Dr Jaffar Raza Syed

Smoking

Smoking & PDD

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Dr Jaffar Raza Syed

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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.

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.