Periodontics Exam 6 CH 17, 16, 37

tobacco smoking effects on the periodontium

less inflammation of the periodontium than seen in nonsmokers

reduced bleeding due to decreased vascularization of the periodontium

changes in pocket environment resulting in different bacterial pathogens

IQOS

modified tobacco product

volatile components of cigarette smoke

acrolein and acetaldehyde

acrolein and acetaldehyde

may inhibit gingival fibroblast attachment and proliferation

propylene glycol

releases arsenic when heated

flavoring agents

noncombustible nicotine products linked to lung disease

if a product claims to not contain nicotine

it may not be accurate because it is not tightly regulated

cigarette smoking is associated with lower oxygen tension in the periodontal pocket, thereby creating a subgingival environment favorable to

anaerobic bacteria

smoking-mediated destruction impacts

oral microbial biofilm

bone metabolism

immune system

diethylene glycol

ingredient in e-juice that is poisonous and used as a solvent in antifreeze

diacetyl

hazardous chemical when heated that causes popcorn lung (butter flavor)

cannabis use

has the same, if not higher, risk of periodontitis than combustible and noncombustible products

smoking

very strong risk factor for periodontal disease and increases the risk for periodontal disease by 2-3 times

smokeless tobacco

associated with severe recession and loss of attachment to buccal surfaces where it is placed

oral problems with smoking

halitosis, dry mouth, staining, periodontal disease, cancer

porphyromonas gingivalis

colonizers of plaque biofilm in smokers

cigarette smoking

associated with a lower oxygen tension in the periodontal pocket and thus is favorable for the growth of anaerobic bacteria."

smokers

decreased signs of inflammation and a decreased gingival crevicular blood flow that is indicative of impaired gingival blood flow in smokers. This is due to the vasoconstrictor properties of nicotine.

neutrophils

have shown decreased adherence, chemotaxis, and phagocytosis in smokers

IgG2

antibody that decreases in smokers

bone

one of the tissues most affected by smoking

alveolar bone destruction

is greater in smokers compared to non smokers

nicotine

suppresses osteoblasts while stimulating alkaline phosphatase activity and increases the secretion of IL-6 and TNF-a in osteoblasts

nicotine

alter normal bone remodeling by increasing the release of matrix metalloproteinases.

environmental tobacco smoke

"secondhand smoke" or "passive smoking"—are at increased risk for periodontitis.

e-cigarettes

do not contain tobacco. Instead, there is a mechanism that heats up liquid nicotine, which turns into a vapor that smokers inhale and exhale.

waterpipe smoking

hookah

associated with respiratory and cardiovascular problems and also has a significant impact on the oral cavity (increase pocketing, CAL, bone loss)

smokers

have delayed wound healing

implant failure

more common in smokers than nonsmokers

tobacco cessation counseling

includes information on smoking cessation and prevention of tobacco use, as well as referrals to other health professionals for tobacco cessation programs.

nicotine

nor carcinogen by itself but has addictive properties (psychological dependence)

smoking dependence

-occurs when brain adapts to large amounts of nicotine binding to acetylcholine receptors on neurons, facilitating release of dopamine

-desensitization over time leads to greater dependence

nicotine

pregnancy category D drug

Noncombustible nicotine products

does not undego the burning process, instead they use battery powered devices composed of a heating element and a container filled with liquid nicotine (e-cigarettes)

tobacco products

cigarettes, cigars, pipes, smokeless tobacco

toxins in cigarette smoke

Carbon monoxide, oxidizing radicals,

carcinogens, and addictive

psychoactive substances

noxious

harmful byproducts; poisonous; lethal ; causes cancer

Benzene, carbon monoxide, carbon dioxide, nitrogen

oxides, ammonia, hydrogen cyanide, volatile sulfur containing compounds, and volatile hydrocarbons

tar

a thick, sticky, dark residue produced when tobacco burns that can be on the epithelial lining of oral cavity, teeth, and lungs

it is not addictive, but it is dangerous and causes dark staining and halitosis

combustible tobacco delivery systems

traditional cigarette, cigar, pipe, waterpipe (hookah) smoking

noncombustible tobacco delivery systems

heated tobacco products (heated - not burned) that are battery operated with not many harmful effects (IQOS)

IQOS

inhalable aerosol that is a modified tobacco product

not FDA approves

contains real tobacco leaves

waterpipe tobacco smoking

charcoal, tobacco, and flavoring agents that releases vapors

smokeless tobacco products

- chewed, sniffed, or placed in oral cavity

- include snuff, lozenges, strips, and candy-like sticks

noncombustible nicotine products

electronic nicotine delivery systems

battery powered devices (e-cigs, vapes)

these are not safer

noncombustible nicotine products

just as addictive as tobacco with noxious chemicals with flavoring additives that cause lung disease - some effects unknown

nicotine pouches

noncombustible nicotine delivery system that does not contain tobacco

chemicals released during vaping

propylene glycol

vegetable glycerin/glycerol

diethylene glycol

diacetyl

formaldehyde

acetaldehyde

arcolein

EVALI

e-cigarette or vaping product use-associated lung injury that mimics the flu and cause death

symptoms are: shortness of breath, night sweats, low oxygen levels

hazy spots on lung x-ray

evali

associated with vitamin E acetate

national health interview survey

2019

national youth tobacco survey

National survey of middle and high school youth's tobacco-related beliefs, attitudes, behaviors, and exposure to pro- and anti- tobacco influences (2021)

