Smoking and Periodontal Disease

Smoking and Periodontal Disease

• Smoking is a modifiable risk factor increasing susceptibility to periodontal disease.
• Periodontal disease is linked to general well-being.
• Studies show that smoking has a strong association with increased risk of periodontal attachment loss, pocket formation, and alveolar bone loss.

GDC Learning Outcomes

• Understand the impact of general and systemic diseases on oral health
• Consider the effects of the patient's periodontal and general health on treatment plans.

Intended Learning Outcomes

• Understand the negative affects of smoking on the periodontium
• Identify harmful chemicals in tobacco
• Explain why smoking affects periodontal health

Links to Associated Lectures

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

Dental Relevance

• Taking social history/risk assessment
• Discussing the impact of smoking on periodontal outcomes with patients.
• Encouraging smoking cessation

Adverse Effects of Smoking

• Smoking's effects are cumulative and depend on the dose ("Pack Years").
• The adverse effect of smoking on periodontal tissues is dose-dependent.
• The daily number of cigarettes and duration of smoking are related to the severity of periodontal problems.
• Smoking is second only to bacterial plaque as a modifiable risk factor for periodontitis.
• Smoking has been associated with a 2- to 8-fold increased risk for periodontal attachment and/or bone loss.

Clinical Appearance of Smokers

• Fibrotic, "tight" gingivae with rolled margins
• Reduced gingival redness and bleeding
• More widespread and severe disease in smokers compared to non-smokers
• Nicotine staining
• Calculus build-up, particularly in anterior maxilla and palate regions

Clinical Characteristics of Smokers

• Early onset of symptoms with rapid disease progression
• More tooth loss
• Poorer response to non-surgical periodontal treatment (NSPT)
• Recurrence of periodontal disease within a year of treatment
• Increased refractory rate to periodontal treatment

Smoking and Dry Mouth

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

Water Pipes (Hookah/Shisha)

• Water pipes also cause periodontal damage.
• They are used for heating and vaporizing tobacco, cannabis, or hashish.

Why Smokers Have Worse Results/Susceptibility

• Discussion points on why smokers experience more severe periodontal disease, poorer treatment responses, increased susceptibility, and increased implant failure,

Components of Tobacco Smoke

• Four thousand chemicals found in tobacco smoke
• Nicotine is an addictive drug that increases heart rate
• Tar stains teeth brown
• Carbon monoxide lowers the blood's oxygen-carrying capacity

Reasons for Smoking's Adverse Effects

• Direct damage by toxins
• Increased periodontopathic bacteria (questionable)
• Impaired innate and adaptive immune responses: decreased IgG production, and increased neutrophil effects (oxidative damage)
• Negative effects on tissue repair, cytokine, growth factor production
• Decreased tissue vascularity and angiogenesis; inhibition of fibroblast growth and collagen production.

Effect of Smoking on Periodontium

• Smokers often bleed less than non-smokers.
• This may be linked to nicotine-induced vasoconstriction (dose-dependent).

Level of Risk

• Level of risk is directly related to the number of pack years smoked
• One pack year equals 20 cigarettes/day for one year

Questions to Answer

• Harmful effects of tar in the mouth: stains teeth
• Effect of carbon monoxide: binds to hemoglobin, preventing sufficient oxygen carriage, lowering blood's ability to transport oxygen around the body

Smoking Cessation

• Smoking cessation improves periodontal treatment prospects.

Useful References

• Include references that were listed in the slides.