H.K.Ajeya Ranganathan

G D C R I , Bangalore.

EFFECTS OF TOBACCO ON PERIODONTAL TISSUES

Periodontitis* Periodontitis is one of the most common oral diseases

and is characterised by gingival inflammation and alveolar bone resorption

* Periodontitis is a multifactorial and cumulative condition, initiated and propagated by bacteria and host factors

* There are two forms of periodontitis; chronic and aggressive Periodontitis

* Both differ from each other not only in clinical findings but also age of onset and rate of progression.

*General causes for periodontitis*Factors playing role in Periodontitis are

LOCAL FACTORS like calculus, food impaction and microbial

plaque which includes Aggrobacter actinomycetemcomitans, Bacteroides forsuthus & Prevotella intermedia , Fusobacterium nucleatum , Bacteroides melaninogenicus

ENVIRONMENTAL FACTORSCigarette smoking, beedi,

Smokeless tobacco usage like beeda, pan masala, pan chewing, Gutka

SYSTEMIC FACTORS

Periodontitis: Environmental Factors* Environmental factors are not found in oral cavity

always but are acting as and when habits are cultivated

*Environmental factors include

*SMOKING

*Pan chewing

*Smokeless tobacco consumption and

*Poor dental awareness

Contents of cigarattes

*Acetone            Cyanide Aluminium          DDT/Dieldrin Ammonia            Ethanol Arsenic             Formaldehyde Benzene             Hydrogen cyanide Butane               Lead Cadmium             Methanol Carbon monoxide  Nicotine Carbon dioxide     Tar Chloroform          Vinyl Chloride

 

*1. Filter made of 95% cellulose acetate.

*2. Tipping paper to cover the filter.

*3. Rolling paper to cover the tobacco.

*4. Tobacco blend.

Functions of different layers and part of cigarette

Rolling paper• Holds tobacco blend • Controls the rate of

burning and production of ash

Tobacco blend• It provides taste and

flavour• It may vary from

region to region

Cigarette filter• It is the

biodegradable part of cigarette made of cellulose acetate.

• It filters the main stream of smoke from tobacco blend to the mouth piece

Cigarette but• It holds the burnt ash

and remnants of tobacco

• It is 30% of the length of a cigarette

Effects on periodontia*Gingivitis:

smokers develop less inflammatory response than non smoking counterparts which shows that occurrence of gingivitis is comparatively low in smokers than in non-smokers

*Periodontitis

Smokers are more prone to periodontitis than non smokers since smoking plays an important role in destruction of periodontium , loss of attachment and sub-gingival plaque accumulation.

Biochemical findings in smokers

Osteoprotegerin levels increased initially followed by decreased gradually

M-CSF, OPG , PGE2 are decreased

Serum OPG levels

decreased and sRANKL levels increased

OPG/sRANKL ratio is reduced

Saliva

Effects of tobacco smoking on microbiology, immune inflammatory response & physiology of periodontitis

*Increased destruction of periodontia by smoking would lead to the breakdown balance between microbial colonies and host immune response and causes changes in the contents of sub-gingival plaque

* This would lead to increased virulence and changes the host response to the bacterial challenge which in turn lead to increased periodontal destruction

Effects of tobacco on microbiology of plaqueIncreased levels of

T.forsythia ,

T.denticola,

P.gingivalis

Increased colonization of bacteria

in sub gingival plaque

Impaired mechanical prophylaxis

Increased tissue

destruction

Effects of tobacco smoking on immune response during Periodontitis

Increased risk of tissue

destruction

Impaired neutrophil

activity

Increased levels of TNFα and

matrix metalloprotie

n 8 Decreased levels of

neutrophils and PGE2

Effects of tobacco smoking on periodontal

Physiology

Decreased Microvasculatu

re

Decreased blood flow

Decrased GCF production

DecreasedInflammatory

response

Added vasoconstrictio

nSlow recovery

from Local anaesthasia