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![TOBACCO SMOKING IS A SIGNIFICANT RISK FACTOR
FOR PERIODONTAL DISEASE
Specif
ic
pathogen
ic
bacteri
a
Host
immun
e
inflam-
matory
respon
se
Connecti
vetissue
&
bonemetabolis
m
Clinical
expressi
on of
disease,
initiationprogressi
on
Environmental &acquired risk
factors [SMOKING]
Genetic risk factors
A
g
LP
S
A
b
PMN
s
Cytokines,
PGE2
MMP
s](https://image.slidesharecdn.com/24-04-2020bds3rdyearlectureonsmoking-200514183158/75/24-04-2020-Bds-third-year-lecture-on-smoking-and-periodontium-7-2048.jpg)
Uploaded byDr. Mamta Singh
24 04-2020 Bds third year lecture on smoking and periodontium
The document discusses the significant negative impact of tobacco smoking on periodontal disease, highlighting that smoking is a major risk factor accounting for about 40% of chronic periodontitis cases. It covers how smoking affects oral health, including increased plaque development, altered immune responses, and impaired healing following therapy. Dental health professionals play a crucial role in tobacco cessation efforts, and quitting smoking can greatly improve periodontal health outcomes.
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Similar to 24 04-2020 Bds third year lecture on smoking and periodontium
24 04-2020 Bds third year lecture on smoking and periodontium
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- 3. CONTENTS Introduction Prevalence of tobaccousers Cigarette smoking Effects of smoking on the General health Effect of smoking on the Oral health- plaque development Periodontium Smoking and Gingivitis and Bleeding Smoking effect on GCF 14-05-2020
- 4. Smoking and ANUG Effectof smoking on etiology and pathogenesis of periodontal disease - Microbiology - Immunology - Physiology Effect on the Response to Periodontal therapy -Non surgical - Surgical - Implants Refractory periodontitis Role of Dental Health professionals in Tobacco Cessation Conclusion 14-05-2020
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- 6. • In thelast 10 years, Periodontology has witnessed a major breakthrough which has affected profoundly our understanding of the disease process, its diagnosis, and treatment. • The identification of groups of individuals at high risk for periodontal infections and disease has revolutionized the periodontal community and with it, patient management.13 • Several risk factors have been described which increases the risk for periodontitis. • Smoking - undoubtedly one of the main and most prevalent, risk factors for chronic periodontitis, risk calculations suggesting 40% of the cases of chronic periodontitis may be attributable to smoking. 14-05-2020
- 7. TOBACCO SMOKING ISA SIGNIFICANT RISK FACTOR FOR PERIODONTAL DISEASE Specif ic pathogen ic bacteri a Host immun e inflam- matory respon se Connecti vetissue & bonemetabolis m Clinical expressi on of disease, initiationprogressi on Environmental &acquired risk factors [SMOKING] Genetic risk factors A g LP S A b PMN s Cytokines, PGE2 MMP s
- 8. 14-05-2020 • 40 yearshave passed since the landmark U.S. general Surgeon’s report in 1964 warned that smoking played a causative role in Lung Cancer and was associated with Cardiovascular Disease. Since then, the list of smoking-related health- effects has grown and includes • lung cancer, as well as other cancers, • Chronic Obstructive Lung disease • Cardiovascular Disease • Pregnancy complications • Osteoporosis And various other adverse health consequences.
