Smoking has significant negative effects on the periodontium and increases the risk and severity of periodontal disease in several ways:
1) Smoking alters the subgingival microbiota in favor of pathogenic species and impairs the host immune response, making the tissues more susceptible to bacterial infection.
2) Components of smoke such as nicotine, carbon monoxide, and tar are toxic to periodontal tissues and cells, impairing wound healing and reducing blood flow and oxygen levels in the gingiva.
3) Smokers have higher rates of periodontitis, greater attachment and bone loss, and their periodontal disease is less responsive to treatment compared to non-smokers. Quitting smoking can reduce disease
Smoking is a major environmental risk factor associated with Periodontitis. Cessation of smoking is essential to prevent the progression of periodontal disease and for maintenance of health.
Smoking and its influence on Periodontium and Periodontal Health
Enlists mechanism of nicotine addiction, its ill effects on individual aspects of the oral cavity and ways to quit smoking to improve health
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Smoking is a major environmental risk factor associated with Periodontitis. Cessation of smoking is essential to prevent the progression of periodontal disease and for maintenance of health.
Smoking and its influence on Periodontium and Periodontal Health
Enlists mechanism of nicotine addiction, its ill effects on individual aspects of the oral cavity and ways to quit smoking to improve health
Smoking and periodontal disease, smoking as a risk factor, incidence of smoking, effects of smoking on periodontium, smoking and gingivitis and smoking and periodontitis, effect of surgical and non surgical therapy on smokers
Bone loss and patterns of bone destructionvidushiKhanna1
- introduction
- bone resorption
- factors causing bone destruction in periodontal disease
-- destruction by extension of gingival inflammation
--- histopathology
--- pathways of spread of inflammation
--- radius of action
--- periods of destruction
---- mechanism of destruction
-- bone destruction caused by TFO
-- bone destruction caused by systemic disorders
- factors determining bone morphology in periodontal disease
-- normal variation of alveolar bone
-- exostosis
-- butressing bone formation
-- food impaction
-- agressive periodontitis
- patterns of bone destruction
-- horizontal bone loss
-- vertical or angular defects
-- osseous craters
-- bulbous bone contours
-- reversed architecture
-- ledges
- furcation involvement
-- classification
-conclusion
Health complications of various forms of tobacco such as Chewing tobacco, Snuff, Creamy snuff, Dipping tobacco, Gutka, Snus, Cigarette, Cigar, Bidi, Kretek and Hookah are discussed in this presentation.
It is a slide show about tobacco. It can be used for college seminars & other seminar related to cancer or tobacco......For description you can collect info's from internet of all slides.....A little editing is required as your need....
Smoking represents the most readily preventable risk factor for morbidity and mortality.
Smoking related disease will kill one in 10 adults globally.
There are more than 6 million smoker in KSA that represent about 30% from population in 2004.
Smoking and Cardiovascular Disease:
coronary artery disease
cardiac arrhythmias.
Atherosclerosis
Cigarette smoking increases blood cholesterol levels, causing a buildup of arterial plaque that narrows the blood vessels over time.
Blood Clots
Low Blood Oxygen
stroke
The Tobacco and Smoking Control Bill in Malaysia-Potential Implication In Fut...Ali Abu
Malaysia planned for generational end game (Generasi Penamat); by prohibiting sales of tobacco product and its alternative to people born after 2005.
Here, we would discuss on future implication; in term of public health, business economy, biodiversity and environmental.
24 04-2020 Bds third year lecture on smoking and periodontiumDr. Mamta Singh
Periodontitis is a group of inflammatory diseases affecting the supporting tissues of the tooth (periodontium). The periodontium consists of four tissues : gingiva, alveolar bone and periodontal ligaments. Tobbaco use is one of the modifiable risk factors and has enormous influance on the development, progres and tretmen results of periodontal disease. The relationship between smoking and periodontal health was investigated as early as the miiddle of last century. Smoking is an independent risk factor for the initiation, extent and severity of periodontal disease. Additionally, smoking can lower the chances for successful tretment. Tretmans in patients with periodontal disease must be focused on understanding the relationship between genetic and environmental factors. Only with individual approach we can identify our pacients risks and achieve better results.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
1. Smoking and its effects
on the
Periodontium and
Periodontal therapy
2. CONTENTS
• Introduction
• Epidemiological evidence
• Toxic subtances in tobacco
• Mechanism for negative effects of smoking on periodontium
• Effect of smoking on gingival & periodontal tissues
• Smoking and periodontitis in adults
• Smoking and ANUG
• Smoking and systemic health
• Smoking and oral health
• Effect on periodontal therapy
• Cessation of smoking
• Conclusion
3. Periodontal disease is defined as
inflammatory destruction of periodontal
tissue and alveolar bone supporting the
teeth.
