Smoking and Periodontal Disease medium

Smoking and Periodontal Disease

• Smoking is a modifiable risk factor increasing susceptibility to periodontal disease.
• Smoking is associated with a 2-8 fold increased risk of periodontal attachment and/or bone loss, depending on disease severity and smoking dose.
• The severity of effects is dose-dependent, related to the daily number of cigarettes and duration of smoking.
• Periodontal disease is the 6th most prevalent disease globally and significantly linked to general well-being.
• In the UK, 14.7% of adults aged 18 and over smoke cigarettes (7.2 million people).
• Those aged 25-34 had the highest proportion of current smokers (19.0%).

GDC Learning Outcomes

• Explain general and systemic diseases and their relevance to oral health.
• Explain and consider the impact of a patient's periodontal and general health on the overall treatment plan and outcomes.

Intended Learning Outcomes

• Describe the adverse effects of smoking on the periodontium.
• List harmful chemicals in tobacco.
• State possible reasons why smoking has adverse effects on periodontal health.

Links to Associated Lectures

• Smoking Cessation (lecture date TBC)
• Periodontal disease
• Gingival histology
• Immunology

Dental Relevance

• Taking social history (risk assessment).
• Discussing impact on periodontal outcomes with patients.
• Encouraging smoking cessation.
• Assessing patient susceptibility to disease, likely severity, and treatment outcome.

Effects of Smoking on the Periodontium

• Smoking is second only to bacterial plaque as a modifiable risk factor for periodontitis.
• Passive smoking is mildly associated with periodontitis.
• Smoking seems to worsen periodontal conditions in those already susceptible, e.g., diabetics.
• Effects are cumulative and related to dose ("pack years").

Smokers Compared to Non-Smokers

• Deeper pockets
• More bone loss (CAL)
• More furcation involvement
• More infrabony defects
• Missing teeth (especially molars)
• More recession
• More fibrotic gingivae
• Less bleeding on probing (BOP)
• Higher levels of calculus, independent of plaque levels

Periodontal Treatment in Smokers

• All types of periodontal treatment (non-surgical, surgical, muco-gingival, implants) are less effective in smokers.
• Smokers have 50-75% less improvement in clinical parameters compared to non-smokers for both surgical and non-surgical treatment.
• Implant failure rates are higher in smokers (15% compared to 4% in non-smokers over 10 years).

Smoker - Clinical Appearance

• Fibrotic "tight" gingivae, rolled margins
• Less gingival redness and bleeding
• More severe, widespread disease
• Nicotine staining
• Calculus
• Anterior, maxillary, and palatal areas are most affected.

Smoker - Clinical Characteristics

• Early onset
• Rapid disease progression
• Increased severity (pockets, CAL, bone loss)
• More tooth loss
• Poorer response to non-surgical periodontal treatment (NSPT)
• Recurrence within one year of surgery
• Increased refractory cases to treatment.

Smoking and Dry Mouth

• Smoking causes a dry mouth due to the effect of tobacco smoke on saliva.

Water Pipes (Hookah/Shisha)

• Water pipes (hookahs/shishas) also cause periodontal damage.
• A single or multi-stemmed instrument used for heating and vaporizing tobacco, cannabis, or hashish.

Reasons for Increased Periodontal Disease in Smokers

• Reasons for more severe periodontal disease:
  • Increased periodontopathic bacteria,
  • Impaired innate and adaptive host response, and
  • Negative effects on tissue repair and healing.

Factors Influencing Periodontal Treatment in Smokers

• Impact of smoking on susceptibility and healing
• Factors of vasoconstriction in relation to nicotine

Level of Risk = Number of Pack Years

• Calculating pack years: Average packs smoked per day x number of years smoked.
• A direct linear relationship exists between smoking exposure (pack years) and alveolar bone loss.

Harmful Effects of Tar and Carbon Monoxide

• Tar: Sticky - stains teeth.
• Carbon monoxide: Binds to haemoglobin, reducing blood oxygen-carrying capacity.

Smoking Cessation

• Smoking cessation is associated with a reduction in risk of tooth loss.
• Cessation improves prospects for successful periodontal treatment.

Useful References

• Includes specific studies and authors relevant to the topic

This quiz explores the relationship between smoking and periodontal disease, highlighting how smoking acts as a modifiable risk factor. Learn about the dose-dependent effects of smoking on periodontal health and its broader implications for general well-being. Understand the significance of these factors in the treatment planning process for patients.