- 9. • For Dentalhealth Professionals, the knowledge that Oral Cancer and Periodontal Disease are adverse health effects of smoking is particularly significant.7 14-05-2020
- 10. PREVALENCE OF TOBACCOUSERS :- 14-05-2020
- 11. Tobacco -derived fromthe Nicotiana in the potato family, …………….Nicotiana Rustica and Nicotiana Tabacum. Chewed, Smoked, Sucked and Sniffed. In India, tobacco was introduced by Portuguese 400 years ago. It has been estimated that there are 1.1 billlion are smokers worldwide and 182 million (16.6%) of them live in India.6 The International Classification of Disease (ICD-10) has recognized that “Tobacco Dependence” is a disease. 14-05-2020
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- 13. • Predicted byWHO that more than 500 million people alive today will be killed by 2030 and tobacco consumption will become the single leading cause of death. • However, it is an irony that the tobacco use is the major preventable cause of death worldwide. 14-05-2020
- 14. Tobacco is usedin various ways which include smoked tobacco and smokeless tobacco used for chewing. The various smoking habits prevailing in India are :- • Bidi • Chillium • Chutta • Cigarettes • Dhumti • Gudakhu • Hookah • Hookli 14-05-2020
- 15. Smokeless tobacco includes • Khaini •Manipuri tobacco • Mawa • Mishri • Paan • Snuff • Zarda 14-05-2020 R:
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- 18. CIGAR, PIPE ANDCIGARETTE SMOKING 8: Less information is available on the effects of Cigar, Pipe smoking but it appears that effects similar to cigarette smoking may be observed with these forms of tobacco use. The prevalence of moderate and severe periodontitis and the percentage of teeth with 5mm or more attachment loss was most severe in current cigarette smokers but cigar, pipe smokers showed a severity of disease intermediate between the current cigarette smokers and non-smokers. There are at least 2550 known compounds in tobacco and more than 4000 compounds in tobacco smoke. 14-05-2020
- 19. Primary tobacco biohazardsinclude at least 43 carcinogens such as the nicotine nitrosamines and alpha- emitting radionuclides such as Polonium 210. 2 Tobacco smoke contains Carbon monoxide, Thiocyanate, Herbicide, Fungicide and Pesticide residues, Tars, and many other substances that promote disease and impair body functions. 14-05-2020
- 20. Cigarette smoke- There isincreasing evidence that cigarette smoking is a risk factor for periodontitis. The severity of periodontal destruction is directly related to the quantity of cigarette consumption12. The identification in the early 1990s of cigarette smoking as quite possibly the most significant risk factor for periodontal disease triggered a considerable amount of research examining the relation between smoking and periodontal disease. As a result, observational studies rather consistently reported that cigarette smoking increases the severity of periodontitis measured either as pocket depth or clinical attachment level independent of oral hygiene status. 14-05-2020
- 21. The negative ofcigarette smoking on the Periodontium is Cumulative and Dose dependent. The severity of Attachment loss is directly related to the amount of smoking measured either as pack- years or number of cigarettes per day, that is, the more cigarettes smoked per day and the longer the individual has smoked, the more severe the level of attachment loss. Pack years…… Cigarette smoking significantly increases the risk for tooth loss by 70%.2 14-05-2020
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- 23. • The ratioto have periodontal disease Moderate smokers is 2.77 times Heavy smoker is 4.75 times than a non-smoker1. • Cigarette smoking is associated with increased severity of Generalized Aggressive Periodontitis in young adults1. • Those age 19-38 years who smoke are 3.8 times more likely to have periodontitis than non-smokers1. 14-05-2020
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- 25. The combination ofsmoking with other systemic factors further enhances the risk of periodontal destruction. In Erie County study, Diabetes were approximately twice as likely to exhibit periodontal attachment loss compared to non- diabetes. the combination of Diabetes and heavy smoking in an individual over the age of 45 years who harbour P.gingivalis or T. forsythensis resulted in an odd ratio of attachment loss that was 30 times that of a person lacking these risk factors. 14-05-2020
- 26. Smoking also increasesthe risk of attachment and/ or bone loss in postmenopausal women and AIDS and HIV-seropositive patients. Effect of smoking on osteoporosis5 A negative association between smoking and bone density has been demonstrated by Krall & Dawson-Hughes (1991). Smokers can differ from non-smokers in weight, caffeine intake, age at menopause and alcohol consumption (Rigotti 1989, Lindquist & Bengtsson 1979); All these factors can potentially confound an association between smoking and bone density. 14-05-2020
- 27. Collectively, the variousstudies suggest that smoking interacts with various conditions, the end result is purely additive, but can be synergistic, resulting in greater disease severity than either factor alone. 14-05-2020
