic ‘tight’ ginger, rolled margins
- less gingival redness and bleeding
- more severe, widespread disease than same age non smoking control
- anterior,maxialla,palate worst affected
- anterior recession,open embrasures
-nicotine staining calculus
what does the 10 year study show about smoking and periodontal risk
-dentally aware musicians
- significantly greater frequency diseased sites and reduced bone height
- dose réponse
Describe symptoms of necrotising gingivitis
- rapid onset, specific features
-painful interdental necrosis, bleeding gingival
-nectroic ulcers affecting interdental papillae
-‘punched out’ appearance - ulcers painful, covered by grey slough
- gingival bleeding with little provocation
- possible halitosis,’foetor iris’
-possible lymph nodes involvement
list the toxic substances found in smoking
particles - nicotine,benzene,benzopyrene
gases- hydrogen cyanide, carbon monoxide,ammonia, formaldehyde, dimethylnitrosamine,arcolein
Free radicals
Continue - metabolite of nicotine which measures exposures to tobacco smoke
describe pathogenesis of smoking
local and systemic effects not fully understood
-inhibition of phagocytosis of neutrophils
-reduction in chemotaxis and migration or rural PMNs exposed to nicotine
- nicotine affects PMNs respiratory burst
- nicotine adversely affects fibroblast function and penetrates oral epithelium - reduced antibody production serum IgG2
- altered peripheral blood immune regulatory T cell subset ratios in some studies
- reduced bone mineralisation
- cytotoxic vasoactive constituents
- adverse effect on micro circulation, gingival circulation,blood flow
- possible vasoconstriction of gingival capillaries but evidence inconsistent
- Chronic hypoxia of periodontal tissues
- high proportion of small blood vessels in smokers compared with large vessels but no difference in vascular density
- fewer gingival vessels in smokers
reduction in ICAM-1 expression may affect neutrophil emigration from vessels
- less gingival redness- less bleeding on probing
- fewer vessels clinically and histologically
- healing response may be affected by impairment of revascularisation
describe smokers response to therapy
- smokers have poorer response to non surgical therapy
-presumably relates to the cola, systemic and microbiological effects of smoking - over 90% of refractory patients have been found to be smokers
- 6 month study shows inflammation decrease and GCF, Igg decreases to A.a and poorer peridotnla outcome in smokers
what are the clinical implications of smoking
- advise your patients of adverse effects of smoking on their oral and periodontal health
- record giving advice In patients notes
- explain poorer response to periodontal therapy
- give smoking cessation counselling
what is smoking cessation?
- brief advice from a heath professional can result in up to 5% of patients quitting smoking
- after smoking cessation, time dependent changed in periodontal tissues
- recovery of inflammatory response leads to transient increased bleeding (approx 6 months)
return to normal architecture of gingival tissues (approx 12 months)
what should be mention in smoking cessation
- nhs stop smoking service
VBA
ask, advice,act
smokers up to 4X more likely to quit with support
describe what E cigarettes are?
do not contain tobacco
do not produce tar or carbon monoxide
heat solution that typically contains nicotine, propylene glycol and/or vegetable glycerine and flavourings
what is physiological stress?
- psychological stress can be defined as the phsyciologicla or psychological changes that occur in the body when an external demand or stressor taxes an individuals adaptive capacity
-Psychologicla stress refers to the emotional and phsyciologicla reactions experienced when a person confronts a life event, such as marital conflict, financial debt or death of loved one, that exceeds his or her ability to cope effectively with the situation
describe types of psychological stresses
- disasters or crises e.g major floods,earthquake or wars
- major life events; marital separation imprisonment,death of a close family member
- micro-stressors eg. daily hassles can have same negative impact as any major stressful event - different for each individual
-also categorised as -a cute stressor- shrift term and time limited events/chronic stressors; conditions that a re long lasting
how is stress induced
stress induced response transmitted to the hypothalamus- pituitary adrenal-axis
- Corticotrophin-releasing hormone from hypothalamus
- Adrenocorticotropic hormone form pituitary
- Glucocorticoids form adrenal cortex which. decreases production of proinflamamtory cytokines
