Systemic risk factors

Question 1

when is world no tobacco day

Answer 1

31st may

Question 2

how many hospital admissions are attributable to smoking?

Answer 2

489000

Question 3

what trends are found related to smoking

Answer 3

• increase in vapers
• more men smoke than women
  higher levels of smokers in younger groups of patients
• e cigarettes are used to help quit smoking
  no long term effects

Question 4

what ingredient makes a smoker addicted

Answer 4

nicotine
develop dependance
Somers smoke for the nicotine but die from the tar

Question 5

list smoking related diseases

Answer 5

cancer; lung, mouth,p[jarynx, lung, bladder,pancreas,kidney,oesophagus,stoamch,kidney,leaukemia

Potentially fatal; ischaemic/respiratory heart disease, obstructive lung disease eg bronchitis, stroke, penuomina, aortic aneurysm, foetal/neonate death

Non fatal; periodontal disease, low brith weight baby

Question 6

what is tobacco smoking and smokeless tobacco related to?

Answer 6

Tobacco smoking
- periodontitis
-periotntiist that is refractory to treatment
- Necrostiign periodontal disease

Smokeless tobacco
- localised recession manifesting as attachment loss and also increased oral cancer risk
-severe active periodontal disease

Question 7

what effects does tobacco have on periodntium

Answer 7

• higher levels of pd
• poorer oral hygiene
• hypothesised that poorer OH may be responsible for higher disease levels ie smoking indirectly affected periodontium
• greater bone loss and attachment loss
• increased. number of deeper pockets

Question 8

what is the clinical appearance of smokers pd

Answer 8

• fibrotic ‘tight’ ginger, rolled margins
• less gingival redness and bleeding
• more severe, widespread disease than same age non smoking control
• anterior,maxialla,palate worst affected
• anterior recession,open embrasures
  -nicotine staining calculus

Question 9

what does the 10 year study show about smoking and periodontal risk

Answer 9

-dentally aware musicians
- significantly greater frequency diseased sites and reduced bone height
- dose réponse

Question 11

Describe symptoms of necrotising gingivitis

Answer 11

• rapid onset, specific features
  -painful interdental necrosis, bleeding gingival
  -nectroic ulcers affecting interdental papillae
  -‘punched out’ appearance
• ulcers painful, covered by grey slough
• gingival bleeding with little provocation
• possible halitosis,’foetor iris’
  -possible lymph nodes involvement

Question 12

list the toxic substances found in smoking

Answer 12

particles - nicotine,benzene,benzopyrene
gases- hydrogen cyanide, carbon monoxide,ammonia, formaldehyde, dimethylnitrosamine,arcolein

Free radicals

Continue - metabolite of nicotine which measures exposures to tobacco smoke

Question 13

describe pathogenesis of smoking

Answer 13

local and systemic effects not fully understood
-inhibition of phagocytosis of neutrophils
-reduction in chemotaxis and migration or rural PMNs exposed to nicotine
- nicotine affects PMNs respiratory burst
- nicotine adversely affects fibroblast function and penetrates oral epithelium - reduced antibody production serum IgG2
- altered peripheral blood immune regulatory T cell subset ratios in some studies
- reduced bone mineralisation
- cytotoxic vasoactive constituents
- adverse effect on micro circulation, gingival circulation,blood flow
- possible vasoconstriction of gingival capillaries but evidence inconsistent
- Chronic hypoxia of periodontal tissues
- high proportion of small blood vessels in smokers compared with large vessels but no difference in vascular density
- fewer gingival vessels in smokers

reduction in ICAM-1 expression may affect neutrophil emigration from vessels
- less gingival redness- less bleeding on probing
- fewer vessels clinically and histologically
- healing response may be affected by impairment of revascularisation

Question 14

describe smokers response to therapy

Answer 14

• smokers have poorer response to non surgical therapy
  -presumably relates to the cola, systemic and microbiological effects of smoking
• over 90% of refractory patients have been found to be smokers
• 6 month study shows inflammation decrease and GCF, Igg decreases to A.a and poorer peridotnla outcome in smokers

Question 15

what are the clinical implications of smoking

Answer 15

• advise your patients of adverse effects of smoking on their oral and periodontal health
• record giving advice In patients notes
• explain poorer response to periodontal therapy
• give smoking cessation counselling

Question 16

what is smoking cessation?

Answer 16

• brief advice from a heath professional can result in up to 5% of patients quitting smoking
• after smoking cessation, time dependent changed in periodontal tissues
• recovery of inflammatory response leads to transient increased bleeding (approx 6 months)
  return to normal architecture of gingival tissues (approx 12 months)

Question 17

what should be mention in smoking cessation

Answer 17

• nhs stop smoking service
  VBA
  ask, advice,act
  smokers up to 4X more likely to quit with support

Question 18

describe what E cigarettes are?

Answer 18

do not contain tobacco
do not produce tar or carbon monoxide
heat solution that typically contains nicotine, propylene glycol and/or vegetable glycerine and flavourings

Question 19

what is physiological stress?

Answer 19

• psychological stress can be defined as the phsyciologicla or psychological changes that occur in the body when an external demand or stressor taxes an individuals adaptive capacity
  -Psychologicla stress refers to the emotional and phsyciologicla reactions experienced when a person confronts a life event, such as marital conflict, financial debt or death of loved one, that exceeds his or her ability to cope effectively with the situation

Question 20

describe types of psychological stresses

Answer 20

• disasters or crises e.g major floods,earthquake or wars
• major life events; marital separation imprisonment,death of a close family member
• micro-stressors eg. daily hassles can have same negative impact as any major stressful event - different for each individual
  -also categorised as -a cute stressor- shrift term and time limited events/chronic stressors; conditions that a re long lasting

Question 21

how is stress induced

Answer 21

stress induced response transmitted to the hypothalamus- pituitary adrenal-axis
- Corticotrophin-releasing hormone from hypothalamus
- Adrenocorticotropic hormone form pituitary
- Glucocorticoids form adrenal cortex which. decreases production of proinflamamtory cytokines