Smoking and Periodontal Disease PDF

Smoking and periodontal Disease Oral and Dental Science Coralie Frances GDC Learning Outcomes 1.1.3 Explain general and systemic disease and their relevance to oral health 1.11.2 Explain and take account of the impact of the patient’s periodontal and general health on the overall treatmen...

Smoking and periodontal Disease Oral and Dental Science Coralie Frances GDC Learning Outcomes 1.1.3 Explain general and systemic disease and their relevance to oral health 1.11.2 Explain and take account of the impact of the patient’s periodontal and general health on the overall treatment plan and outcomes Intended Learning Outcomes At the end of the session the student should have knowledge of the effects of smoking and periodontal disease Be able to: 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 Periodontal Gingival histology Immunology (Lecture date TBC) disease The dental relevance… Discussing Impact on Taking social history Encouraging smoking periodontal outcomes ----Risk assessment cessation with patients  The adverse effect of o k in g is a m o d ifi able Sm smoking on the is k fa c to r th at in creases Smoking is associated periodontal tissues is r with an increased risk of to the susceptibility periodontal attachment dose-dependent e rio d o n ta l d is e a se (ref p loss, formation of l Clerehugh,V. et a The daily number of periodontal pockets and ta cigarettes and Periodontology a alveolar bone loss duration of smoking glance p. 21) are related (Ref Zee, K-Y) Smoking tobacco is linked to an increased risk of periodontitis Periodontitis is the 6th most prevalent disease throughout the world and significantly linked to general well-being. number of people who smoke in Europe number who smoke in world “In the UK, 14.7% aged 18 years and over smoked cigarettes (7.2 million people)” “Those aged 25 to 34 years had the highest proportion of current smokers (19.0%).” Ref 1 (www.ons.gov.uk) Effects of smoking on the periodontium Smoking is second only to bacterial plaque as a modifiable risk factor for periodontitis Smoking is associated with a 2- to 8- fold increased risk for periodontal attachment and/or bone loss, depending on the definition of disease severity and smoking dose Passive smoking is mildly associated with periodontitis Effects are cumulative and related to dose Smoking seems to promote even worse (“Pack Years”) periodontal conditions in those who are already highly susceptible, e.g. Diabetics Compared with non-smokers smokers have: Deeper pockets More CAL More periodontal bone loss More furcation involvement More infra-bony defects More missing teeth (especially molars). More recession More fibrotic gingivae Less BOP Higher levels of calculus, independent of plaque levels All Types of Periodontal Treatment are less effective in smokers: Non-surgical Surgical Muco-gingival (recession coverage) Implants Smokers have 50-75% of the improvement in clinical parameters of non-smokers for both surgical and non-surgical treatment. Implant failure rate has been reported as 4% over 10 y in non-smokers compared with 15% in smokers (Mundt et al 2006) Smoker - Clinical appearance Fibrotic “tight” gingivae, rolled margins Less gingival redness and bleeding More severe, widespread disease for same age non smoking control Nicotine staining Calculus Worst affected areas - anterior, maxilla, palate Smoker - Clinical characteristics Increased severity Rapid disease & extent of disease Early onset (pockets, CAL, bone progression loss) Increased % are Poorer response to Recurrence within refractory to More tooth loss NSPT one year of surgery treatent Smoking causes a dry mouth The effect of tobacco smoke on sa liva Water pipes (Hookah/shisha) Water pipes may also cause periodontal damage Also known as hookahs or shishas A single or multi-stemmed instrument used for heating or vaporising and then smoking tobacco, cannabis or hashish Why? Why are smokers Why do smokers more susceptible to have more severe periodontal disease? periodontal disease? Why are smokers Why do smokers have a more likely to have poorer response to increased implant surgical and nonsurgical failure? treatment? 4000 chemicals in tobacco smoke Tar causing Nicotine brown staining Tar Carbon monoxide Nicotine, an addictive drug, increases heart rate Reasons why smoking may have adverse effects on periodontal health 1. Direct damage by toxins 2. More periodontopathic bacteria? 3. Impairs innate and adaptive host response: Decrease in IgG production Shift towards destructive neutrophil effects e.g. oxidative damage Negative effects on cytokine and growth factor production. 4. Effects on tissue repair and healing: Decrease in tissue vascularity and angiogenesis Inhibition of fibroblast growth; attachment and collagen production Affect of smoking on periodontium Smokers have less gingival bleeding than non smokers:- This is dose dependent This may be linked to the vasoconstriction of nicotine Level of risk = number of pack years “There is a direct linear relationship Smoking is now one of the diagnosis between the exposure to smoking and the terms in risk factors amount of alveolar bone loss” (ref. Clerehugh et al)  What are the deleterious effects of tar in the mouth? What is the effect of carbon monoxide? Answers Tar – sticky – stains teeth Carbon monoxide – binds to haemoglobin in blood preventing sufficient carriage of oxygen- lowers the blood’s ability to transport oxygen around the body. Smoking cessation Improves the prospects for a good periodontal treatment outcome Useful References Clerehugh,V., Tugnait A. and Genco R.J. 2010 Periodontology at a Glance Wiley-Blackwell Feifei Qui, Chun-ling Liang Zhenhua Dai Impacts of cigarette smoking on immune responsiveness: Up and down or upside down? Oncotarget. 2017 Jan 3; 8(1): 268-284 Gautam, D.K. Jindal, V. Gupta, S.C. Tuli, A., Kotwal, B. and Thakur, R. Effect of cigarette smoking on the periodontal health status: A comparative, cross sectional study J Indian Soc Periodontol. 2011 Oct-Dec; 15(4): 383–387. Gehrig, J.S., Shin D.E. & Willman D.E.(2020) Foundations of Periodontics for the Dental Hygienist 5th Edition Wolters Kluwer References Feifei Qui, Chun-ling Liang Zhenhua Dai Impacts of cigarette smoking on immune responsivenessand Jiang,Y., Zhou, X., Cheng, L., and Mingyun Subgingival Microflora: From Periodontal Health to Disease Waugh, A. and Grant, A. (2018) Ross & Wilson Anatomy And Physiology In Health And Illness. 13th ed. Elsevier Zee, K.Y. Smoking and periodontal disease, Australian Dental Journal Vol 54 Issue s1 pS44-S50 2009