SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS WHO

SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS

WHO: • • • SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE MORTALIRY

MORTALITY • 50 % OF SMOKERS WILL DIE DUE TO SMOKING • HALF OF THEM PREMATURERLY • THEY LOST 20 -25 YEARS OF THE LIFE • DIFFERENCES ARE SIGNIFICANT AFTER 20 YEARS OF SMOKING

CASES OF SMOKERS ´ DEATH • • • - SMOKING ATTRIBUTES TO 25 DIFFERENT DISEASES; ANUALLY DIE DUE TO SMOKING CVD …………………. 1, 7 mil CHOPD …… ………. . . 970 tis LUNG CANCER …… 850 tis

SMOKING AND CANCER • HEAD and NECK – RR 10 – 12 + ALCOHOL - RR 40 - 135 • URINARY ORGANS CANCER • CERVICAL CANCER • STOMACH, COLORECTAL CANCER • HEPATAL, PANCREATIC CANCER • LEUKEMIE (MYELOID)

IN CIGARETTE SMOKE • Cca 5. 000 CHEMICALS • 67 HUMÁN CARCINOGENS • 33 TOXIC CONTAMINANTS OF AMBIENT AIR • 47 CHEMICALS REGISTERED AS TOXIC WASTE

OTHER FORMS of TOBACCO • SMOKELESS • PIPES. CIGARS • ARE THE IMPORTANT CAUSES OF HEAD AND NECK CANCERS

RISK FOR REPRODUCTION • IMPOTENCE, INFERTILITY • HORMONAL DYSBALANCE • COMPLICATION DURING PREGNANCY • ABORTS • PREMATURE DELIVERY • CONGENITAL MALFORMATIONS

INTRAUTERINE EXPOSURE • • FETAL TOBACCO SYNDROME => PROGRAMMING CONGENITAL MALFORMATIONS NEUROPSYCHICAL DYSORDERS (ADHD, conduct dysorders, addiction, criminality) • GENOTOXICITY =>CANCER

SMOKING and ORAL HEALTH • THE MAIN CAUSES OF TEETH LOST ARE CARIES and PARODONTITIS • SMOKING CONTRIBUTES TO BOTH OF THESE DISEASES

ORAL HYGIENE • IS WORSE AMON SMOKERS, EVEN AMONG SMOKING DENTISTRY STUDENTS • NO-SMOKERS DECLARED 9 times HIGHER FREQUENCY OF DAILY TTETH BRUSH compared with SMOKERS

NIKOTINOVÁ STOMATITIS

KUŘÁCKÁ MELANÓZA

TABÁKOVÉ SKVRNY

ABRASE ZUBŮ

CHLUPATÝ JAZYK

PRENATAL RISKS OF CARIES • • MOTHER´S OBESITY ………… 1, 21 MOTHER´S SMOKING. . ………. . 1, 33 LOW BIRTHWEIGHT PREMATURE DELIVERY

POSTNATAL RISK FACTORS • • PARENTAL LOW EDUCATION…. 1, 38 LOW SOCIAL POSITION. ………. . . 1, 35 MATERNAL AGE UNDER 23 Y. . . 1, 27 IMIGRANTS…………. 1, 7 -1, 8

SMOKING and CARIES • SMOKERS HAVE: • HIGHER SCORE kpe • HIGHER SCORE KPE • In DOSE-RESPONSE ASSOCIATIONS (salivary cotinine, years of smoking, number cig/day)

SMOKERS HAVE WORSE: • • NUTRITION ORAL HYGIENE SECONDARY PREVENTION HIGHER BACTERY COLONISATION LAKTOBACILY a Str. MUTANS • PROTEKTIVE SALIVARY ROLE (lower p. H, lower production)

PASIVE SMOKING: • PRENATALY: DEVELOPMENTAL DYSORDERS • INFECTIONS BY MOTHERS in 1 st year of the life • IMMUNOSUPRESION : respiratory inf. • = > breathing by mouth => higher risk of inf. In oral cavity • MODIFIKATION of IMUNITY Th 1 / Th 2

PARODONTAL DISEASES • G neg. , anaerob and mikro-aerofil bakteries => • ENHANCES PRO-INFLAMMATORY PROSTAGLANDINS A CYTOKINES => • DESTRUKCION OF TISSUE

VASOCONSTRICTION • LOWER GUMS OXYGENATION • BETTER CONDITION FOR ANAEROBES

AMONG SMOKERS • 3 x – 4 x MORE OFTEN SERIOUS PARODONTITIS: - DEEP LOBES, - HIGHER BONE LOST - MORE SUBGINGIVAL DEPOSITS of CALCULUS

PARODONTAL DISEASES • ARE MORE OFTEN ALSO AMONG YOUNG SMOKERS - IZRAEL STUDY - CARDIFF DENTAL STUDY - WORSE EFFECTIVENESS OF TREATMENT

TEETH LOST • - MORE THAN 8 TEETH HAVE NOT (45 -69 letí): 30%NON-SMOKERS 29% EX-SMOKERS (abstinence >31 y) 33% EX-SMOKERS (abstinence 21 -30 y) 42% EX-SMOKERS (abstinence 11 -20 y) 49% EX-SMOKERS (abstinence < 10 y) 50% SMOKERS

LEUKOPLAKIE • OCCURES 6 times MORE OFTEN AMONG SMOKERS • SIDES: - BUCAL – cigarettes smoking - PALATE – pipes/cigars smoking - LIPS, BUCAL – smokeless tobacco

Homogenní leukoplakie

Verukózní leukoplakie

Nodulární leukoplakie

ORAL CANCER • RELATIVE RISK 2 – 18 • WITH ALCOHOL 100 • WITH OTHER RISKS: Malnutrition, chr. Candidosis, viral infections (human papiloma v. , herpes simplex)

CANCER EPIDEMIOLOGY • • • Male: female rate 6: 1, now 2: 1 More often among patients aged 45 + Among young smokeless tobacco users TONGUE – 20% GUMS – 18% LOWER ORAL CAVITY + SALIVARY GLANDS – 20% • LIPS – 11%

Nádor jazyka

SMOKING IS A DISEASE • DEPENDENCE – dg F 17 • FYSICAL PART – NIKOTIN • BEHAVIORAL PART – AUTOMATIC BEHAVIOR

LEVEL OF DEPENDENCE • FAGERSTROM QUESTIONNAIRE: 6 QUESTIONS 10 „PENALTY“ POINTS 4 LEVELS OF DEPENDENCE

SMOKING CESSATION– 4 A / 4 P • ASK • ADVICE TO STOP • ASSIST WITHDRAWAL SYMPTOMES • ARRANGE FOLLOW UP

TERAPEUTIC HELP • NICOTINE REPLACEMENT THERAPY chewing gums, sticks, inhalator, tablets • Antidepresivum BUPROPION: Zyban, Wellbutrin • Nicotine Agonis VARENICLIN: Champix • VAKCINATION

CONCLUSION • SMOKING IS AN IMPORTANT HEALTH RISK • SMOKING DAMAGES ORAL HEALTH • PROFESSIONAL DENTISTS ARE ACTIVE IN TOBACCO CONTROL IN MANY COUNTRIES