NHANES

Greater periodontal destruction for smokers than for former and never smokers

NHANES III

half of cases due to current/former smoking

task force of 2017 AAP/EFP says smoking

• Increases rate of progression of

periodontitis

• Alters responsiveness to standard

therapeutic practices

• Negatively impacts general health

or systemic disease

• Could cause disease to progress

from one stage to next

combustible smoking on oral biofilm

depletion of beneficial bacteria and increase pathogenic bacteria

lower oxygen

in periodontal pocket favoring anaerobic bacteria

impact of smoking on immune system

cellular and humoral inflammatory responses

vasoconstriction

decrease neutrophil function and IgG2

nicotine

suppress osteoblasts, alkaline phosphatase activity, IL6 and TNF in osteoblasts, and matrix metalloproteinases causing greater alveolar bone destruction

environmental tobacco smoke

increases risk for perio and is dose-dependent (doubling odds of periodontitis)

waterpipe tobacco smoking

has nicotine and carcinogens that cause resp and CV problems, impacting the oral cavity

smokeless tobacco

moist snuff, loose-leaf chewing

common in young males causing oral carcinoma and white oral mucosal lesions

chemical products and toxins in cigarette smoke

delay wound healing

smokers

have poorer response to periodontal treatment and less improvement of pocketing and CAL

cannabis

can be medical or recreational

psychoactive THC that has no nicotine

still a risk factor for periodontal disease

cannabis effects on periodontium

poor oral health

gingival enlargement

erythroplakia

chronic inflammation of oral mucosis

hyperkeratosis

leukoplakia

frequent recreational use of cannabis

can cause deeper pocketing, increased CAL, and higher incidence of periodontitis

cannabis

patients have poorer oral health and may have acute anxiety and dysphoria during dental treatment

chronic cannabis use

increased risk of leukoplakia, cancer, candidiasis, and infection

peri-implant mucositis

(also known as peri-implant gingivitis) plaque-induced gingivitis in tissues surrounding the implant

peri-implantitis

chronic periodontitis in tissues surrounding osseointegrated implant, resulting in bone loss

smoking cessation

reduces pathogenic bacteria in subgingival biofilm

improves vascular circulation

improves host inflammatory response

most important action to prevent periodontal disease

counseling the perio patient on smoking

less than 5 mins

establish use

ask questions

clear, firm, personalized advice explaining risks

(establish, advise, assess, highlight, stress)

local contributing factors for periodontal disease

intraoral conditions or habits that increase an individual's susceptibility to periodontal infection or that can damage the periodontium in specific sites within the dentition.

local contributing factors

do not actually initiate either gingivitis or periodontitis, but contribute to progression of an already established disease that is previously initiated by bacterial plaque biofilm

primary etiologic factor

Root cause(s) of condition that initiates pathologic effect

disease site

an area of tissue destruction (individual tooth or specific surface)

examples of local contributing factors

•Factors that increase plaque biofilm retention

-Rough restoration

•Factors that increase plaque biofilm pathogenicity

-Calculus

•Factors that can inflict damage to the periodontium

-Occlusal trauma, high frenal attachment, traumatic TB

factos that increases plaque biofilm retention

rough restoration

factors that increase plaque biofilm pathogenicity

calculus

Factors that can inflict damage to the periodontium

occlusal trauma, high frenal attachment, traumatic TB

dental calculus

mineralized plaque biofilm, covered on its external surface by nonmineralized, living bacterial plaque

mineralization of biofilm

begins from 28 hrs up to 2 weeks after plaque accumulation

Effects of Calculus on the Periodontium

•Surface is irregular and always covered with plaque

•Roughened porous surface harbors bacteria

•The more calculus build-up, the more areas of plaque biofilm

•Difficult or impossible for a patient to clean

inorganic portion of calculus

- Comprises 70% to 90% of calculus

- Primarily calcium phosphate with smaller portions of calcium carbonate and magnesium phosphate

- Similar to inorganic components of bone

- Dense, radiopaque appearance on radiograph

- Not foolproof method for calculus detection

organic portion of calculus

- 10% to 30% of overall composition

Includes

- Materials derived from plaque biofilm

- Dead epithelial cells

- Dead white blood cells

May also include living bacteria.

types of dental calculus

crystalline form, brushite, octocalcium phosphate, hydroxyapatite

brushite

newly formed calculus in a crystalline form

crystalline form of calculus

inorganic component of calculus during aging

octocalcium phosphate

Calculus that is less than 6 months old

hydroxyapatite

mature deposits of calculus more than 6 months old

supragingival calculus

located coronal to the gingival margin (visible)

also known as supramarginal or salivary calculus

usually localized areas (lingual of mandibular anterior teeth and buccal of maxillary posterior teeth)

adjacent to large salivary ducts

irregular, large deposits

supragingival calculus

irregular, large deposits

subgingival calculus

located apical to the gingival margin—not visible

submarginal or serumal calculus

detected with tactile sensitivity and can be localized or generalized

subgingival calculus

flattened shape, not as irregular

modes of calculus attachment

-Pellicle Attachment

-attachment to irregularities

-attachment by direct contact of calcified component and tooth

attachment to the pellicle

•Most common means of attachment to enamel surfaces

•Calculus deposits attached by pellicle are removed easily because attachment is on surface of the pellicle, not locked to the tooth

pellicle

thin, bacteria-fre membrane that forms on the surface fo the toth during late stages of eruption

attachment to irregularities in the tooth surface

cracks in the teeth

tiny openings from PDL detachment

grooves in cementum

difficult to remove

Attachment to the Tooth Surface

•The matrix of calculus deposit may interlock with inorganic crystals of the tooth.

•Deposits are firmly interlocked in the tooth and are difficult to remove.

tooth morphology

the study of the anatomic surface features of the teeth