Smoking has significant negative effects on periodontal health and outcomes of periodontal treatment. Smoking increases the prevalence and severity of periodontal disease by reducing gingival inflammation and bleeding, increasing attachment loss and bone loss, and elevating levels of periodontal pathogens. Heavier smoking is associated with greater periodontal destruction. While smoking cessation decreases the risks, it does not fully reverse the effects of smoking on the periodontium.

1. Effect of different smoking habits on periodontitis
Presented By: Stéphanie Chahrouk

2. What does means?
“
Types of
"The action or habit of inhaling and exhaling the smoke of burning tobacco or a drug”
"Bidis are small, thin
hand-rolled cigarettes
consist of tobacco
wrapped in a tendu or
temburni leaf"
"Cigarettes is a
combination of cured and
finely cut tobacco
reconstituted tobacco and
other additives rolled or
stuffed into a
paperwrapped cylinder."
"Cigars, Cigarillos and Little
Cigars are made up of a
single type of air-cured or
dried tobacco."
"Dissolvable Tobacco This
type of tobacco is finely
processed to dissolve on
the tongue or in the
mouth."
"Electronic cigarette or E- cigarette is a
battery-powered device that contains a
cartridge filled with nicotine, flavor and
other chemicals. The ecigarrette is not a
tobacco product but a nicotine delivery
system. The e-cigarette turns the nicotine
and other chmicals into a vapor that is
then inhaled by the user"

3. Is safe?
 “Smoking is harmful to every organ in the body
o it is associated with multiple diseases include:
 lung cancer, heart disease, stroke, emphysema, bronchitis
 Cancers of the oral cavity, bladder, kidney, stomach, liver, and cervix.”
o “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:
o Benzene: solvent used in fuel manufacture.
o Formaldehyde: highly poisonous, colorless liquid used to preserve dead
bodies.
o Ammonia: the delivery of nicotine. chemical found in cleaning fluids.
Used in cigarettes to increasethe delivery of nicotine.
o Hydrogen cyanide: poisonous gas used in the manufacture of plastics,
dyes, pesticides and often used as a fumigant to kill rats.
o Cadmium: extremely poisonous metal found in batteries. 6. Acetone:
solvent found in nail polish remover.”
"Hookah or Arguila or Shisha:
is a pipe used to smoke
Shisha, a combination of
tobacco and fruit or vegetable
that is heated and the smoke
is filtrated through water."
"Kreteks are sometimes
referred to as clove
cigarettes."
"Pipes are often reusable and
consist of a chamber or bowl,
stem and mouthpiece.
Tobacco is placed into the
bowl and lit. The smoke is
than drawn through the stem
and mouthpiece and inhaled."

4. “ elements!?
What does contains?
What Does affect?
 “Retardsgrowthof gingival fibroblasts.
 Reduces fibronectin& collagen.
 Increases breakdowncollagen.
 A rise in bloodpressure.
 Increased heartand respiratoryrates.
 Peripheral vasoconstriction.”
"A.Nitrosamines." "B. Polycyclicaromatic
hydrocarbon".
"C. Radiation-emitting
polonium"
"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"

5. “Epidemiological evidence
 Cross-sectionalandcase 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.”
“Age, Sex, and Cigarette Smoking
 Ages30 to 59 whosmoke cigaretteshave twice the chance of havingperiodontal
disease orbecomingedentulousasdonon-smokers
 Significantdifferencein lossofalveolar bone heightwhencomparingmale andfemale
smokers.
 The effectsof smokingonperiodontal statustobe more pronouncedin younger
women.
 Thiswas inspite of the fact femalesandyoungersubjectsweregenerallyperiodontally
healthierthan theirmale and oldercounterparts.”
“Effect of Smoking on the plaque
 Several studiesdemonstrated higherlevelsof oral debrisinsmokersthaninnon-
smokers.
 Increasedlevelsofdebris observedinsmokershave beententativelyattributedto
personalitytraitsleadingtodecreasedoral hygiene habits, increasedratesofplaque
formation,or a combinationof the above.”

6. “
A. Plaque Development
a. Early observational studies report smokers showed a higher prevalence of dental
plaque than non-smokers
b. Other studies indicated smoking did not appear to increase the amount of
plaque when controlling for other factors”
B. “Subgingival MicroflorainPeriodontitis
a. actinomycetemcommitans, P. gingivalis, and T. forsythesis were higher among
smokers
b. increased counts of exogenous flora (Escheria coli and Candida albicans) have
been reported in smokers”

