Ch. 19 Tobacco, Smoking, and Periodontal Disease

Smokers are…

• 2-3 times more at risk for periodontal disease.

• More likely to lose more teeth than non-smokers.

• More likely to have attachment loss and periodontal destruction than former and never smokers.

• Cigar and pipe smoking are significant risk factors for attachment loss

Smokeless tobacco is associated with severe _____ and loss of buccal attachment where plug is placed

recession

Smoking may be responsible for about ___% of cases of perio disease among adults in the US

50

There are more than _____ chemicals in cigarette smoking including:

7000

• carbon monoxide

• oxidizing radicals

• carcinogens (nitrosamines)

• addictive psychoactive substances (nicotine)

Smoking Leads to…

• Halitosis

• Xerostomia

• Tobacco staining

• Periodontal disease

• Oral cancer

Impact on Oral Microbial Biofilms:

• May colonize with more potential periodontal pathogens like Porphyromonas gingivalis.

• Favorable environment for growth of anaerobic bacteria in pockets.

• Deplete beneficial bacteria like Treponema.

• Favors early acquisition and colonization of periodontal pathogens in plaque biofilms

Smoking Affects immune system and inflammatory response:

• fewer signs of inflammation

• impaired gingival blood flow

• neutrophil function is impaired

• antibody production may be decresed

Smokers have a greater amount of alveolar bone destruction than nonsmokers

• nicotine may suppress osteoblasts

• nicotine increases secretion of IL-6

• may alter normal bone rebuilding

Environmental Tobacco Smoke:

• non smokers are affected by inhaling second-hand smoke or “passive smoking”

• NHANES III data concluded the odds of having periodontitis are 2 times higher for those exposed to passive smoke

Electronic Cigarettes:

• Introduced in U.S. market in 2007.

• Do NOT contain tobacco.

• Mechanism heats up liquid nicotine, turning it into a vapor.

• Vapor is inhaled and exhaled.

• U.S. FDA shows the fluid and aerosol contains known toxins.

Side Effects of Vapor:

•  Brain development continues till about age 25.

• Nicotine>higher addiction, attention control, learning ability, mood, and impulse control.

• CDC (2020), confirmed 2,807 cases of E-cigarette or vapor use associated lung injury.

•  68 deaths from the condition. (THC being a high contributor to these cases- A medicinal compound utilized to manage/treat chemotherapy induced nausea and vomiting).

Other side effects of vapor:

• Lung scaring (permanent)

• Can lead to Asthma or COPD or other lung issues.

• Organ damage –heart and lungs

• Coughing

• Shortness of breath

• Eye irritation

• Headaches

• Dry and irritated mouth/throat

• Nausea

Waterpipe Smoking:

• AKA Hookah and Shisha.

• Use associated with respiratory and cardiovascular problems.

• Significant impact on the oral cavity.

• Significant amounts of nicotine and 27 known carcinogens.

Waterpipe smokers inhale over __L of smoke per session compared to 1 L of smoke for a single cigarette.

40

Waterpipe Smoking is Associate with:

• increased periodontal pocket depths

• loss of clinical attachment 

• bone loss

Smokeless Tobacco (ST):

• Increased inflammatory response in the tissues.

• This leads to an accelerated breakdown of the periodontium and gingival recession at site of ST placement.

Chemical products and toxins in tobacco smoke:

• May delay wound healing.

• Negatively effects fibroblasts and collagen production.

• Leads to less improvement in probing depths.

• Associated with less clinical attachment improvement after treatment.

Peri-implant mucositis:

• Plaque-induced gingivitis with edema

• Bleeding and purulence on probing

• Probing depths 4 mm or greater

Peri-implantitis:

• More advanced inflammation with deeper pocketing

•  Radiographs with bone loss

Smoking and Peri-implant Disease:

• Heat and toxins from smoking implicated as risk factors for impaired healing after implant surgery.

• Smokers experience twice as many implant failures as nonsmokers.

• Other risk factors for implant disease include poor biofilm control, history of periodontitis, and diabetes.

Smoking Cessation and Periodontal Status:

• Current smokers have worse periodontal conditions than never smokers or former smokers.

• Periodontal health of former smokers is not as good as that of never smokers, but it is better than current smokers

• Treatment outcomes in former smokers are like never smokers and better than current smokers

Benefits of smoking cessation on the periodontium result from:

• Reduction in pathogenic bacteria in subgingival plaque

• Improved gingival circulation

• Improvements in host’s immune-inflammatory response