YENEPOYA DENTAL COLLEGE MANGALORE DEPARTMENT OF PERIODONTICS SMOKING

YENEPOYA DENTAL COLLEGE , MANGALORE DEPARTMENT OF PERIODONTICS SMOKING & PERIODONTAL DISEASES Dr. Sruthy Prathap Periodontology 08 March 2021 1

CONTENTS Introduction Effects of smoking on Prevalence and severity of periodontal diseases Effects of smoking and pathogenesis of periodontal disease Effects of smoking on response to periodontal therapies Smoking cessation program Recurrent disease Conclusion References 08 March 2021 2

INTRODUCTION Tobacco use 4 leads to death 3 rd largest producer of tobacco th largest consumer of tobacco 250 million tobacco users 08 March 2021 3

q Tobacco is a major contributor to oral diseases. q Utilization of tobacco products has long been linked to periodontal diseases. q 67% greater tooth loss among smokers. q Smokers are 3 times more likely to get acute periodontitis. q Smoking influences the outcome of non surgical and surgical periodontal therapies. 08 March 2021 4

SMOKING EFFECTS Excessive brown or black tar like deposits and discoloration of tooth surface Diffuse grayish discoloration and leukoplakia of the gingiva Smokers palate Delay in post surgical healing Heavy amount of calculus Gingivitis and periodontitis 08 March 2021 5

EFFECTS OF SMOKING ON PREVALENCE AND SEVERITY OF PERIODONTAL DISEASES GINGIVITIS gingival inflammation bleeding on probing GCF flow 08 March 2021 6

PERIODONTITIS ü prevalence & severity of periodontal destruction ü pocket depth, attachment loss, bone loss ü rate of periodontal destruction ü tooth loss ü severe periodontitis ü Increased prevalence with increased no. of cigarettes smoked/day ü Decreased prevalence and severity with smoking cessation 08 March 2021 7

FACTORS RESPONSIBLE FOR INCREASED PERIODONTAL PROBLEMS Increased keratinized cells in gingiva Presence of nicotine metabolites PMNLs have reduced phagocytosis Vascular reaction is suppressed 08 March 2021 8

EFFECTS OF SMOKING AND PATHOGENESIS OF PERIODONTAL DISEASE Host – bacterial interactions seen in chronic periodontitis are altered in smokers This imbalance may be caused by changes in the composition of subgingival plaque 08 March 2021 9

MICROBIOLOGY v Alteration in the microbial challenge results from a qualitative alteration in the plaque v Smokers had higher levels of Bacteroides forsythus (Tannerella fortsythia) v Eikenella nodatum, Fusobacterium nucleatum, P. intermedia, Peptostreptococcus micros, Treponema denticola were significantly more prevalent in current smokers 08 March 2021 10

IMMUNOLOGY v Neutrophils have been shown to demonstrate functional alterations in chemotaxis, phagocytosis v Reduced production of Ig. G 2 in smokers v Elevated levels of TNF α in GCF v Increased production of PGE 2 by monocytes v Nicotine…. affects fibroblast function suppresses osteoblast proliferation alter normal reparative and regeneration potential of periodontium 08 March 2021 11

PHYSIOLOGY v Clinical signs of inflammation are less pronounced… due to alteration in the inflammatory response in smokers or due to alteration in vascular response of gingival tissues v Decreased subgingival temperature v Increased time needed to recover from local anesthesia 08 March 2021 12

EFFECTS OF SMOKING ON RESPONSE TO PERIODONTAL THERAPIES 1. NON SURGICAL THERAPY Studies have shown that even after non surgical procedures including oral hygiene instructions, scaling and root planning : Ø pocket depth reduction is not effective Ø no gains in clinical attachment loss 08 March 2021 13

Even though scaling and root planning are used in combination with topical subgingivally placed tetracycline fibers, subgingival metronidazole gel or minocycline gel, smokers continue to show less pocket reduction. 08 March 2021 14

2. SURGICAL THERAPY AND IMPLANTS § § In a comparative study of the effects of coronal scaling, root planning, modified widman flap surgery and osseous resection surgery, smokers showed: less pocket reduction less gain in clinical attachment levels. Smoking cessation should be recommended prior to implant placement 08 March 2021 15

3. MAINTENANCE THERAPY After four different treatment modalities of therapy including scaling and root planning, modified widman flap surgery and osseous surgery, maintenance therapy was performed by a hygienist every 3 months for 7 years. Ø Increased pocket depth Ø Decreased gain in clinical attachment levels 08 March 2021 16

Even after the periodontal treatment, periodontal diseases become refractory Leading to…. . increased need for re-treatment increased need for antibiotics increased tooth loss in smokers after surgical therapy 08 March 2021 17

SMOKING CESSATION PROGRAMM AD VIC E ASSES ASK FIVE A’s 08 March 2021 AS S IST ARRANGE 18

NICOTINE WITHDRAWAL SYMPTOMS Craving for tobacco Depressed mood Insomnia Irritability Frustrations Anxiety Difficulty in concentrating Restlessness Decreased heart rate Increased appetite and weight gain 08 March 2021 19

Lessen cravings &other withdrawal symptoms E. g. Nicotine gum Nicotine patch Nicotine inhaler Nicotine nasal spray Nicotine lozenges 08 March 2021 20

They function as anti-craving medications e. g. Clonidine Nortryptiline 08 March 2021 21

ASK / ADVICE the patient about: RELEVANCE REPEAT RISKS THE 5 R METHOD REWARDS ROADBLOCKS 08 March 2021 22

CONCLUSION Smoking has a detrimental effect on the progression of periodontal diseases. Its effects are well established in the literature and studies So, as dentists we have to make an effort to counsel and motivate the users to quit smoking 08 March 2021 23

Every year 700000 people QUIT SMOKING by DYING…. !!!!!!! 08 March 2021 24

REFERENCES Clinical Periodontology - Carranza – 10 th edition Essentials of Clinical Periodontology and Periodontics – Shanthipriya Reddy – 2 nd edition Textbook of Preventive Dentistry – Hiremath. S. S – 1 st edition Helping your patients remain tobacco free – Ministry of Health and Family Welfare, WHO 08 March 2021 25

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