Progression and severity of the disease
depends on complex interactions between
several risk factors such as microbial,
immunological, environmental and genetic
factors, as well as age, sex, and race.
.
INTRODUCTION
4. Tobacco smoking is a significant risk factor for
periodontal disease
Specific
pathogenic
bacteria
Host
immune
inflam-
matory
response
Connective
tissue &
bone
metabolism
Clinical
expression
of disease,
initiation
progression
Environmental &acquired risk factors
[SMOKING]
Genetic risk factors
Ag
LPS
Ab
PMNs
Cytokines,PGE2
MMPs
5. EPIDEMIOLOGICAL EVIDENCE
• Cross-sectional and case-control studies
demonstrate a moderate to strong association
between smoking and periodontitis[Hill’s criteria].
• Smokers are 4x as likely to develop
periodontitis as non-smokers.
• Smoking may be responsible for more than
half of the periodontal disease among adults.
• Up to 90% of refractory periodontitis patients
are smokers. (MacFarlane et al, 1992)
6. RISK ASSESSMENT -
ATTACHMENT LOSS
Variable Estimated odds ratio
Age 1.72 - 9.01
Smoking 2.05 - 4.75
Diabetes 2.32
P gingivalis 1.59
Education 0.65
(Grossi et al, 1994)
7. healthy low moderate high severe
40
30
20
10
0
Pack
years
ATTACHMENT LOSS AND SMOKING
(Grossi et al, 1994)
8. 10 year prospective study of
smoking and
periodontitis
[Bergstrom et al 2000]
Smokers lost significantly
more periodontal
bone compared to non-
smokers (p<0.001)
9. AGE, SEX, AND CIGARETTE SMOKING
Carranza stated women from ages 20 to 39
and men from ages 30 to 59 who smoke
cigarettes have twice the chance of having
periodontal disease or becoming
edentulous as do non-smokers
The effects of smoking on
periodontal status
to be more pronounced in
younger women.
[Goultschin et al.10]
10. PREVALENCE OF MODERATE AND
SEVERE PERIODONTITIS
• Current smokers - 25.7%
• Former heavy smokers - 20.2%
• Cigar/pipe smokers - 17.6%
• Non-smokers - 13.1%
[ Albandar et al 2000]
11. Stopping smoking (for 10 years)
reduces risk of
periodontitis to that of non-smokers
0-2 years -> OR=3.2
>10 years -> OR=1.2
The more you smoke the worse the
periodontitis
(dose response)
Smoking <10 cigs/day OR = 2.8
Smoking >30 cigs/day OR = 6.9
[Tomar and Asma 2000]
12. Tobacco contains over 4,000chemicals, many of
which are harmful. These include:
Benzene
- solvent used in fuel manufacture
Formaldehyde
- highly poisonous, colourless liquid used to preserve dead
bodies
Ammonia
- chemical found in cleaning fluids. Used in cigarettes to
increase the delivery of nicotine
Hydrogen cyanide
-poisonous gas used in the manufacture of plastics, dyes,
and pesticides.
- Often used as a fumigant to kill rats
Cadmium
- extremely poisonous metal found in batteries
Acetone
- solvent found in nail polish remover
13. COMPONENTS OF INHALED SMOKE
•Nicotine
•Carbon monoxide
•Tar
all of which can cause disease
POTENT CARCINOGENS
• Nitrosamines
• Polycyclic aromatic hydrocarbons
• Radiation-emitting polonium
14. Nicotine action
• Accelerates release of
neurotransmitter
dopamine in the
brain’s NA*
& increases
metabolism in NA
*NA = nucleus accumbens
15. •Nicotine retards growth of gingival
fibroblasts reduces fibronectin &
collagen increases collagen breakdown
Other actions are:
•raise blood pressure
•stimulants
•vasoconstriction
•psychological - social dependency
•physical dependancy - craving
16. CARBON MONOXIDE-ACTIONS
•Carbon monoxide is a poisonous gas found in
car fumes, which reduces the amount of
oxygen carried in the blood.
