Smoking

Smoking cigarette rates have ___, but smoking vapes/E-cigarette rates have ___ recently

gone down

gone up

Smoking is harmful to ___ and is associated

with multiple diseases that reduce ___ and ___

almost every organ in the body

life expectancy and quality of life

Diseases associated with smoking include ...

lung cancer, heart disease, stroke, emphysema, bronchitis, and cancers of the oral cavity, bladder, kidney, stomach, liver, and cervix

Approximately ___ of long-term smokers will die early as a result of smoking,

and those who die before the age of 70 years will lose an average of ___ years of life

half

20

not many smokers will live to 80/90 years old

Most deaths from smoking are due to ...

lung cancer, chronic obstructive pulmonary disease, and coronary heart disease

Tobacco smoke contains thousands of noxious chemicals, comprised in ___ and ___ phases

gaseous

solid (particulate)

Gas Phase

carbon monoxide, ammonia, formaldehyde, hydrogen cyanide, and many other toxic and irritant compounds, including more than 60 known

carcinogens such as benzo(a)pyrene and dimethylnitrosamine

Particulate Phase

nicotine, "tar" (itself made up of many toxic chemicals),

benzene, and benzo(a)pyrene

What causes the staining on your fingers and teeth, from smoking?

tar

___ is found within the tobacco leaf and evaporates when the cigarette is lighted

Nicotine

Nicotine is quickly absorbed in the ___, and it reaches the brain within ___ seconds

lungs

10 to 19

Nicotine is known for being highly ___

addictive

Nicotine causes ...

rise in blood pressure, increased heart and respiratory rates, and peripheral vasoconstriction

Smoking causes (more/less) bleeding on probing

less

this, obviously, does not imply health of the tissue!!!

Cigarette smoking associated with lower ___ delivery in periodontal pocket is favorable for growth of ___ bacteria; it favors early

acquisition and colonization of ___ pathogens in oral biofilms

oxygen

anaerobic

periodontal

Smokeless tobacco exist in 3 forms:

moist snuff

dry snuff (powder)

chewing (coarse cut)

Snus

Swedish snuff

linked to pancreatic, but not mouth or lung, cancer

All dental patients must be asked about their ___

smoking status/tobacco usage

Is it more important to measure daily average or cumulative exposure to cigarette smoke?

cumulative

record pack-years of smoking

Many smokers are trying to quit, and therefore simply asking how many cigarettes they are smoking today may not give an ___

accurate assessment of their lifetime exposure - a patient who is currently smoking 5

cigarettes per day may have been smoking 40 cigarettes per day until yesterday

Smoking is a major risk factor for ___, affecting the ... of the disease

periodontitis

prevalence, extent, severity

Smoking has an adverse impact on the clinical outcome of ___ therapies, as well as on the long-term success of ___

nonsurgical/surgical

implant placement

___% periodontitis cases in the USA is attributable to smoking

41.9

initiation, progression, management

Smoking affects both ___ systems and ___ responses

immune

inflammation

Gingivitis in smokers... more or less prevalent?

less! interesting

However, smoking is a major risk factor for increasing the prevalence and severity of ___

periodontal destruction

(periodontitis)

Which features of periodontitis are more prevalent and severe in patients who smoke?

pocket depth

attachment loss

alveolar bone

On average, smokers are ___ times as likely to have periodontitis as compared with the ones who had never smoked

4

In former smokers, the odds of having periodontitis declined with the ___

number of years since quitting

Current smokers are almost ___ more likely to have SEVERE periodontitis as compared to nonsmokers

3x

Over a 10-year period, ___ has been reported to be twice as rapid in smokers as in nonsmokers and to proceed more rapidly even in the presence of ___

bone loss

excellent plaque control

The prevalence of moderate and severe periodontitis and the % of teeth with

___ were most severe in current cigarette smokers

+5mm of CALoss

___ rates are also increased among smokers

Tooth loss

Why do people smoke?

it releases dopamine and adrenaline in the brain when nicotine is inhaled

The brain becomes reliant on nicotine for ___ and develops ___ to it, requiring increasing amounts to achieve the same level of (first __)

pleasure

tolerance

pleasure

What are some alternatives for smoking?

"heat-not-burn" tobacco products

water pipes — hookah, shisha

nicotine gels

Periodontal disease often features an altered ___ infections that causes more extensive breakdowns

host-bacterial

___ biofilm tends to differ between smokers and nonmokers... smokers generally have significantly higher levels of ___ bacteria

Subgingival

T. forsythia

Which other bacteria are also generally present in higher levels in smokers?

actinomyces

P. gingivalis

Smoking may cause alterations in ___ number or function that may result in localized and systemic infections

neutrophil

Critical functions of neutrophils include ...

chemotaxis, phagocytosis, and killing

Elevated levels of ___ have been demonstrated in smokers, as well as ...

TNF-alpha

prostaglandin E2, neutrophil elastase, and matrix

metalloproteinase-8

Smoking ___ leads to decreased prevalence and severity of periodontitis

cessation

E-cig liquid is comprised of ...

diluents, nicotine, flavorings

Diluents are usually ...

propylene glycol

vegetable glycerin

E-cigs help smokers stop smoking... what type of smokers?

those unwilling to quit, exclusively

if they are motivated to quit, do not recommend e-cig 'therapy'

Which is generally more expensive: cigs or e-cigs?

e-cigs

What can e-cigs lead to?

cytotoxicity

DNA damage

The oral health risks of e-cigs are currently unknown, but they are likely to be (more/less) than those associated with tobacco smoking

less

Current smokers do not respond as well to ___ as nonsmokers or former smokers

periodontal therapy

= less PD reduction after surgery

= less pronounced clinical attachment level gain

What is a surgical therapy for periodontitis?

GTR — guided tissue regen

involves putting bone in and covering with membrane

you need deeper defects to be present to be successful with this protocol

Smoking Cessation: 5A's

ask — about tobacco use at every visit

advise — all tobacco users at every visit

assess — willingness to quit

assist — patient in quitting

arrange — follow up contact

Smoking Cessation: Stages of Change

precontemplation —> not ready

contemplation —> planning to; no set date

preparation —> planning to; set date

action —> has quit!

maintenance —> no use for 6 months after quitting

Is "cold turkey" very effective?

no

___ can increase the rare of quitting, over a span of 12 months, by ___%

NRT

50-70

NRT involves usage of drugs, such as ___ and ___

Varenicline

Buproprion

V

reduces withdrawal symptoms

reduces pleasure of smoking

B

antidepressant at higher doses, anti-smoking at lower doses

via increasing levels of dopamine and norepinephrine in the brain, which mimics nicotine's rewarding effects and stabilizes your mood as you quit

Nicotine Withdrawal Symptoms

• Depressed mood

• Insomnia

• Irritability

• Anxiety

• Difficulty concentrating

• Restlessness

• Decreased heart rate

• Increased appetite + weight gain

— you feel horrible

— lasts about 4 weeks

— "cravings" last for a while

Medications for cessation reduce ___ and ___

craving

withdrawal severity

Overall, smoking is ___

extremely dangerous/harmful to your health

How long should you wait, after a patient successfully quits smoking, to place an implant?

unknown... may take up to 10 years