This document discusses periodontitis and the role of smoking in its progression. It notes that periodontitis is characterized by gum inflammation and bone loss. It is caused by bacteria and influenced by host factors. The two main forms are chronic and aggressive periodontitis. Local factors like plaque and calculus contribute, as do environmental factors like smoking. Smoking increases the severity of periodontitis by impairing the immune response and increasing harmful bacteria in plaque. It alters serum and saliva biomarkers and promotes more tissue destruction.

1. H.K.Ajeya Ranganathan
G D C R I , Bangalore.

2. *
Periodontitis is one of the most common oral diseases and is
characterised by gingival inflammation and alveolar bone
resorption
*
Periodontitis is a multifactorial and cumulative condition,
initiated and propagated by bacteria and host factors
*
There are two forms of periodontitis; chronic and aggressive
Periodontitis
* Both differ from each other not only in clinical findings but also
age of onset and rate of progression.

3. *
*Factors playing role in Periodontitis are
 LOCAL FACTORS
like calculus, food impaction and microbial plaque
which includes
Aggrobacter actinomycetemcomitans, Bacteroides
forsuthus & Prevotella intermedia , Fusobacterium nucleatum ,
Bacteroides melaninogenicus
ENVIRONMENTAL FACTORS
Cigarette smoking, beedi,
Smokeless tobacco usage like beeda, pan masala, pan chewing, Gutka
SYSTEMIC FACTORS

4. *
Environmental factors are not found in oral cavity always
but are acting as and when habits are cultivated
* Environmental factors include
* SMOKING
* Pan chewing
* Smokeless tobacco consumption and
* Poor dental awareness

5. * Acetone
Aluminium
Ammonia
Arsenic
Benzene
Butane
Cadmium
Carbon monoxide
Carbon dioxide
Chloroform
Cyanide
DDT/Dieldrin
Ethanol
Formaldehyde
Hydrogen cyanide
Lead
Methanol
Nicotine
Tar
Vinyl Chloride
* 1. Filter made of 95% cellulose acetate.
* 2. Tipping paper to cover the filter.
* 3. Rolling paper to cover the tobacco.
* 4. Tobacco blend.

6. Rolling paper
Tobacco blend
Cigarette filter
Cigarette but
• Holds tobacco blend
• Controls the rate of
burning and production
of ash
• It provides taste and
flavour
• It may vary from region
to region
• It is the biodegradable
part of cigarette made
of cellulose acetate.
• It filters the main
stream of smoke from
tobacco blend to the
mouth piece
• It holds the burnt ash
and remnants of
tobacco
• It is 30% of the length
of a cigarette

7. * Gingivitis:
smokers develop less inflammatory response than non smoking
counterparts which shows that occurrence of gingivitis is
comparatively low in smokers than in non-smokers
* Periodontitis
Smokers are more prone to periodontitis than non smokers since
smoking plays an important role in destruction of periodontium , loss
of attachment and sub-gingival plaque accumulation.

8. Serum
Osteoprotegerin
levels increased
initially followed
by
decreased
gradually
M-CSF, OPG , PGE2
are decreased
Saliva
OPG levels
decreased and
sRANKL levels
increased
OPG/sRANKL ratio
is reduced

9. * Increased destruction of periodontia by smoking would lead to the
breakdown balance between microbial colonies and host immune
response and causes changes in the contents of sub-gingival
plaque
*
This would lead to increased virulence and changes the host
response to the bacterial challenge which in turn lead to
increased periodontal destruction

10. Increased
levels of
T.forsythia ,
T.denticola,
P.gingivalis
Increased
tissue
destruction
Increased
colonization
of bacteria in
sub gingival
plaque
Impaired
mechanical
prophylaxis

11. Increased
levels of TNFα
and matrix
metalloprotien
8
Decreased
levels of
neutrophils
and PGE2
Impaired
neutrophil
activity
Increased
risk of
tissue
destruction

12. Decrased GCF
production
Decreased blood
flow
Decreased
Microvasculature
Added
vasoconstriction
Decreased
Inflammatory
response
Slow recovery
from Local
anaesthasia