The past effects of smoking on periodontium cannot be reversed but smoking cessation is beneficial to periodontium.
In a study by Grossi SG, Zambon J in 1997, it has been found that amongst current, former and non-smokers, both never and former- smokers respond more favorably to therapy than current smokers.
Moreover, it has also been found that there is an early benefit of smoking cessation.
In a study by Bain CA in 1998 where the effects of smoking cessation on implant failure was assessed, it was observed that patients who quit smoking for 1 week before and 8 weeks after implant placement had significantly lower failure rates than those who continued to smoke. Failure rates in these patients were not significantly different from non- smokers.
For these reasons American Academy of Periodontology (AAP) strongly recommends than inclusion of Tobacco counseling in periodontal therapy.
Tobacco Counseling and periodontal therapy –
There is a lack of direct experimental evidence indicating that quitting smoking or reducing current exposure will significantly affect the risk of developing periodontitis and / or outcomes of periodontal therapy.
The detrimental effect of smoking on both periodontal health and Periodontal therapy seems to be dose dependent.
Both, the rate of progression of periodontitis and the expected treatment outcomes are more favorable in former smokers than in current smokers and not dissimilar from those in never smokers.
A’s for Comprehensive Intervention
Ask – Identifying patient’s tobacco use status (current/former/never). Question regarding tobacco use should be part of health questionnaire.
Advise – Smoking cessation is beneficial.
Assess – patient’s interest and readiness to attempt tobacco cessation.
Assist – in helping the patient quit the habit of cigarette smoking.
Pharmacotherapy
1.Nicotine Replacement Therapy –
2.Nicotine chewing gum/nicotine lozenges/nicotine patches/ nicotine nasal sprays/ nicotine inhalers.
3.For patients who smoke less than 20 cigarettes/day – patch is most popular form of replacement.
4.Patients who smoke more than 20 cigarettes per day – patch for constant nicotine blood levels & any one of these products (gum/nasal spray/lozenge/inhaler).
5.Sustained release bupropion – helpful in heavy smokers or smokers who have experienced multiple failed cessation attempts.
6.Bupropion sustained release – 150 mg. every morning for 3 days, then 150 mg. twice daily (begin treatment 1 to 2 weeks precessation) for 7 – 12 weeks. Can be used for up to 6 months for maintenance therapy.
7.Nicotine gum – 1 to 24 cigs/day – 2 mg. gum, 25+ cigs/day – 4 mg. gum (upto 24 pieces/day) for 12 weeks.
8.Nicotine inhaler – 6 to 16 cartridges/day – upto 6 months.
9.Nicotine nasal spray – 8 to 40 doses/day for upto 6 months.
10.Nicotine patch – 22 mg./24 hours for 4 weeks, 14 mg./24 hours for next 2 weeks, 7 mg./24 hours for next 2 weeks, 15 mg./16 hours for next 8 weeks
11.Nicotine lozenges – use 2 mg. lozenge (if first cigarette is 30 min. or more after awakening)
– use 4 mg. lozenge (if first cigarette is less than 30 min. after awakening)
– Weeks 1 to 6 – 1 lozenge every 1 to 2 hours
– Weeks 7 to 9 – 1 lozenge every 2 to 4 hours
– Weeks 10 to 12 – 1 lozenge every 4 to 8 hours
Relapse Prevention
â—¦Tendency for relapse is high
â—¦Alternate treatment approaches might be indicated
â—¦Smokers generally have multiple failed attempts before long term success can be achieved with quitting smoking.
â—¦Discussions should include benefits of cessation and problems that they encountered.
â—¦Scheduling follow up visits, sending notes and making telephone calls of support help patient remain abstinent.
â—¦Of all the preventive services traditionally offered by a dentist, those related to tobacco cessation are by far the most beneficial to the patient relative to general health and quality of life.
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