GOOD MORNING

Submitted by SARANYA S GUIDED BY DR.MAHMOOD MOOTHEDATH

periodontium

 INTRODUCTION  SMOKING HABITS IN INDIA  TOXICITY OF TOBACCO SMOKE  SMOKING AND HOST RESPONSE  TOOTH BRUSHING BEHAVIOUR  SMOKING AND ORAL MICROBIALS  Contd…….

 Plaque formation  Calculus formation  Smoking and gingival inflammation  Smoking and gingival bleeding  Effects of smoking on prevalence and seveiourity.  Effects on etiology and pathology.  Effects on response to therapy.  Scope of primary prevention  Conclussion

 Cigerette, hookah, chilum  Beedi, dhumti  Cigar/cheroot/chutta  Reverese chutta smoking  Gudakhu

dhumti Reverse smoking pipe chillum hookah

 Contents  benzanthracene, hydrogencyanide,  Alkaloid- nicotine  - autonomic stimulation increase heart rate increase cardiac output increase BP and peripheral vasoconstriction

 Nicotine metabolites concentrates in periodontium  Promotion of vasoconstriction  Effects on WBC  Reduce flow of gingival exudate

 Smokers have more plaque  Highercalcium concentration in dental plaque  More plaque remaining after tooth brushing  Behavioural difference – poorer oral cleanliness

Lowering of oxidation-reduction potential Increase anaerobic plaque bacteria Phenols & cyanides – antibacterial & toxic Greater risk of infection with Tanarelle forcithensis Porphyromonas - subgingival infection

 Smokers have poor oral hygiene  Increase plaque deposits

 Smokers have more calculus  Pipe smokers salivate more  More calculus formation due to increased salivary flow  Increased calcium concentration following smoking  Calcium phosphate,organic components- proteins & polypeptides derived from saliva

 Heavy smokers have grayish discouloration & hyperkeratosis of gingiva  Smokig- etiologic factor in ANUG  Tar- irritating effects on gingiva giving rise to gingivitis  Nicotine cause contraction of capillaries  Reduction in clinical signs of gingivitis

 Nicotine stimulate sympathetic ganglia- produce neurotransmitters (catecholamines) vasoconstriction clinical signs of gingival inflammation-less evident

 GINGIVITIS  Reduced development of inflammation in response to plaque accumulation  Less gingival inflammation & bleeding on probing  PERIODONTITIS  Risk factor for increasing the prevalence & severity of periodontal destruction  Contd…….

 Older adult smokers- severe periodontal disease,tooth loss,coronal root caries  Increased severity of generalised aggressive periodotitis  Highest risk for tooth loss, attachment loss, bone loss  Risk decreases with increasing number of years since quitting smoking  Effects of smoking on host are reversible

 MICROBIOLOGY  No effects on rate of plaque accumulation  Increase colonization of shallow & deep periodontal pockets by periodontal pathogens IMMUNOLOGY Altered neutrophil chemotaxis, phagocytosis, & oxidative burst Increase TNF-Alpha & PGE2 in GCF Contd….

 Increase neutrophil collagenase & elastase in GCF  Increase production of PGE2 by monocytes in response to LPS  PHYSIOLOGY  Decrease gingival blood vessels with increase inflammation  Decrease GCF flow & bleeding on probing with increase inflammation  Decrease subgingival temperature  Increase time needed to recover from local anesthesia

 NONSURGICAL  Decrease clinical response to scaling & root planing  Decrease reduction in pocket depth  Decrease gain in clinical attachment levels  Decrease negative impact of smoking with increase level of plaque control  Contd….

 SURGERY & IMPLANTS  Decrease pocket depth reduction after surgery  Increase deterioration of furcation after surgery  Decrease gain in clinical attachment levels, decrease bone fill, increase recession & increase membrane exposure after GTR  Decrease pocket depth reduction after DFDBA  Contd….

 Decrease pocket depth reduction & gain in clinical attachment levels after open flap debridement  Conflicting data on the impact of smoking on implant success  Smoking cessation shoud be recommended before implants  Contd….

 MAINTENANCE  Increase pocket depth during maintenance therapy  Decrease gain in clinical attachment levels RECURRENT DISEASE  Increase recurrent disease  Increase need for re-treatment in smokers  Increase need for antibiotics to control negetive effects of periodontal infection on surgical outcomes  Increase tooth loss in smokers after surgical therapy

 Several week following smoking cessation, gingival inflammation & bleeding on brushing occurs bacause of smoking cessation, gingiva loses its thick fibrotic appearance & assumes normal anatomy

 5 STEP PROGRAM RECOMMENDED BY AGENCY FOR HEALTH CARE RESEARCH & QUALITY  5 “As” 5 “R”  1.Ask 1.Relevance  2.Advise 2.Risk  3.Assess 3.Rewards  4.Assist 4.Roadblocks  5.Arrange 5.Repeat

 Poorer oral hygiene in smokers  Smoking causes a marked increase in salivary flow-accumulate increased amounts of calculus  Increase the mineralizing potential of saliva  More plaque in smokers  Smoking appears to suppress visible gingival inflammation  Contd….

 Smokers have severe destructive periodontal disease, deeper periodontal pockets & more alveolar bone loss  Tobacco smoke- strong reducing capacity- in favour of anaerobic micro-organism- predispose oral infection by anaerobes- ANUG  Smoking depress activity of oral PMNs  Reduced bloodflow in gingiva & output of GCF  Decrease immune components in gingival crevice  Impair periodontal wound healing- nonsurgical & surgical therapy

 Carranzas Clinical Periodontology  Clinical Periodontology & Periodontics- Shantipriya Reddy  Tobacco related mucosal lesions & conditions in India- Mehta & Hammer  Internet-  Preventive & Community Dentistry – Soben Peter

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