This study examined the effects of cigarette smoking on gingival blood flow (GBF) in 12 healthy smokers. The experiment involved 4 phases - resting, sham smoking, smoking, and recovery. GBF increased slightly during sham smoking but rose significantly during actual smoking before returning to baseline within 10 minutes. There was great variability between individuals in their GBF responses to nicotine. Placing the probe in the gingival sulcus resulted in a linear rise in GBF, which was not seen when the probe was placed externally. The findings confirm that cigarette smoking profoundly impacts cardiovascular measures like blood pressure and heart rate, and conclusions were that smoking causes a significant increase rather than decrease in human gingival circulation.

1. Presented By :
Dr. Abhishek Gaur

2. Cigarette smoking has been associated with increased calculus
formation and periodontitis (Solomon et al. 1968, Bergstrom &
Floderus-Myrhed 1983, Feldman et al. 1983).
This association between poorer periodontal health and smoking
remains after taking account of age. oral hygiene, sex. race and
socioeconomic status (Ismail et al. 1983).

3. An even stronger relationship exists between smoking and acute
necrotizing ulcerative gingivitis (ANUG).
Patients treated for this disease are almost invariably smokers
(Pindborg 1951, Kowoiik & Nisbet 1983).
In addition, the incidence of ANUG rises with increasing tobacco
consumption (Pindborg 1949. Goldhaber & Giddon 1964).

4. 12 healthy subjects, 6 men and 6 women, volunteered for the study.
The subjects' ages ranged from 19 to 25 years (mean = 22.4).
All were college students who habitually smoked cigarettes, consuming 5 to 15
per day
(mean= 10.8) for the past 2 to 8 years (mean = 4.7). Informed consent was
obtained
before each experiment using a form approved by the hospital's Human
Subjects Committee.

5. The experiments took place during the Swedish Fall and Winter in a
room maintained at 22-23''C.
Volunteers were excluded who lacked an intact buccal surface of the
upper left canine and first molar {nos. 23 and 26), or who reported
a history of hypertension, angina or emphysema.
Marginal gingiva appeared healthy at the test tooth; pocket depth
was < 3 mm and attachment loss < 1 mm.

6. Each experiment had 4 phase';: resting, sham smoking, smoking and recovery.
During the first phase, the subject rested quietly in the dental Chair for 5 min. During
sham smoking, the subject puffed on an unlighted filter cigarette every 30 s for 5 min,
A filter tip cigarette was used to prevent the subjects" contacting nicotine before
smoking, and yet simulate smoking's hyperventilation.
The interval between inhalations was standardized for both sham smoking and smoking
phases to control the effects of hyperventilation on blood flow.
The subjects were instructed to inhale as they would if they were actually smoking. An
audible signal was provided every 30 s to prompt the subjects when to puff.

7. Relative blood flow to the gingiva (GBF) increased slightly during sham
smoking by 2,8%.

8. As expected, smoking raised both the systolic and diastolic blood pressures. Mean
resting values of 110.5/70.5 mmHg remained unchanged during sham smoking,
increased to 119.0/75.7 mmHg during smoking, and returned to 113.6/73.3 mmHg 25
min later.

10. This study indicated that relative gingival blood flow (GBF) immediately
rose during smoking and rapidly returned toward baseline within 10 min.
Great variability in GBF was observed between smokers' responses to
nicotine in cigarette stroke. Placing the probe into the sulcus resulted in a
nearly linear rise in GBF during the experiment.
This phenomenon was not observed when the probe was removed from
the sulcus and placed external to the crestal gingiva

11. Our findings confirmed those of others regarding the profound
cardiovascular effects of cigarette smoking, LDF skin blood flow to
the forearm has been shown to decrease during and immediately
after smoking, but only in those subjects who had high levels of
plasma vasopressin (Waeber et al, 1984),

12. Our study also showed that 50% of the subjects' SBF dropped
during smoking; the other 50%'s SBF remained relatively
unchanged. Heart rate and BP also increased significantly with
smoking, thus confirming findings of others.
(Coffman & Javett 1963, Trap-Jenson et al, 1979. Lehtovirta & Forss 1980)

13. In conclusion, this study indicated that
cigarette smoking caused a significant increase,
rather than a decrease, in human gingival
circulation.

14. Thanking You