•Oxygen is vital for the body’s organs to
function efficiently.
• The reduction in oxygen changes the
consistency of the blood, making it thicker
and putting the heart under increased strain
as it pumps blood around the body
17. TAR-actions
•Tar contains many substances proven to
cause cancer.
•Irritants found in tar damage the lungs
causing narrowing of the tubes(bronchioles)
and damaging the small hairs (cilia) that
protect the lungs from dirt and infection
20. PERIODONTAL PATHOGENS
The proportions of subjects positive for
A. actinomycetemcommitans,
P. gingivalis, and T. forsythesis were higher
among smokers.
{Zambon et al.(1996),using a fluorescence
technique in a Cross sectional study from
Erie County Study population}
Furthermore, increased counts of
exogenous flora (Escheria coli and Candida
albicans) have been reported in smokers
21. SMOKING AND HOST RESPONSE
• Smoking decreases salivary IgA and
serum IgG,and specifically reduces
IgG2 levels against A.a.commitans
(Bennet & Read, 82; Barbour et al.,97).
• The ability of tobacco products to
decrease the proliferating capacity
of T and B lymphocytes might
contribute to this diminished
production of protective
antibodies.
22. • Smoking can exert deleterious effects on
polymorphonuclear leukocytes (PMN) and other
neutrophil functions such as chemotaxis &
phagocytosis so that they cannot efficiently deal
with the bacterial infection
(Kenney et al., 1977; Eichel & Shahrik, 1969; Selby et al., 1992).
• Impaired phagocytosis function of neutrophils among smokers
with refractory periodontitis. (MacFarlane et al., 1992).
23. In addition, tobacco smoking may modify
the production of pro-inflammatory
cytokines IL-1 and TNF-ᾳ which are
considered key regulators of the host
response to microbial challenge.
( Kornman et al. ,1997)
24. Genetic Polymorphism and Smoking
Investigators have looked at genetic variability,
its relationship with periodontal disease, and its
interaction with smoking.
Tooth loss reported a positive genotype of IL-1
increases the risk for tooth loss by 2.7 times,
while smoking increases the risk by 2.9 times.
When both were combined, the risk increased to
7.7 times.[JCDP’08]
26. Cigarette Smoking and Gingival
Bleeding
Smokers expressed less gingival bleeding than
non-smokers
This is also proved to be dose dependant
This may be due to vasoconstrictive effect of
nicotine.Clarke et al 1984
27. Effect of Smoking on Gingival Blood
Flow
• In smokers,
gingival blood flow was significantly increased
by cigarette smoking.
• However, intravenous
administration of nicotine reduces the marginal
temperature of gingival sites suggesting a
decrease in gingival blood flow which lead to
the hypothesis this phenomenon is caused by
vasoconstriction induced by nicotine and stress.
28. Oxygen Tension in the Gingival Tissues
• Smoking Decreases Tissue Oxygen
• Tissue oxygen decreases: 65 ± 7 to 44 ± 3
mmHg [Jensen, et al. Arch Surg, 1991]
• Tissue oxygen 40-50 mmHg —> infection
Effects on the Gingival Vasculature
researchers found a high proportion
of small vessels compared with large vessels in
smokers than non-smokers but no difference in
the vasculature density.
[journal CDP nov08]
29. Evidence From Studies on (GCF)
Smoking may result in lower resting GCF flow rate.
The increase in GCF during an experimental gingivitis may be less
in smokers.
Studies have shown higher levels of TNF-α and decreased levels of
IL-1α and IL-1β ,enzyme elastase in GCF when compared between
smokers and nonsmokers.
This research has demonstrated there are lower levels of
cytokines, enzymes, and possibly polymorphonuclear leukocytes
(PMNs).
This correlates with the lower levels of inflammation observed
clinically and within the tissues.
Kinane and Radvar 1997
30. Smoking and Fibroblast Function
Gingival Fibroblasts
In vitro studies have shown reduction in the
production of Type 1 collagen and fibronectin
and an increase in the collagenase activity.
Cellular changes like disruption
of cell orientation, changes in cytoskeleton,
presence of large vacuoles, and significant
reduction in cell viability have been noticed.
31. Smoking and gingival inflammation
Smokers may present with lower
levels of gingival inflammation than nonsmokers.
Furthermore,
development of gingival inflammation in
response to experimental plaque accumulation
(experimental gingivitis) was less pronounced
in smokers than in non-smokers.
