Smoking and Periodontium

[Ritika Bhat]

Effects of smoking on periodontium : . decrease in inflammation and bleeding on probing

. increase in the prevalence and severity of periodontal destruction.

. increase in pocket depth, attachment loss and bone loss.

. increase in colonization of periodontal pathogens in shallow periodontal pockets.

. increase of periodontal pathogens – B. FORSYTHUS
P.GINGIVALIS
A.ACTINOMYCETEM COMITANS

. altered neutrophil’s function of phagocytosis and chemotaxsis.

. increase in TNF – alpha and PGE2 in gcf , increase in collagenase and elastase

. increase in matrix mettaloproteinase and decrease in IgG2

. decrease in gcf and in gingival blood vessels.

. decrease in subgingival temperature and increase in time to recover from Local anaesthesia.

Contents of tobacco :

Nicotine : Most toxic conetnt
triggers the release of dopamine in brain and associated with the feeling of pleasure
increase in heart rate and blood pressure.
increase in platelete stickiness and aggregation and damage to lining of blood vessel.
nitrosamine – potent carcinogene
adult lethal dose- 30-60mg

Tar : particulate matter inhaled and in its condensed form it is sticky brown and stains finger and teeth yellowish brown.
benzopyrene a polycyclic aromatic hydrocarbon found in tar is carcinogenic

carbon monoxide: binds to haemoglobin 200 times more than oxygen

nitric oxide : responsible to initiate lung damage leading to emphysema

hydrogen cyanide and ciliatoxic agent : lung damage

metal : Ni and Cd :carcinogenic

Patients exposure to tobacco smoke can be measured by following ways:

1. Questionare and biochemical analyses.

2. Exhaled carbon monoxide in breath.

3. Cotinine ( a metabolite of nicotine) in saliva , plasma/ serum or urine
cotinine is more reliable than nicotine because cotinine has half life of 14- 20 hrs as compared to nicotine – 2-3 hrs

4. Plasma and saliva cotinine concentration in
smoker : 300 ng/ml
non- smoker : 2 ng/ml

        

[drmithila]

Smoking has been linked by doctors as being one of the biggest reasons for gum disease. Numerous studies have been done that show that there is a connection between smoking mouth disease, including cancer. Most show you can be 4 to 5 times more likely to have gum disease if you are a smoker. It can be really hard to kick the smoking habit once you are already addicted. Here are the things you need to know if you think you may have periodontal disease:
YOU ARE LIKELY GOING TO GET GUM DISEASE IF YOU KEEP SMOKING

You are likely going to develop periodontal disease later in life if you keep smoking. If you are smoking now, you will likely develop problems as you get into your 30s and 40s. If you are older than that and haven’t developed any gum conditions from smoking cigarettes, you should consider yourself lucky.
THE BEGINNING SIGNS OF GUM DISEASE BEGIN AS EARLY AS THE TEENAGE YEARS

Most people start smoking when they are a teenager. For some teens, they are peer-pressured into smoking. It is a rite of passage into adulthood. Once you get older, you realize how naïve you were in your younger years. If you always have bad breath everyday, this could be a sign of gum disease. Another sign is if you are not brushing your teeth religiously two times a day.
YOU CAN STILL REVERSE THE TREND TO GET GUM DISEASE IF YOU STOP SMOKING

A lot of these same studies have shown that people that stopped smoking years ago are at no greater risk to developing gum disease than the general public. If you can quit smoking now, you have a chance to lower your risk.

 

        

[Drsumitra]

The tar and other products in smoking tobacco will turn teeth yellow after a period of time. This actually can also happen to the tips of the fingers used to hold the cigarette as well. Brushing after every cigarette is really not practical and this is probably the only way to prevent the yellowing from occurring.
SMOKING AND GUM DISEASE
Studies show that there is definitely a connection between smoking and an increased risk of gum disease. In addition there are other periodontal diseases that you are at a higher risk for if you smoke. Some of these are:
Bad Breath
Tooth Loss
Bone Loss
Gum Recession
Mouth Sores
MOUTH CANCER
Smoking increases the risk of certain types of cancers and among these is mouth cancer. Mouth cancer generally begins as a sore on the mouth that will not heal or go away. It can occur on the mouth, gums, roof of the mouth or even on the lips. Some of the other symptoms of mouth cancer are:
Jaw Pain
Sore Throat
Difficulty Swallowing
Sores that will not go away
Loose Teeth
White patches inside your mouth

