Prepared by: Athraa A. Mahmood

M.Sc. of Periodontics

• Smoking is harmful to every organ in the body, and it is associated

with multiple diseases include lung cancer, heart disease, stroke,

emphysema, bronchitis, and cancers of the oral cavity, bladder, kidney,

stomach, liver, and cervix.

• Smoking: It is the major risk factors for increasing prevalence and

severity of periodontal disease.

• Risk factors can be divided into 2 types:

1. Intrinsic factor.

2. Extrinsic factor.

Tobacco smoke contains over 4,000 of chemicals, many of which are harmful.

These include:

1. Benzene: solvent used in fuel manufacture.

2. Formaldehyde: highly poisonous, colorless liquid used to preserve dead

bodies.

3. Ammonia: the delivery of nicotine. chemical found in cleaning fluids. Used in

cigarettes to increasethe delivery of nicotine.

4. Hydrogen cyanide: poisonous gas used in the manufacture of plastics, dyes,

pesticides and often used as a fumigant to kill rats.

5. Cadmium: extremely poisonous metal found in batteries.

6. Acetone: solvent found in nail polish remover.

Potent carcinogens:

A. Nitrosamines.

B. Polycyclic aromatic hydrocarbon.

C. Radiation-emitting polonium.

Components of inhaled smoke:

1. Carbon monoxide: is a poisonous gas found in car

fumes, which reduces the amount of oxygen carried

in the blood.

2. Tar: is the sticky brown substance proven to cause

cancer and stains fingers and teeth to the yellow and

brown colours.

3. Nicotine: which is an alkaloid, is found within the

tobacco leaf and evaporates when the cigarette is

lighted. It is quickly absorbed in the lungs, and it

reaches the brain within 10 to 19 seconds. Nicotine is

highly addictive.

Nicotine action

Nicotine can be causes:

Retards growth of gingival fibroblasts.

Reduces fibronectin & collagen.

Increases breakdown collagen.

A rise in blood pressure.

Increased heart and respiratory rates.

Peripheral vasoconstriction.

• Cross-sectional and case control studies demonstrate a

moderate to strong association between smoking and PD.

• Smokers are four times as likely to develop periodontitis

as non-smokers.

• Smoking may be responsible for more than half of the PD

among adults.

• up to 90% of refractory periodontitis patients are smokers.

Epidemiological evidence

Effect of Smoking on the oral hygiene

Several studies demonstrated higher levels of oral debris in

smokers than in non-smokers.

Increased levels of debris observed in smokers have been

tentatively attributed to personality traits leading to decreased

oral hygiene habits, increased rates of plaque formation, or a

combination of the above.

Effect of Smoking on the plaque

1) Reduction of the gingival inflammations.

2) Reduction of bleeding on probing due to

vasoconstrictive (effect of nicotine).

The effect of smoking on gingivitis is:

A. Increase the prevalence and severity of periodontal destruction.

B. Increase pocket depth, attachment loss, bone loss.

C. Increase the prevalence of sever periodontitis and tooth loss with

increase the number of cigarettes smoked per day.

D. Decrease prevalence and severity with smoking cessation.

The effect of smoking on periodontitis:

The microbiological effect of smoking an periodontal

disease are the followings:

Increase the levels of periodontal pathogens in the deep

periodontal pockets.

Increase the colonization of the shallow periodontal pockets by the

periodontal pathogens.

The immunological effect of smoking of the periodontal

disease are:

Impairment of chemotaxis and phagocytosis activities of

neutrophils.

Reduction in the production of the antibodies essential for killing

the bacteria, especially (IgG2).

Increase in the production of the TNF-α ,PGE2 and neutrophil

collagenase and elastase in the GCF.

↓ Gingival blood vessels and bleeding on probing with ↑

inflammation (vasoconstriction).

↓ Gingival crevicular fluid flow with ↑ inflammation.

↓ Subgingival temperature.

↑ Time needed to recover from local anesthesia.

The physiological effect of the smoking on the periodontal

diseases are:

The effects of smoking on periodontal therapy are:

Non-surgical Therapy

↓ Clinical response to root surface debridement..

↓ Pocket depth reduction.

↓ Gain in clinical attachment levels.

↓ Negative impact of smoking with

↑ level of plaque control.

↓ Pocket depth reduction and ↓ gain in clinical attachment levels

after access flap surgery.

↑ Deterioration of furcations after surgery.

↓ Gain in clinical attachment levels, ↓ bone fill,↑ recession, and ↑

membrane exposure after guided tissue regeneration.

↓ Root coverage after grafting procedures for localized gingival

recession.

↓ Pocket depth reduction after bone graft procedures.

↑ Risk for implant failure and periimplantitis.

Surgical Therapy

Maintenance phase :

↑ Pocket depth and attachment loss.

↑ Disease recurrence in smokers.

↑ Need for retreatment in smokers.

↑ Tooth loss in smokers after surgical therapy.

TOBACCO CESSATION

• The “5 A’s” To Intervention

1.ASK about tobacco use.

2.ADVISE to quit.

3.ASSESS willingness to make a quit attempt.

4.ASSIST in quit attempt.

5.ARRANGE for follow-up.

• Nicotine withdrawal: the 4 ‘D’s1. Drink water slowly

2. Deep breathe

3. Do something else (eg exercise)

4. Delay acting on the urge to smoke

pharmacotherapy

• Nicotine replacement (2-mg or 4-mg over 30-min.)

1. NRT: Nicotine patches: Common side effects skin

sensitivity and irritation

2. NRT: Nicotine nasal spray: Common side effects

nasal and throat irritation, coughing and oral burning

3. NRT: Nicotine gum: Common side effects

gastrointestinal disturbances and jaw pain

4. Nicotine Tabs: Common side effects burning

sensations in the mouth, sore throat, coughing, dry lips,

and mouth ulcers

•Bupropion(150mg bd)• The most common side effects are insomnia, dry mouth, headache

, nausea, constipation , and agitation.