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- 29. EFFECT OF SMOKINGON PLAQUE DEVELOPMENT: • Earlier studies report that smokers showed a higher prevalence of dental plaque than non-smokers. • However, other studies indicate that, when controlling for other factors, smoking did not appear to increase the amount of plaque. • In addition, studies in which the development of plaque and inflammation was observed in an experimental gingivitis model showed that the rate of plaque formation was similar between smokers and non-smokers(Bergstorm, Preber 1986). 14-05-2020
- 30. EFFECT OF SMOKINGON THE PERIODONTIUM 14-05-2020
- 31. : • Smoking hasdetrimental effects on the Periodontium. Although the exact mechanisms are not known, it appears that the host response to bacterial plaque and the ability of the wound healing response in the host are significantly affected. • Much of the impairment centres on vascularity and the functions of vascularity ie ability to provide O2, nutrients, cells and growth stimulants to the tissues. • Even slight alteration in the vascularity can have significant effects on the tissues. • The negative periodontal effects of smoking are:- 14-05-2020
- 32. 14-05-2020 • Vascular alterations •Altered neutrophil function • Decreased IgG production • Decreased lymphocyte proliferation • Increased prevalence of periopathogens • Altered fibroblast attachment and function • Difficulty in eliminating pathogens by mechanical therapy • Negative local effects on cytokine and growth factor products
- 33. • Harber hasdescribed a discrete, smoking specific disease entity – characterized by • Fibrotic Gingiva • Limited gingival redness and edema relative to disease severity • Proportionally greater pocket depths in Ant and maxillary lingual sites • G. Recession at anterior sites • Lack of association between PD status and the level of Oral hygiene. (Haber 1994) 14-05-2020
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- 35. The gingival tissuein smokers tends to be • fibrotic • hyperkeratotic with thickened margins. • minimal erythema and edema as compared to that manifested by the gingival tissue of nonsmokers with disease of equal severity and similar plaque volume. • Several studies have shown that Smokers with periodontal disease have less clinical inflammation and gingival bleeding than do nonsmokers. (Axelson 1990,1998, Bergstorm 1983,1990,Bergstorm and Prebor1985,1986) 14-05-2020
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- 37. A 30 YEAROLD SMOKER PATIENT WITH ADVANCED PERIODONTITIS 14-05-2020
- 38. GENERALIZED ADVANCED BONELOSS PROBING DEPTH >6MM 14-05-2020
- 39. SMOKING AND ANUG •Ulceromembranous gingivitis, Vincent's Infection, Trench mouth. Ulcerative gingivitis and Acute Necrotizing Ulcerative Gingivitis (ANUG) • PINDBERG in a series of studies (1947-51) determined that tobacco smoking was a factor in NUG and that with increase in the use of tobacco, there was increase in the frequency of NUG. • Giddon and co-workers in 1964, studied the NUG in exam going students and concluded that both stress and smoking were important factors in the pathogenesis of NUG. 14-05-2020
- 40. EFFECT ON GCF •Inflammatory components in GCF have been studied in relation to smoking. • It has been proposed that there is decrease in GCF flow (Peerson, Bergstorm 1999)in smokers. • (Soder1997)Elevated levels of PGE2 TNF-A Neutrophil elastase MMP-8 In another report(Bergstrom2002), TNF-A and IL-8, were found to be depressed. Hence, to summarize, the role of pro-inflamatory factors in the overall picture of the immune response in smokers is not clear. 14-05-2020
- 41. 14-05-2020 EFFECTS OF SMOKINGON ETIOLOGY AND PATHOGENESIS OF PERIODONTAL DISEASE
- 42. • The increasedprevalence and severity of periodontal destruction associated with smoking suggests that the host-bacterial interactions normally seen in chronic periodontitis are altered, resulting in more aggressive periodontal breakdown • In a study,(Bergstorm 1992) of 142 patients with chronic periodontitis, plaque samples from deep pockets showed no differences in the counts of A.a, P.g, P.i. • In a similar study (Stoltenberg 1993),the prevalence of A.a, P.g, P.i, and Eikenela corrodens, was not found to be have shown differences in the microbial composition of subgingival plaque between smokers and non-smokers1. 14-05-2020
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- 44. • In arecent study(Haffajee etal 2001) sampled subgingival plaque and was found that • Eikenella nodatum, • Fusobacterium nucleatum ss. vincentii, • P. intermedia, • Peptostreptotouus micros, • Prevotclla nigrescens, • T. forsythia, • P. gingivalis, and • Treponema denticola were significantly more prevalent in current smokers than in nonsmokers and former smokers. 14-05-2020
- 45. • These datasuggest that smokers have a greater extent of colonization by periodontal pathogens than nonsmokers or former smokers and that this colonization may lead to an increased prevalence of periodontal breakdown. 14-05-2020
- 46. 14-05-2020 EFFECT OF SMOKING ONRESPONSE TO PERIODONTAL THERAPY
