SMOKING & PERIODONTAL DISEASES

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

2. 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

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

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

5. 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

6. EFFECTS OF SMOKING ON PREVALENCE AND SEVERITY OF PERIODONTAL DISEASES • GINGIVITIS gingival inflammation bleeding on probing GCF flow

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

8. Factors responsible for increased periodontal problems • Increased keratinized cells in gingiva • Presence of nicotine metabolites • PMNLs have reduced phagocytosis • Vascular reaction is suppressed

9. 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

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

11. IMMUNOLOGY • Neutrophils have been shown to demonstrate functional alterations in chemotaxis, phagocytosis • Reduced production of IgG2 in smokers • Elevated levels of TNF αin GCF • Increased production of PGE2 by monocytes • Nicotine…. affects fibroblast function suppresses osteoblast proliferation alter normal reparative and regeneration potential of periodontium

12. PHYSIOLOGY • 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 • Decreased subgingival temperature • Increased time needed to recover from local anesthesia

13. 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 : • pocket depth reduction is not effective • no gains in clinical attachment loss

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

15. 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

16. 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 3months for 7 years. • Increased pocket depth • Decreased gain in clinical attachment levels

17. RECURRENT (REFRACTORY) DISEASE 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

18. SMOKING CESSATION PROGRAMM ASSES ADVICE ASSIST ASK ARRANGE FIVE A’s

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

20. NICOTINE REPLACEMENT THERAPY (NRT) • Lessen cravings &other withdrawal symptoms E.g. Nicotine gum Nicotine patch Nicotine inhaler Nicotine nasal spray Nicotine lozenges

21. ANTI DEPRESSANTS • They function as anti-craving medications e.g. Clonidine Nortryptiline

22. COUnsELLING THOSE UNWILLING TO QUIT ASK / ADVICE the patient about: RELEVANCE THE 5 R METHOD RISKS REPEAT REWARDS ROADBLOCKS

23. 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

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

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

26. THANK YOU !