016.smoking and periodontal diseases

1. Dr Jaffar Raza Syed
SmokingSmoking & PDD
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Microbiology
--Smokers had higher level of
B. forsythus.
A. actinomycetemcomitans
P. gingivalis
Remaining in the pocket after therapy when compared to nonsmokers.
--Fusobacterium nucleatum,
--S.vincentii,
--P. gingivalis,
--P. intermedia,
--Peptostreptococcus micros,
--Prevotella nigrescens,
--B. forsythus
were significantly more prevalent in current smokers than in nonsmokers and
former smokers

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Immunology
• Altered neutrophil chemotaxis, phagocytosis and oxidative burst.
• Increased TNF- α, and PGE2 in GCF.
• Increased production of PGE2 by monocyte in response to LPS.
• IgG2 level is reduced suggesting reduced protection against
periodontal infection.
• Nicotine, a major component of tobacco adversely affect
fibroblast function.
• Tobacco products alter normal reparative and regeneration potential
of periodontium.

5. Dr Jaffar Raza Syed
Physiology
• Reduced signs of inflamation
• Decreased gingival vessels
• Decreased GCF flow and bleeding on probing
• Decreased subgingival temperature
• Increased time needed to recover from
inflamation due to alter inflamatory response
gingival vessels with increased inflammation.
bleeding on probing with increased inflammation
temperature.
• Increased time needed to recover from local anesthesia.
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due to alter inflamatory response
increased inflammation

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Effect Of Smoking On The Response To Periodontal Therapy
Non-surgical
• Decreased clinical response to scaling and root planing
• Decreased reduction in pocket depth
• Decreased gain in clinical attachment level.
• Decreased negative impact of smoking with increased level of plaque control.

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Surgery and implants
• Decreased pocket depth reduction post surgery.
• Increased deterioration of furcation post surgery.
• Decreased gain in clinical attachment level, decreased bone fill,
increased recession and increased membrane exposure following
guided tissue regeneration (GTR).
• Decreased pocket depth reduction after DFDBA allograft.
• Decreased pocket depth reduction and gain in clinical attachment level
after open flap debridement.
• Conflicting data on the impact of smoking on implant success.
• Smoking cessation should be recommended prior to implant.

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Maintenance
• Increased pocket depth during maintenance.
• Decreased gain in clinical attachment level.
Recurrent (refractory) Disease
• Increased recurrent/refractory disease in smokers.
• Increased need for retreatment in smokers.
• Increased need for antibiotics in smokers to control the negative effect
of periodontal infection onsurgical outcome.
• Increased tooth loss in smokers after surgical therapy.