 

        

[drmithila]

Scientists in the USA have discovered why smokers may be more prone to chronic gum disease (periodontitis). One of the bacteria responsible for this infection responds to cigarette smoke – changing its properties and the way it infects a smokers mouth.
The study published recently in the Society for Applied Microbiology journal Environmental Microbiology, showed that the bacterium Porphyromonas gingivalis adapts and changes its DNA and membrane proteins in response to cigarette smoke.
Several genes of P. gingivalis associated with its virulence (infectivity), detoxification, oxidative stress mechanisms and DNA repair are altered by exposure to cigarette smoke. As a result, the expression of a number of the proteins in the cell membrane is changed. This affects important characteristics of the bacterial cells themselves and how the immune system recognizes this pathogen.
This could explain why smokers are more likely to be resistant to treatment for periodontitis and are more susceptible to oral disease caused by infection with P. gingivalis.
Finding an effective treatment for smokers infected with P. gingivalis will be easier now that these changes in the bacterium’s ‘properties’ have been identified.
University of Louisville researcher, Dr David Scott said: “It has long been known that smokers are more susceptible to periodontitis than are non-smokers. However, the reasons why are not so clear. Our study shows, for the first time, that components in cigarette smoke alter key characteristics of a major bacterial pathogen which, subsequently, changes how our immune system reacts to it. It may turn out that we need to develop alternate treatment plans for smokers and non-smokers”

        

[drsushant]

Nicotine gum has been in use for over 20 years to help smokers quit abruptly yet close to two-thirds of smokers report that they would prefer to quit gradually. Researchers from the University of Pittsburgh and GlaxoSmithKline Consumer Healthcare have now found that smokers who are trying to quit gradually can also be helped by nicotine gum.
The results of the first study to test the efficacy and safety of using nicotine gum to assist cessation by gradual reduction are published in the February 2009 issue of the American Journal of Preventive Medicine.
Almost 3300 smokers participated in this double-blind, placebo-controlled study. Participants were enrolled in 27 study sites across the US. Participants were allowed to choose between 2-mg and 4-mg doses of nicotine gum, with the higher doses generally being selected by heavier smokers. Within each dose group, participants were then randomized to receive either the active gum or a placebo, yielding 4 approximately equal groups.
The study assessed initial 24-hour abstinence and 28-day abstinence, and participants were followed up at 6 months to determine overall success rates for quitting. The odds of smokers achieving 24-hour abstinence were 40 to 90% higher using active gum compared to placebo, and 2 to 4.7 times higher for attaining 28-day abstinence. At the end of 6 months, while absolute quit rates were somewhat low, the odds of quitting were about 2 to 6 times greater for active gum users as for the placebo users, with a quit rate of 6% in the 4-mg group.
The study also evaluated the safety of using nicotine gum while reducing smoking. The authors report that no unexpected adverse events were observed, even among those who most heavily smoked and used gum, concluding that “Using nicotine gum while smoking carries little to no incremental risk.”
Writing in the article, Saul Shiffman, states, “This is the first study to demonstrate that smokers wanting to quit by gradual reduction can substantially increase their success by using nicotine gum to facilitate reduction and cessation. Nicotine gum helped smokers reduce smoking, achieve initial abstinence and maintain abstinence. The advantage of active nicotine replacement therapy (NRT) treatment is particularly evident for heavy smokers treated with the 4-mg nicotine gum, for which treatment increased the odds of quitting for 6 months sixfold. This expands treatment options for the substantial proportion of smokers who prefer quitting gradually, who have relatively low chances of quitting and who have heretofore been implicitly excluded from the use of NRT to help them quit. Offering this new way to use NRT may enhance the appeal and reach of a treatment that increases success, and thereby have positive public health impact. Given the ongoing extraordinary health toll from smoking, consideration should be given to novel approaches that increase success in quitting.”

        

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