SMOKING

SMOKING

1. Profound effects on the immune and inflammatory systems

2. Increased number of WBC in systemic circulation, but decreased number migrate to the gingival crevice and/or pocket "lazy leukocyte syndrome" = poor healing

3. Perio

   • Nicotine has a drying effect on the mucosa = perio
   • Reduced blood flow = difficult to detect disease
   • Neutrophils are stimulated to release proteases which destroy perio tissues
     • They also reduce the ability to repair and regenerate tissues due to reduced IgG production
       • IgG = phagocytosis of microoganisms = key in immune response

4. Primary contributor to oral malignancies - especially when chewing tobacco

   • Direct effect upon oral cleanliness
   • Reduced sensation of the tongue, palate & mucosa
   • Reduced taste & smell
   • Reduced oral awareness
   • Resistant staining

5. Major risk factor for perio

6. Some components of tobacco smoke exaggerate the inflammatory response to perio pathogens and some suppress the immune system

   • Local effects: direct toxic effects to cells, thermal trauma, increased staining & calculus, effects on the flora and on bone tissues

7. Clinical appearance

   • Fibrotic, tight gingivae with rolled margins
   • Reduced erythema and bleeding
   • More severe, widespread disease compared to a non smoking peer
   • Anterior recession
   • Nicotine staining
   • Calcuius

8. Local risk factors

   • Anatomical factors: furcation, root grooves
   • Restorations
   • Partial dentures
   • Ortho appliances
   • Calculus
   • Local trauma
   • Mouth breathing/lack of lip seal
   • Frenal attachments
   • Root fractures, cervical root resorption