Periodontal disease and smoking Flashcards
why are pack years important?
the higher the pack years- the higher the risk of PD
how do you calculate pack years?
no. of cigarettes per day x no of years smoked divided by 20 (1 pack)
what must you always ask smokers?
- how many
- how long
- how long have you stopped for and how long were you smoking/how many years
how many cigs in:
1g pipe tobacco
small cigar
large cigar
1 cig
3 cigs
5 cigs
what is seen clinically with a smoker?
- deeper pockets
- more bone loss
- more tooth loss
- more furcation involvement
- more LOA
- more calculus due to increase salivary flow rate due to irritants
- more plaque- more likely to be above disease TH
- more dark staining
- keratinisation due to irritants in smoking
- gingivae appear pale and healthy
- lack of BOP
- increased risk of oral cancer
- xerostomia
what is different about smoking as a risk factor?
- it causes both local (increased PR) and systemic (affects IR) effects
what is the impact of smoking on non-surgical and surgical treatment?
poorer response to treatment
what evidence is there that smoking cessation is effective?
- LONGITUDINAL STUDIES SHOWING REDUCED BL AND TL IN THOSE WHO QUIT SMOKING COMPARED TO SMOKERS
- pershaw study over 12 months found 0.3mm reduced pocket depths in those who quit smoking compared to smokers
- the longer patients stop- the more likely they will response will be like that of non-smokers
those with PD- who quit smoking, what should you warn them?
rebound effect- bleeding will “increase” but this is due to masking not due to worsening of disease
- occurs within 2 weeks of stopping
what are the 3 stages of smoking cessation?
pre-contemplative- not interested
contemplative- interested but not ready
active quitter- making attempt
explain 5As of smoking cessation
ask about smoking- type, how long how many
advise of risks of smoking on the periodontium and the benefits of quitting - brief intervention
assess their willingness or readiness to quit
assist in their quitting attempt- NRT or NNRT or refer to GP/pharmacy for further advice
arrange- follow up to praise and motivate pt on quit attempt
what is a brief intervention?
- less than 5 mins
- link to current situation in very casual terms
- inform them you need to discuss it and write it in notes
- pts often don’t respond to cessation advice if they feel lectured
if someone is pre-contemplative what should you do?
5 Rs
-relevance to dentistry- often patients only link smoking to general health
- risks involved with smoking- tooth loss, oral cancer risk
rewards- hold onto teeth for longer- better aesthetics
roadblocks- is there anything that may be stopping them at that moment e.g stress/bereavement
repetition- repeat at each checkup and add to clinical notes
what are the effects of smoking on the periodontium?
reduced inflammatory effects: due to
- reduced vasodilation
- reduced vascularity (fewer large bvs more smaller)
- reduced leakiness of bvs
- nicotine is a vasoconstrictor but in human studies reduced inflammatory effects actually due to reduction in vascularity of tissue
- reduction in neutrophils and their function and motility of neutrophils
- increase in MMPs (collagenases) which breakdown collagen and ECM
- reduction in fibroblasts needed for healing
- reduced GCF due to reduced inflammatory response meaning periopockets not flushed and immune cells do not reach pockets to kill bacteria
- reduced immune cells and inflammatory infiltrate including immunoglobulins
- reduced helper T cells which send signals and activate macrophages, killer T cells and B cells
- more periopathogens due to less immune cells killing bacteria
- causes gingivae appears healthy due to lack of BOP, and increased keratinisation
explain how smoker respond to healing
- little initial inflammation therefore little or no reduction in ppds
- reduced fibroblasts which are essential to healing therefore less gingival collagen fibres laid down- less improvement in elasticity and less gingival shrinkage as less tightening of gingival cuff
- LITTLE GAIN IN ATTACHMENT DUE TO REDUCED EPITHELIAL FUNCTION TO FORM NEW LJE
- REDUCED VASCULARITY SO LITTLE O2 AND NUTRIENTS NEEDED FOR HEALING REACH TISSUE