- 47. Another milestone inperiodontal research during the 1990 was the overwhelming number of studies supporting the negative effects of smoking on response to periodontal therapy. Scientific evidence has demonstrated that virtually all modalities of periodontal therapy less predictable and have poor outcomes in smokers compared with nonsmokers, indicating that smoking impairs periodontal wound healing. • Now has been concluded that “cigarette smoking is not only a major risk factor for periodontal disease, but adversely affects the response to therapy as well.” 14-05-2020
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- 49. VARIOUS STUDIES …. Ano. of studies have been done to study the effects of smoking on the periodontal health of the individual, few…… With non-surgical therapy as the main treatment modality, most authors report greater reductions in probing depth in smokers compared with non-smokers. (Preber n Bergstorm 1985,Prebor 1995, Groosi etal 1997,Jin etal 2000) With surgical therapy, Flap Surgery at the furcation defects showed significant PD reduction and clinical attachment gain , but smokers exhibited less favourable healing outcome following surgery 14-05-2020
- 50. • Tomasi andWenstrom(2004), studied the effect of Non surgical treatment with Atridox (locally delivered doxycycline gel) and concluded that smoking negetively influences treatment outcomes in terms of PD reduction and CAL gain. • Preshaw etal(2005) used Periostat (systemic doxycyline) as an adjunct to SRP, concluded with non-smokers showing greater CAL gain and reduction in PD. 14-05-2020
- 51. REFRACTORY PERIODONTITS • Asit is difficult to control the disease in smokers, the smokers become refractory to the traditional periodontal treatment and tend to show more periodontal breakdown than non- smokers after therapy. • In studies of patient who failed to respond to the conventional therapy, including different combinations of OHI, SRP, Surgery and Antibiotics, approximately, 90% were smokers 14-05-2020
- 52. ROLE OF DENTALHEALTH PROFESSIONALS IN TOBACCO CESSATION 14-05-2020
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- 54. 14-05-2020 So, it’s thedoctors, without a doubt- Dentists are the ones with the greatest chance to significantly encourage and affect the patient’s desire to want to quit. 1st and the foremost, a concrete and tangible ill consequences of smoking is at hands for the patient to consider. The presence of PD pockets, tooth mobility, suppuration, and other problems offer the Dentist the unique opportunity to connect the patients habit to a disease process that has already taken place
- 55. • Thus, thepatient is confronted with a health consequence of tobacco smoking that is REALITY rather than probability. • The basic steps are known as “5 A’s” -: (Glynn and Manley) ASK – All your patients about tobacco use ADVISE – Tobacco users to quit ASSESS - Tobacco user’s willingness to quit ASSISST – Tobacco user’s in developing a quit plan ARRANGE – Tobacco user’s follow up contact 14-05-2020
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- 57. CONCLUSION • Substantial evidencesupports the concept that tobacco smoking has a profound negative effect on PD disease severity, Prevalence, Incidence, and Progression. • It has a negative effect on all forms of PD therapy, leading to less favorable treatment outcomes. • 3-5 mins of cessation assisstance integrated into clinical services is a potentially life-saving service that benefits patient, community and practice. 14-05-2020
- 58. • Periodontal health andPrognosis for PERIODONTAL THERAPY substantially improve when patients QUIT SMOKING. We as PERIODONTISTS CAN MAKE A DIFFRENCE 14-05-2020 SMOKING IS INJURIOUS TO HEALTH
- 59. REFERENCES 1) CARRANZA’s ClinicalPeriodontology. 10th edition 2) Periodontics- Medicine,Surgery, and Implants. Rose, Mealey 3) Diagnosis and Risk Predictions Of Periodontal Diseases, vol 3. Per Axelsson 4) WILKIN’s Clinical Practice for Dental hygienists. 5) Clinical Periodontology and Implantology.Lindhe 6) Soben Peter’s Cigarette smoking and the Periodontal patient. State of the Art Review. JP 2004,2,75,196-206 14-05-2020
- 60. 7.) Smoking andRisk for Periodontal disease and tooth loss. JP 2000,12,71,1875-1881 8.) Effect of cigarette smoking on Gingival bleeding. JP 2004,75,16-22. 9) Cigarette smoking increases risk for subgingival infection with periodontal pathogens. JP 1996,67,1050-1054 10) Effect of smoking on the periodontal response: Review. CP 2006,33;241-253 11) Levels of cigarette consumptions and response too periodontal therapy. JP 1996,67;675-687. 12) Response to periodontal therapy in Diabetics and Smokers. JP1996,67,1094-1102. 13)Systemic Reviews of effects of smoking of non surgical periodontal therapy. Perio2000,2005,37,124-137. 14)Smoking and Periodontal disease. Perio 2000, 32,2003, 50-58. 14-05-2020
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Editor's Notes
- #23 9. Current smokers: Smoke more than 100 cigarettes in their lifetime and have stopped currently Smoke not more than 100 cigarettes in their lifetime Smoked 100 or more than 100 cigarettes in their lifetime but currently not smoking Smoke 100 or more than 100 cigarettes in their lifetime and smoked at the time of interview.