[Albander et al 99, Lie et al 98]
32. Periodontal fibroblast
PDL fibroblast growth, attachment and
integrin expression was inhibited by
nicotine at high concentrations (≥1 mg/ml)
Nicotine at high concentrations (100 ng/ml
to 25μg/ml) to be cytotoxic by inhibiting
the vacuolation and proliferation of
fibroblasts. [Giannopovlou et al.27]
PDL cell proliferation and protein synthesis
were also inhibited in a dose dependent
manner.
Cell attachment was significantly less on
root surfaces obtained from heavy smokers
compared with nonsmokers.
33. Smoking and periodontitis in young adults
(≤35 years)
Several studies have shown young adult smokers
aged 19-30 years had a higher prevalence and
severity of periodontitis compared to non-smokers
despite similar or lower plaque levels.
The prevalence of periodontitis,
defined as having a site with attachment loss
of ≥2 mm and probing depths of ≥4 mm, was
three to four times higher in young smokers
compared to non-smokers.
[Haber et al]
34. Smoking and Periodontitis in Adults
Current smokers have deeper probing
depths, greater attachment loss, more bone
loss, and fewer teeth.
Smokers also exhibit
more supragingival calculus deposits.
Smokers were four times more likely to have
periodontitis as compared to non-smokers.
35. Among 20-49 year-olds, the adjusted
odds ratio for a mean attachment loss
of 1 to 1.99 mm among current smokers
was 2.29, whereas the odds ratio for
attachment loss ≥3 mm was over 18.43.
This suggests smoking is particularly
important in the etiology of severe
periodontal attachment loss.
{NHANES}
36. There is a strong dose-response relationship
between the amount smoked and the severity of
periodontal destruction which further supports the
role of smoking as a risk factor for periodontitis.
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.
37. Effects of Smokeless Tobacco on
Periodontal Tissues
It involves chewing a quid that includes betel
leaf,lime, areca nut, and tobacco.
Tobacco use may significantly increase bleeding
on probing and periodontal attachment loss.
Other studies have also shown the negative
effect of the areca nut on host immunity by
affecting PMNs.
Arecanut extracts have also been shown to
inhibit the growth, attachment, and matrix
protein synthesis of cultured human gingival
fibroblasts.
38. Smoking and Acute Necrotizing Ulcerative
Gingivitis (ANUG)
An association between necrotizing forms
of periodontal disease and tobacco smoking
was reported as early as 1947
Preexisting gingivitis, emotional/psychic stress,
and smoking forms a triad of interrelated
predisposing factors in the etiology of the disease.
.
39. SMOKING
influence the tissue
response to irritation.
activates the release of epinephrine
promotes contraction of peripheral vessels
reducing blood flow to the gingiva
loss of vitality to the gingival epithelium
onset of ANUG .{Karadachi et al}
41. Smoking and cardiovascular system
•Smoking causes coronary heart disease,
atherosclerosis, arteriosclerosis, heart attack the
leading cause of death
•Cigarette smoking causes reduced circulation by
narrowing the blood vessels (arteries) and puts
smokers at risk of developing peripheral vascular
disease
•Smoking causes abdominal aortic aneurysm
(i.e., a swelling or weakening of the main artery
of the body—the aorta—where it runs through
the abdomen).
42. Smoking and Respiratory Disease
Smoking causes lung cancer.
Smoking causes lung diseases (e.g.,
emphysema, bronchitis, chronic airway
obstruction) by damaging the airways and
alveoli (i.e., small air sacs) of the lungs.
Smoking and brain
Can cause stroke which may be fatal or
cause mental and physical disability
43. Smoking and Cancer
Smoking causes the following cancers:1
*Acute myeloid leukemia
*Bladder cancer
*Cancer of the cervix
*Cancer of the esophagus
*Kidney cancer
*Cancer of the larynx (voice box)
*Lung cancer
*Cancer of the oral cavity (mouth)
*Pancreatic cancer
*Cancer of the pharynx (throat)
*Stomach cancer
44. Smoking and Other Health Effects
Smoking has many adverse reproductive and
early childhood effects, including increased
risk for—
infertility,
preterm delivery,
stillbirth,
low birth weight, and
sudden infant death syndrome (SIDS).
Smoking is associated with the following
adverse health effects:
Postmenopausal women who smoke have lower bone
density than women who never smoked.