7. A. “Cigarette Smoking andGingivitis
a. smokers may present with lower levels of gingival inflammation to a specific
level of plaque than non-smokers
b. development of gingival inflammation in response to experimental plaque
accumulation (experimental gingivitis) was less pronounced in smokers than in
non-smokers”
B. “Cigarette Smoking andGingival Bleeding
a. Smokers expressed less gingival bleeding than nonsmokers.”
C. “Effect of Smoking on Gingival BloodFlow
a. In smokers, gingival blood flow was significantly increased by cigarette smoking.
b. However, intravenous administration of nicotine reduces the marginal
temperature of gingival sites suggesting a decrease in gingival blood flow which
leads to the hypothesis this phenomenon is caused by vasoconstriction induced
by nicotine and stress.
c. The light smokers responded with a significant increase in blood flow, but heavy
smokers showed no response, indicating a high level of tolerance”
D. “OxygenTensionin the Gingival Tissues
a. Oxygen saturation of hemoglobin is affected by cigarette smoking,
b. healthy gingiva smokers appear to have lower oxygen saturation
c. oxygen tension in periodontal pockets”

8. “ ”
A “Gingival Fibroblasts
a. Reductioninthe productionof Type 1 collagenandfibronectinandan increase inthe
collagenase activity
b. Cellularchangeslikedisruptionof cell orientation,changesincytoskeleton,presence of
large vacuoles,andsignificant reductionincell viability”
B “Periodontal Fibroblasts
a. Periodontal ligament(PDL) fibroblastsgrowthandattachmenttotissue culture plates
are inhibitedbynicotine athighconcentrations
b. PDL cell proliferation andproteinsynthesis are inhibited
c. Cell attachmentwassignificantly lessonrootsurfacesobtainedfromheavysmokers
comparedwithnonsmokersandhealthycontrols.”

9. “
 There’s a positive association between smoking and measures of periodontal disease.
 The existence of potential confounding factors such as socioeconomic status, education,
and, ultimately, the level of oral hygiene were revealed.
 Higher levels of oral debris in smokers than non-smokers.
 Smokers had a significantly higher prevalence of periodontal disease after correcting for
potential confounders; oral hygiene in particular.
 smokers have a tendency to display lower levels of oral hygiene, oral hygiene and/ or
socioeconomic factors alone are unable to account totally for the observed increase in
prevalence and severity of periodontal disease”
“Smoking and Periodontitis inYoung Adults (≤35 years)
o Young adultsmokersaged19-30 yearshad a higherprevalenceandseverityof
periodontitiscomparedtonon-smokersdespitesimilarorlowerplaque levels.
o Depths of ≥4 mm are three tofour times higherinyoungsmokers19-30 yearsof age
comparedto non-smokers.
o The high“periodontal cost”of smokinghasbeencalculatedas27 yearsof disease
progression.
o In otherwords,a 32-year-oldsmokerhadsimilarperiodontalattachmentlossasa 59-
year-oldnon-smoker.
o Recentstatisticsindicate more than23% of highschool studentsare currentsmokers”

10. “Smoking and Periodontitis inAdults
o Current smokers had deeper probing depths
o Greater attachment loss
o More bone loss,
o And fewer teeth.
o Smokers also exhibit more supragingival calculus deposits,
o Smokers were four times more likely to have periodontitis as compared to non-
smokers.
o Smoking is particularly important in the etiology of severe periodontal
attachment loss
o The most marked difference between smokers and non-smokers in probing
depths or attachment loss occurs in the maxillary lingual area and mandibular
anterior area, suggesting a local effect of smoking.”

11. “Effects of Smokeless Tobacco on Periodontal Tissues
o The habit of betel chewing with tobacco is a particular form of smokeless
tobacco consumption that is predominantly practiced in South Asian countries
like India and Sri Lanka
o It involves chewing a quid that includes betel leaf, lime, areca nut, and tobacco.
o Quantified tobacco use may significantly increase bleeding on probing and
periodontal attachment loss.
o Negative effect of the areca nut on host immunity by affecting PMNs.
o Areca nut extracts have also been shown to inhibit the growth, attachment, and
matrix protein synthesis of cultured human gingival fibroblasts.”
“
Non-surgical andSurgical Therapy
o The numerical differencesbetweensmokersandnon-smokersbecome more
pronouncedinprobingdepths ≥5mm, where smokersdemonstrated0.4mmto 0.6 mm
lessimprovementinclinical attachmentlevelsfollowingscalingandrootplanning.
Followingflapdebridementsurgery,smokersexperiencedupto1 mm less
improvementinclinical attachmentlevelsinprobingdepthsthatwere initially ≥7mm.”
Summary
“
Reduction of the gingival inflammations.
Reduction of bleeding on probing due to vasoconstrictive (effect of nicotine).”
“
Increase the prevalence and severity of periodontal destruction.
Increase pocket depth, attachment loss, bone loss.
Increase the prevalence of severs periodontitis and tooth loss with increase the number
of cigarettes smoked per day.
Decrease prevalence and severity with smoking cessation.”

12. “
Increase the levels of periodontal pathogens in the deep periodontal pockets.
Increase the colonization of the shallow periodontal pockets by the periodontal
pathogens.”
“
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.”

14. Sources:
- Tobacco Use and Its Effects on the Periodontium and Periodontal Therapy By
Vandana K. Laxman, The Journal of Contemporary Dental Practice, Volume 9,
No. 7, November 1, 2008.
-PubMed.gov