INDEX

GOOD MORNING Smoking and periodontium

Submitted bySARANYA S

GUIDED BY DR.MAHMOOD MOOTHEDATH

periodontium

CONTENTSINTRODUCTIONSMOKING HABITS IN INDIATOXICITY OF TOBACCO SMOKESMOKING AND HOST RESPONSETOOTH BRUSHING BEHAVIOURSMOKING AND ORAL MICROBIALSContd.

Plaque formationCalculus formationSmoking and gingival inflammationSmoking and gingival bleedingEffects of smoking on prevalence and seveiourity.Effects on etiology and pathology.Effects on response to therapy.Scope of primary preventionConclussion

Smoking habits in IndiaCigerette, hookah, chilumBeedi, dhumtiCigar/cheroot/chuttaReverese chutta smokingGudakhu

6

dhumti

Reverse smoking

pipe

chillumhookah

Toxicity of tobacco smokeContents benzanthracene, hydrogencyanide,Alkaloid- nicotine - autonomic stimulation increase heart rate increase cardiac output increase BP and peripheral vasoconstriction

Breath monitor CO

SMOKING & HOST RESPONSE

Nicotine metabolites concentrates in periodontiumPromotion of vasoconstrictionEffects on WBCReduce flow of gingival exudate

Smokers have more plaqueHighercalcium concentration in dental plaqueMore plaque remaining after tooth brushingBehavioural difference poorer oral cleanlinessTOOTH BRUSHING BEHAVIOUR

SMOKING & ORAL MICRO-ORGANISMLowering of oxidation-reduction potential Increase anaerobic plaque bacteria Phenols & cyanides antibacterial & toxic Greater risk of infection with Tanarelle forcithensisPorphyromonas - subgingival infection16

PLAQUE FORMATIONSmokers have poor oral hygieneIncrease plaque deposits

CALCULUS FORMATIONSmokers have more calculusPipe smokers salivate moreMore calculus formation due to increased salivary flowIncreased calcium concentration following smokingCalcium phosphate,organic components- proteins & polypeptides derived from saliva

SMOKING & GINGIVAL INFLAMMATIONHeavy smokers have grayish discouloration & hyperkeratosis of gingivaSmokig- etiologic factor in ANUGTar- irritating effects on gingiva giving rise to gingivitisNicotine cause contraction of capillariesReduction in clinical signs of gingivitis

SMOKING & GINGIVAL BLEEDING

Nicotine stimulate sympathetic ganglia- produce neurotransmitters (catecholamines) vasoconstriction clinical signs of gingival inflammation-less evident

EFFECTS ON PREVALENCE & SEVERITY OF PERIODONTAL DISEASEGINGIVITISReduced development of inflammation in response to plaque accumulationLess gingival inflammation & bleeding on probingPERIODONTITISRisk factor for increasing the prevalence & severity of periodontal destructionContd.

Older adult smokers- severe periodontal disease,tooth loss,coronal root cariesIncreased severity of generalised aggressive periodotitisHighest risk for tooth loss, attachment loss, bone lossRisk decreases with increasing number of years since quitting smokingEffects of smoking on host are reversible

EFFECTS ON ETIOLOGY & PATHOGENESIS OF PERIODONTAL DISEASEMICROBIOLOGYNo effects on rate of plaque accumulationIncrease colonization of shallow & deep periodontal pockets by periodontal pathogens IMMUNOLOGYAltered neutrophil chemotaxis, phagocytosis, & oxidative burstIncrease TNF-Alpha & PGE2 in GCFContd.

Increase neutrophil collagenase & elastase in GCFIncrease production of PGE2 by monocytes in response to LPSPHYSIOLOGYDecrease gingival blood vessels with increase inflammationDecrease GCF flow & bleeding on probing with increase inflammationDecrease subgingival temperatureIncrease time needed to recover from local anesthesia

EFFECTS ON RESPONSE TO PERIODONTAL THERAPYNONSURGICALDecrease clinical response to scaling & root planingDecrease reduction in pocket depthDecrease gain in clinical attachment levelsDecrease negative impact of smoking with increase level of plaque controlContd.

SURGERY & IMPLANTSDecrease pocket depth reduction after surgeryIncrease deterioration of furcation after surgeryDecrease gain in clinical attachment levels, decrease bone fill, increase recession & increase membrane exposure after GTRDecrease pocket depth reduction after DFDBAContd.

Decrease pocket depth reduction & gain in clinical attachment levels after open flap debridementConflicting data on the impact of smoking on implant successSmoking cessation shoud be recommended before implantsContd.

MAINTENANCEIncrease pocket depth during maintenance therapyDecrease gain in clinical attachment levels RECURRENT DISEASEIncrease recurrent disease Increase need for re-treatment in smokersIncrease need for antibiotics to control negetive effects of periodontal infection on surgical outcomesIncrease tooth loss in smokers after surgical therapy

EFFECTS OF SMOKING CESSATIONSeveral week following smoking cessation, gingival inflammation & bleeding on brushing occurs bacause of smoking cessation, gingiva loses its thick fibrotic appearance & assumes normal anatomy

PREVENTION

5 STEP PROGRAM RECOMMENDED BY AGENCY FOR HEALTH CARE RESEARCH & QUALITY5 As 5 R 1.Ask 1.Relevance2.Advise 2.Risk3.Assess 3.Rewards4.Assist 4.Roadblocks5.Arrange 5.Repeat

CONLUSIONPoorer oral hygiene in smokersSmoking causes a marked increase in salivary flow-accumulate increased amounts of calculusIncrease the mineralizing potential of salivaMore plaque in smokersSmoking appears to suppress visible gingival inflammationContd.

Smokers have severe destructive periodontal disease, deeper periodontal pockets & more alveolar bone lossTobacco smoke- strong reducing capacity- in favour of anaerobic micro-organism- predispose oral infection by anaerobes- ANUGSmoking depress activity of oral PMNsReduced bloodflow in gingiva & output of GCFDecrease immune components in gingival creviceImpair periodontal wound healing- nonsurgical & surgical therapy

REFERENCECarranzas Clinical PeriodontologyClinical Periodontology & Periodontics- Shantipriya ReddyTobacco related mucosal lesions & conditions in India- Mehta & HammerInternet- www.smoking&periodontiumPreventive & Community Dentistry Soben Peter

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