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 treatm...

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 Immunology (Lecture date disease histology TBC) The dental relevance… Discussing Taking social Impact on Encouraging history ----Risk periodontal smoking assessment outcomes with cessation patients  The adverse Smoking is a effect of smoking k Smoking is modifiable ris on the periodontal c t o r th a t in c reases associated with an tissues is dose- f a increased risk of h e s u s c e p t ib ility to dependent t periodontal e r io d on ta l d isease p attachment loss, e f C le r e h u g h ,V. et The daily ( r formation of P e r io d o n to lo g y at number of a l periodontal pockets cigarettes and ) a glance p. 21 and alveolar bone duration of loss smoking 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 Effects are Passive smoking is mildly cumulative and related to dose associated with periodontitis (“Pack Years”) Smoking seems to promote even worse 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 Early onset disease progression (pockets, CAL, bone loss) Recurrence Increased % Poorer within one More tooth response to are refractory loss year of to treatent NSPT surgery Smoking causes a dry mouth The effect of tobacco smok e on saliva 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 more susceptible smokers have to periodontal more severe disease? periodontal disease? Why are Why do smokers smokers more have a poorer likely to have response to surgical increased and nonsurgical implant treatment? failure? 4000 chemicals in tobacco smoke Tar Nicotine causing brown Tar staining 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 Smoking is now one of the diagnosis relationship between the terms in risk factors exposure to smoking and the 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