systemic risk factors part 1 Flashcards
to develop understanding of tobacco smoking and stress as a risk factor for perio disease
can individual risk factors be altered
some can potentially be altered and some cannot
when is world NO tobacco day
31st May
who is world no tobacco day sponsored by
WHO
what does world no tobacco day highlight
highlights the health risks of tobacco use and promotes effective actions to reduce tobacco consumption
how many people die due to tobacco
more than 7 mil each year
and half of its users
how many people die from direct tobacco
6 million
how many deaths are due to non smokers being exposed to tobacco
890000
how much % of people who smoke live in low income countries
80% of the 1.1 billion people who smoke
in the uk how many men smoke
17% OR 4 million
how many women in the Uk SMOKE
13.3% or 3 million
how many people vape in great Britain
2.8 million
why do smokers keep smoking
because of nicotine dependance
does nicotine kill
no but the other harmful substances do eg tar
what are smoking related diseases
cancer:
ischaemic/resp heart diseases, obstructive lung disease,stroke, pneumonia, aortic aneurysm,
non fatal: low birth weight babies and perio disease
what is tobacco smoking related to
periodontitis
necrotising periodontal disease
periodontitis that is refractory to treatment
what diseases is smokeless tobacco related to
increased cancer risk
increases CAL
what did earlier studies show
high levels of poor OHI
higher levels of perio disease therefore the smoking indirectly affects the periodontium and poor OHI directly affects the periodontium
what does current data now support
that smoking directly affects the periodontium
what do smokers have in regards to epidemiology
greater bone loss and attachment loss
greater pocket depths
than NON SMOKERS WITH SIMILAR PLAQUE
IN CURRENT SMOKERS WHAT % IS IT ESTIMATED THAT the periodontitis is an attribute due to smoking
74.8%
what does smoking have a detrimental affect on
the incidence and the progression of the periodontitis
what are the clinical appearance of smoker tissues
fibrotic tissues with rolled margins less gingival redness and bleeding more severe widespread disease than same non aged smoker anterior maxilla palette worst affected anterior recession open embrasures nicotine staining and calculus
what are the clinical symptoms of necrotising gingivitis NG
rapid onset specific features, painful, interdental necrosis, bleeding gingiva punched out interdental papilla ulcers painful possible halitosis possible lymph node involvement
how many toxic substances are found in cigarette smoke
more than 4000
what particles are found in cigarette smoke
nicotine benzene benzo(a)pyrene
what gases are found in cigarette smoke
hydrogen cyanide, carbon monoxide ammonia formaldehyde dimethylnitrosamine acrolein
what do free radicals in cigarette smoke react with
react with chlesterol on the walls of arteries leading to atheroma
what is cotinine
a metabolite of nicotine
what does cotinine do
measures the exposure to tobacco smoke
what are the effects of smoking
reduction in the migration and chemotaxis of PMN exposed to nicotine
inhibition of the phagocytosis of neutrophils( PMNS)
nicotine effects PMS respiratory burst
what does nicotine also effect
fibroblast function reduces serum antibody IgG reduced bone mineralisation cytotoxic, vasoactive constituents altered T cell numbers
pathogenesis 3
chronic hypoxia of perio tissues
possible vasoconstriction of gingival capillaries
adverse effect on microcirculation
What do smokers suffer from overall
Less gingival bleeding
Less bleeding on probing
Fewer vessels clinically and histologically
Healing response altered
What are the clinical characteristics in regards to perio disease
Rapid onset and poorer response to surgical and non surgical therapy
How many refractory patients have been found to be smokers
90%
What do smokers and non smokers have a difference in regarding blood vessels
Higher proportion of smaller blood vessels compared to larger ones but no difference in vascular density
Out of 14 studies how many show no difference in microbiological differences between smokers and non smokers
6
In how many studies is there a potential for smokers to habour more perio pathogens
8
What was shown in a 6 month study in smokers
Less inflammation Less GCF less IgG to actinomycetes A Poorer perio outcome Also NO microbial differences
What are clinical implications of smoking
Smoking cessation advice in regards to general health and oral health- CVD and cancer
What do we need to record in patients notes
Smoking cessation advice for Medico legal reasons
Also need to explain poorer response to treatment if they continue smoking
How many patients quit smoking when giving advice from health professionals
5% of patients quitting
How long does it take for a smoker tissue to return to normal architecture
Approx 12 months
How long does it take after smoking cessation for the recovery of inflammation- leading to increased bleeding
6 months
What do we suggest for smoking cessation
NHS stop smoking services
Nicotine replacement therapy(NRT)
What can be used for NRT
Bupropion(Zyban)
Varenicline(champix)
What are the three As
Ask - establish and record smoking status
Advise - personal benefits of quitting
Act - offer help
How much more are smokers more likely to quit with help
4 times
What do e cigarettes not contain
Do not contain tobacco but still have nicotine
What does e cigarettes have
Nicotine propylene glycol and vegetable glycerine
What does stress affect
Host immune response
More susceptible to perio disease
What is psychological stress
Can be defined as the physiological and psychological changes that occur in the body when an external demand or stressor taxes an individuals adaptive capacity
Types of psychological stress
Disasters or crisis
Major life events
Micro stressors
Acute stressor/chronic stressor
What is an acute stressor
Short term and time limited events
What is your chronic stressor
Conditions that are long lasting
What is stress induced response transmitted to
The hypothalamus pituitary adrenal a is HPA
What hormone is released from the hypothalamus
Corticotrophin releasing hormone CRH
What hormone is released from the pituitary gland to the adrenal gland
ACTH- adrenocorticotrophic hormone
What does the adrenal gland release
Cortisol
Glucocorticoids
Catecholamines( norepinephrine and epinephrine)
What do glucocorticoids do
Decrease production of pro inflammatory cytokines
What is the pathway of stress
Activation of biological system—> activation of hypothalamus- pituitary- adrenal axis —-> increased glucocorticoids and epinephrine levels in the body —-> leads to immune suppression.
OR
Chronic state of inflammation—-> activation of macrophages and dendritic cells and endothelium —-> release of pro inflammatory cytokines
What can changes in behaviour include
Poor OH smoking Increased alcohol Insomnia Poor nutrition
