This document discusses the effects of smoking on periodontal disease. It finds that smokers have higher levels of certain periodontal pathogens compared to non-smokers. Smoking alters the immune response by impacting neutrophil function, cytokine levels, antibody production, and fibroblast activity. Physiologically, smoking decreases signs of inflammation, reduces gingival blood flow, and delays healing. Regarding treatment, smoking decreases the response to non-surgical therapy, surgery, grafts, and maintenance by reducing clinical improvements and increasing disease recurrence. The document concludes smoking cessation should be recommended prior to implant placement.

1. Dr Jaffar Raza Syed
SmokingSmoking & PDD
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Microbiology
--Smokers had higher level of
B. forsythus.
A. actinomycetemcomitans
P. gingivalis
Remaining in the pocket after therapy when compared to nonsmokers.
--Fusobacterium nucleatum,
--S.vincentii,
--P. gingivalis,
--P. intermedia,
--Peptostreptococcus micros,
--Prevotella nigrescens,
--B. forsythus
were significantly more prevalent in current smokers than in nonsmokers and
former smokers

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Immunology
• Altered neutrophil chemotaxis, phagocytosis and oxidative burst.
• Increased TNF- α, and PGE2 in GCF.
• Increased production of PGE2 by monocyte in response to LPS.
• IgG2 level is reduced suggesting reduced protection against
periodontal infection.
• Nicotine, a major component of tobacco adversely affect
fibroblast function.
• Tobacco products alter normal reparative and regeneration potential
of periodontium.

5. Dr Jaffar Raza Syed
Physiology
• Reduced signs of inflamation
• Decreased gingival vessels
• Decreased GCF flow and bleeding on probing
• Decreased subgingival temperature
• Increased time needed to recover from
inflamation due to alter inflamatory response
gingival vessels with increased inflammation.
bleeding on probing with increased inflammation
temperature.
• Increased time needed to recover from local anesthesia.
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due to alter inflamatory response
increased inflammation

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Effect Of Smoking On The Response To Periodontal Therapy
Non-surgical
• Decreased clinical response to scaling and root planing
• Decreased reduction in pocket depth
• Decreased gain in clinical attachment level.
• Decreased negative impact of smoking with increased level of plaque control.

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Surgery and implants
• Decreased pocket depth reduction post surgery.
• Increased deterioration of furcation post surgery.
• Decreased gain in clinical attachment level, decreased bone fill,
increased recession and increased membrane exposure following
guided tissue regeneration (GTR).
• Decreased pocket depth reduction after DFDBA allograft.
• Decreased pocket depth reduction and gain in clinical attachment level
after open flap debridement.
• Conflicting data on the impact of smoking on implant success.
• Smoking cessation should be recommended prior to implant.

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Maintenance
• Increased pocket depth during maintenance.
• Decreased gain in clinical attachment level.
Recurrent (refractory) Disease
• Increased recurrent/refractory disease in smokers.
• Increased need for retreatment in smokers.
• Increased need for antibiotics in smokers to control the negative effect
of periodontal infection onsurgical outcome.
• Increased tooth loss in smokers after surgical therapy.