Smoking and Periodontal Disease Quiz

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. The risk is dose-dependent.
• The daily number of cigarettes and duration of smoking are related to the adverse effects of smoking on periodontal tissues.
• Periodontal disease is the 6th most prevalent disease worldwide and significantly linked to general well-being.
• In the UK, 14.7% of those aged 18 and over smoke, equivalent to 7.2 million people. (Ref 1 www.ons.gov.uk)
• Those aged 25-34 had the highest proportion of current smokers (19.0%). (Ref 1 www.ons.gov.uk)
• Smoking is second only to bacterial plaque as a modifiable risk factor for perioontitis.
• Smoking is associated with a 2-8 fold increased risk of periodontal attachment and/or bone loss, depending on the definition of disease severity and smoking dose.
• Passive smoking is mildly associated with periodontitis.
• Smoking seems to worsen periodontal conditions in already highly susceptible individuals, such as diabetics.
• Smoking is strongly associated with more severe periodontal problems.

Clinical Appearance of Smokers

• Smokers often present with fibrotic "tight" gingivae, with rolled margins, less gingival redness and bleeding.
• Smokers often have more severe, widespread disease compared to a similar age group without smoking.
• Nicotine staining and calculus build-up are common.
• Worst affected areas are often anterior maxilla and palate.

Clinical Characteristics of Smokers

• Smokers often experience early onset of periodontal disease.
• Disease in smokers often has rapid progression.
• Disease is typically more severe and extensive in smokers.
• Smokers often have poorer responses to non-surgical periodontal treatment.
• Smokers have a higher recurrence rate within one year of surgery.

Effects of Smoking on Periodontal Treatment

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

Why Smoking Affects Periodontal Health

• Smoking causes a dry mouth by reducing saliva flow.
• Smoking causes vasoconstriction, potentially leading to less gingival bleeding in smokers compared to non-smokers. However, this may be inaccurate if not accounting for other reasons such as nicotine effects.
• Tar is sticky and stains teeth.
• Carbon monoxide binds to haemoglobin, preventing the transport of sufficient oxygen.

Water Pipes (Hookah/Shisha)

• Water pipes (hookahs or shishas) may contribute to periodontitis.
• They involve heating or vaporizing tobacco, often cannabis or hashish.

Harmful Chemicals in Tobacco Smoke

• Nicotine is an addictive drug that increases heart rate.
• Tar is sticky and causes brown staining.
• Carbon monoxide is a poisonous gas that lowers the blood's ability to carry oxygen throughout the body.

Reasons for Smoking's Adverse Periodontal Effects

• Direct damage from toxins.
• Increase in periodontopathic bacteria?
• Impairment of the body's innate and adaptive host response: decreased IgG production, shift towards destructive neutrophil effects (eg. oxidative damage), negative effects on cytokines and growth factors.
• Negative effects on tissue repair and healing. Decreased tissue vascularity and angiogenesis, inhibition of fibroblast growth and collagen production.

Level of Risk and Pack Years

• The risk of periodontal disease in smokers is related to the number of pack years smoked.
• Pack years are calculated according to a formula (avg packs smoked per day X years smoked).

GDC Learning Outcomes

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

Intended Learning Outcomes

• Describe how smoking negatively affects the periodontium.
• Detail the harmful chemicals within tobacco use.
• Explain possible reasons why smoking adversely affects periodontal health.

Test your knowledge on the impact of smoking on periodontal disease. This quiz covers facts about smoking as a modifiable risk factor, its statistical prevalence, and the relationship between smoking habits and periodontal health. Learn how smoking significantly affects gum health and general well-being.