Smoking and the Oral Cavity Flashcards
Describe the effect of nicotine on the gingiva
- Nicotine is a vasoconstrictor (restricts the flow of blood to the gingiva)
- Gingiva need a steady flow of blood in order to stay oxygenated and receive the nutrients they need to keep them healthy
- Nicotine also reduces the mouth’s ability to produce saliva
Describe the appearance of gingival tissue affected by smoking
- Little gingival inflammation or edema (due to vasoconstriction)
- Reduced BOP and reduced bleeding
- Reduced GCF
- A tendency to develop a fibrotic appearance
- Palatal changes- nicotine stomatitis
- Potential pathological changes (e.g. leukoplakia, cancer)
Discuss the effects of smoking on the prevalence and severity of gingivitis
- Reduces inflammation
* Reduces bleeding upon probing
Discuss the effects of smoking on the prevalence and severity of periodontal disease
- Smoking increases the prevalence and severity of periodontal destruction
- There is a DECREASED prevalence and severity with smoking cessation
- It increases the occurrence of severe periodontitis
- Increases the rate of destruction
- Increased pocket depth, attachment loss and bone loss
- Increases the tooth loss
- High prevalence is associated with the high amounts of smoking per day
Discuss the effects of smoking on microbiology
- Periodontal pathogens colonise shallow pockets
* High levels of periodontal pathogens in deep pockets
Discuss the effects of smoking on the immune/inflammatory response
- Altered; neutrophil chemotaxis, phagocytosis and oxidative bursts
- Increased levels of TNF-a and PGE2 in GCF
- Increased neutrophil collagenase and elastase in GCF
- LPS causes monocytes to produce high levels of PGEs
Discuss the physiological effects of smoking
- Decreased gingival blood vessels
- Increased inflammation
- Decreased GCF
- Decreased bleeding upon probing
- Decreased subgingival temperature
- Increase time needed for local anaesthesia to work and go away
Describe how neutrophils are impacted by smoking
- Altered neutrophil chemotaxis
* Increased collagenases
List the types of periodontal treatment
- Non-surgical
- Surgery and implants
- Maintenance and care
Describe the effects of smoking in response to non- surgical periodontal treatment
- Decreased positive response to root surface debridement
- Little effect in reducing pocket depths
- Little effect in gaining attachment levels
- The only good thing is there is a decreased impact of smoking and high level of plaque control
Describe the effects of smoking in response to surgery and implant treatment
- Little reduction in pocket depth (after bone grafts)
- Little gain in clinical attachment levels after access flap surgery
- Possibly worsened furcations
- Little bone fill
- Increased recession
- Increased membrane exposure after tissue regeneration
- No root coverage even after grafting for localised gingival recession
- High risk of implant failure and peri implantitis
Describe the effects of smoking in response to maintenance care
- During maintenance therapy, there are increased pocket depths and attachment loss
- Increased disease recurrence
- Increased need for retreatment
- Increased tooth loss even after surgical therapy
Recognise the common oral manifestations of smoking on the periodontium
- Nicotine Stomatitis (Smokers palate)
- Smokers Melanosis
- Hairy Tongue
- Oral Thrush (because smoking impairs immune response)
- Tobacco pouch keratosis
- Leukoplakia
- Squamous cell carcinoma
- Extrinsic staining
- Halitosis
discuss the effects of smokeless tobacco on the oral cavity
- comes in pouches that are placed in the sulcus of the cheek where it is left to sit in the mouth
- chewing and sucking allows for nicotine to be absorbed into the bloodstream through tissues in the mouth
- results in an increased inflammatory response in the tissues
- increased inflammatory response= accelatered breakdown of the periodontium and gingival recession at sit of placement
state general causes of smoking-related lesions such as smoker melanosis and nicotine stomatitis
- irritants such as toxic compounds found in smoke
- xerostomia due to high temperature and inhalation of smoke
- impaired host ability to manage viral and fungal infections