45. SMOKING – MORBIDITY
(miller et al 1999)
50% of total cancer deaths
84% of lung cancer deaths
30% of heart disease deaths
23% of respiratory deaths
80% of bronchitis and
emphysema deaths
46. Interaction between smoking and systemic
Health status and periodontitis
The combination of smoking with other systemic
factors further enhances the risk of periodontal
destruction.
.
47. •Studies say that the combination of diabetes and
heavy smoking in an individual over the age of 45
years who harbored P. gingivalis or T. forsythesis
resulted in an odds ratio of attachment loss 30
times that of a person lacking these risk
factors.(JCDP nov,2008)
•Smoking also increases the risk of attachment
and/or bone loss in AIDS and HIV serotype
patients.
•Periodontitis also may worsen the systemic
status of an individual
49. Tobacco use in all forms, especially cigarette smoking, is
the number one risk factor for oral cancer.
Possible mechanisms are
•Irritants and toxic substances in tobacco
•Change in Ph
•Change in immune response
•Dryness due to heat produced while smoking
The most common form of cancer is Squamous
cell carcinoma.
•The most common sites of the oral cancer is the tongue and the
floor of the mouth.
• The other common sites are buccal vestibule, buccal mucosa,
gingiva and rarely hard and soft palate.
• Cancer of bucco-pharyngeal mucosa is common in smokers.
50. Abnormal Changes at Cancerization site
• Clinically:
– Leukoplakia
– Erythroplasia
– Dysplasia
– Carcinoma in situ
51. OTHER LESIONS:
SMOKER’S PALATE
• Palate becomes white with tiny red spots-raised
duct opening of salivary glands [dried mud
appearance]
SMOKER’S MELANOSIS
• Brown spots on oral mucosa
HAIRY TONGUE
• Overgrowth of papilla on the surface of tongue
COATED TONGUE
• Tongue coated with food particles, bacteria and
debris from epithelium
52. DENTAL CARIES AND EROSION
• Smoking stimulates saliva flow immediately, does not
affect saliva in long term
• Decrease Ph and buffering action
Dental caries Erosion
GINGIVAL RECESSION
53. • STAINING OF TEETH
• HALITOSIS
• DELAYED WOUND HEALING
• DRY SOCKET
• SMOKER’S FACE
55. CIGARETTE SMOKING AND 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.
[JCDP’08]
56. Toothbrushing efficiency of smokers was
much less and
the calcium concentration in the dental
plaque of smokers was found to be
significantly higher than in nonsmokers.
[Medicine and Biology Vol.14, No 2, 2007, pp. 53 – 59]
57. EFFECT OF SMOKING IN WOUND
HEALING
Smoking has
been shown to impair revascularization
during soft and hard tissue wound
healing,
which is critical for periodontal plastic,
regenerative, and implant procedures.
(Nolan et al.,85; Preber &
Bergström, 85a; 86; 90).
58. Non-surgical and Surgical Therapy
Numerous studies have shown smoking
compromises probing depth and/or attachment
gain outcomes following non-surgical or surgical
therapy.
The numerical differences between
smokers and non-smokers become more
pronounced in probing depths ≥5 mm, where
smokers demonstrated 0.4 mm to 0.6 mm
less improvement in clinical attachment levels
following scaling and root planning.
Following flap debridement surgery, smokers experienced
upto 1 mm less improvement in clinical attachment
levels in probing depths that were initially ≥7mm.
59. Antimicrobial Therapy in Smokers
• Because of the diminished treatment response
insmokers, clinicians may recommend adjunctive
antimicrobial therapy for smokers.
• Because subgingival pathogens are more difficult to
eliminate in smokers following SRP.
• Systemic amoxicillin and metronidazole or locally
delivered minocycline microspheres enhanced the
results of mechanical therapy.
• A recent study reported a positive response to sub-
antimicrobial doxycycline (anticollagenase) therapy in
combination with SRP in a group of severe periodontitis
patients that included smokers.
60. Soft and Hard Tissue Grafting
• In guided tissue regeneration procedures
smokers had significantly less root
coverage(57%) compared to nonsmokers
(78%)
• Smoking is detrimental to regenerative
therapy in interproximal and furcation
defects, whether treatment includes the use
of osseous graft, bioabsorbable membrane,
or a combination.
• The results have shown less than 50% as
much improvement in clinical attachment
levels in smokers, which amounted to
differences ranging from 0.35 mm to 2.9 mm.
