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Du Mi

on 5 May 2018

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risk factors of periodontitis
periodontitis due to smoking
Content of cigarettes
Effect smoking on oral cavity
Effect smoking on plaque
Effect smoking on gingiva
Effect smoking on periodontium
Effect smoking on microbiology and immunology

Periodontal disease :
An inflammatory destruction of periodontal tissue and alveolar bone supporting the teeth .

Progression and severity of the disease depends on complex interaction between several risk factors such as microbial , immunological , environmental and genetic disease .

General cause of periodontitis
Periodontitis due to smoking
Content of cigarettes
why !
still want to smoke !
History and studies :
Epidemiological studies published in the 1980s and 1990s
demonstrate an association between smoking and destructive
periodontal disease.
Results from the first United States National health and Nutrition Examination Survey (NHANES I) demonstrated that although current smokers had more plaque and periodontal destruction than former or never smokers, the association between periodontal disease and smoking remained after adjusting for oral hygiene and other variables.

Attachment loss severity was increased by 0.5% by smoking 1 cigarette per day, while smoking up to 10 and 20 cigarettes a day increased attachment loss by 5% and 10%, respectively.

Smoking effect on periodontum :
Tobacco smoking is a significant risk
factor for periodontal disease
Cigarette smoking alone does not cause
periodontal disease.
The utilization of tobacco products has long been linked to periodontal disease.
A strong relationship between the amount smoked and the prevalence and severity of periodontitis.

Pathology of periodontitis :
The pathology is unknown
How ever smoking may have two effects on periodontal disease :

Smoking could impair the normal functions of the host response in neutralizing infection,
- it may alter the host response, resulting in destruction of the surrounding healthy periodontal tissues.

Effect of nicotoine :
Nicotine and other tobacco products produce local and systemic effects
Locally the cytotoxic and vasoactive substances from tobacco smoke can inhibit tissue perfusion and cell proliferation
metabolism of smoking contents causes immuno-suppression and impairment of soft tissue and bone cell function Impairs serum antibody response to some periodontal pathogens Alters PMN leukocyte function (effects rate of chemotactic migration and/or phagocytic activity) ↑ TNF-a and PGE2 in GCF ↑ neutrophil collagenase and elastase in GCF May be associated with reduction of skeletal bone mineral content May interfere with fibroblast attachment .

1.on the circulatory system, which in turn cut down on the blood supply .

2.also reduces the intake of oxygen by hemoglobin thus in turn retards the body's ability to fight the infection

3.bone resorption.

Effect of smoking on plaque development and accumulation

Effect of smoking on the subgingival microflora

Effects of Smoking on Tooth Deposits

Effect of smoking on Lymphocyte Function

Effect of Smoking on Neutrophils

Cytokines & Other factors

serum IgG levels are reduced in smokers and in periodontitis patients; non-smokers have higher levels of IgG2 compared with

Neutrophill respiorotry burst

Smoking constituents inhibit the respiratory burst of neutrophils .
neutrophils kill phagocytosed bacterial cells through the generation of multiple reactive oxygen and reactive nitrogen species

Neutrophil derived degradative proteases

Smoking and neutrophil function

Neutrophil transmigration across the periodontal microvasculature is impeded in tobacco smokers

significant increases in the circulating burden of neutrophil elastase and MMPs

1) Gingival fibroblasts

There is evidence that gingival fibroblasts from smokers may
be less susceptible to the cytotoxic effects of high levels of
nicotine possibly because of the development of tolerance.
There is reduction in cell viability and disruption to the
microtubules, intermediate filaments and actin

2) PDL fibroblasts

Cell attachment was significantly less on root surfaces
obtained from heavy smokers compared with non-smokers
and healthy controls.

Smoking and fibroblast function
Smokers have higher mean probing depths and more sites
with deep probing depths.

Gingival recession is greater in smokers compared to non-smokers.

Smokers have two to four times more teeth with furcation involvement .

are more frequently missing molar teeth, and demonstrate greater loss of alveolar bone .

Smoking affect the mineralization rate of calculus.

A higher amount of alveolar bone destruction has been seen
in smokers and the severity of destruction was also found to
be greater in smokers compared to non-smokers.
The bone mineral content among smokers was found to be 10-30% lower as compared to non smokers

Smokers vs non-smokers
Periodontal therapy

Non surgical
smokers do not respond as well to periodontal therapy as non- smokers or .

reduction in pocket depth is more effective in non- smokers than in smokers after non-surgical periodontal therapy, including oral hygiene instructions, scaling and root planing. Smokers respond less well to non- surgical therapy than nonsmokers
Increased vasoconstriction of peripheral blood vessels observed in smokers has been related to reduce bleeding and edema in periodontal patients

Smokers have a poorer treatment response to scaling and Root planning regardless of the application of either systemic or locally applied adjunctive metronidazole.

Smokers, nonsmokers and ex-smokers did not differ significantly in plaque, BOP, or Attachment levels .

The less response of the periodontal tissues is observed in surgical therapy in smokers.
Smokers exhibit a less favourable healing outcome following
a surgery in terms of vertical and horizontal attachment gain.

Smoking impairs healing of GTR treated infra-bony defect. Smokers respond less favourably to flap debridement surgery in terms of pocket depth reduction and attachment level gains
especially in sites with deep pocket depth.
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