61. Implant Therapy
• In the studies reviewed, 0% to 17% of
implants placed in smokers were
reported as failures as compared to 2%
to 7% in non-smokers.
• The 3-year data demonstrated 8.9% of
implants placed in smokers failed as
compared to 6% in individuals who had
never smoked or had quit smoking.
• The majority of implant failures in
smoking occurred prior to prosthesis
delivery.
62. Maintenance phase
• ↑pocket depth
• ↓gain in clinical attachment level
• Deeper and more residual pockets after flap
surgery
Refractory disease
• ↑recurrence and ↑need for
re treatment and antibiotic therapy
• ↑tooth loss after surgical therapy
65. The “5 A’s” To Intervention
• ASK about tobacco use.
• ADVISE to quit.
• ASSESS willingness to make a
quit attempt.
• ASSIST in quit attempt.
• ARRANGE for followup.
66. Nicotine withdrawal: the 4 ‘D’s
Delay acting on the urge to smoke
Drink water slowly
Deep breathe.
Do something else (eg exercise)
67. PHARMACOTHERAPY
Pharmacotherapy + behavioural counselling improves long-term quit rates
Smokers of 10 or more cigarettes a day
who are ready to stop should be encouraged to use pharmacologial support as a cessation aid
Nicotine replacement
• Begin NRT on the quit date, (apply patches the night before)
• Use a dose that controls the withdrawal symptoms
• NRT provides levels of nicotine well below smoking
• Prescribe in blocks of two weeks
• Arrange follow up to provide support
• Use a full dose for 6 to 8 weeks then stop
68. NRT: Nicotine nasal sp
• Nasal sprays more closely mimic nicotine from cigarettes
• Common side effects with nasal sprays include nasal and throat
irritation, coughing and oral burning
NRT: Nicotine gum
• Instruct the patient to ‘chew and park’
• Absorption may be impaired by coffee and some acidic drinks
• Common side effects with gum include gastrointestinal
disturbances and jaw pain
• Dentures may be a problem!
• Patches provide a slow, consistent release of nicotine
throughout the day
• Available in various shapes and sizes,
• Common side effects with patches include skin sensitivity and
irritation
NRT: Nicotine patches
69. • Begin bupropion a week before the quit date
• Normal dose 150mg bd, (reduce in elderly, liver/renal disease)
• Contra-indicated in patients with epilepsy, anorexia nervosa,
bulimia, bipolar disorder or severe liver disease.
• The most common side effects are insomnia (up to 30%), dry
mouth (10-15%), headache (10%), nausea (10%), constipation
(10%), and agitation (5-10%)
• Interaction with antidepressants, antipsychotics and anti-
arrhythmics
• Nicotine replacement and buproprion should always be used
in conjunction with behavior modification
Bupropion
Nicotine Tabs
• Nicotine tablets deliver 2-mg or 4-mg dosages of nicotine over
30-minutes
• Common side effects with gum include burning sensations in
the mouth, sore throat, coughing, dry lips, and mouth ulcers
70. Nortryptiline
• Tri-cyclic antidepressant
• Not licensed for smoking cessation
• Low cost
• Side-effects include sedation, dry mouth, light-headedness, cardiac
arrhythmia
• Contra-indicated after recent myocardial infarction
Varenicline
• Begin varenicline a week before the quit date, increasing dose
gradually.
• Alleviates withdrawal symptoms, reduces urge to smoke
• Common side effects include: nausea (30%), insomnia, (14%),
abnormal dreams (13%), headache (13%), constipation (9%), gas (6%)
and vomiting (5%).
• Contra-indicated in pregnancy
72. Impact of Smoking Cessation on Periodontal
Status and Treatment Outcomes
•While smoking cessation does not reverse
the past effects of smoking, the rate of bone and
attachment loss slows after patients quit smoking
and the severity of their disease is intermediate
compared to current and non-smokers.
•It is encouraging to note former smokers respond
to non-surgical and surgical therapy in a manner
similar to nonsmokers.
•Similarly, implant success rates for past smokers
were similar to nonsmokers.(JCDP’08)
73. CONCLUSION
It is clear that smokers
• Present with periodontitis at an early age
• Difficult to treat them with conventional therapy
• Continue to have progressive or recurrence of periodontitis
leading to tooth loss
The opportunity for dentists to become more active in
evaluation of tobacco use by patients and more aggressive in
offering counseling and cessation services can positively
impact both the oral and general health of dental patients.