SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE...

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SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS

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Transcript of SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE...

Page 1: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

SMOKING AND ORAL HEALTH

FOR MEDICAL STUDENTS

Page 2: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

WHO:

• SMOKING IS THE MOST IMPORTANT

• SINGLE

• PREVENTABLE

• RISIK FACTOR

• FOR HIGH LEVEL OF MORBIDITY and PREMATURE MORTALIRY

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MORTALITY

• 50 % OF SMOKERS WILL DIE DUE TO SMOKING

• HALF OF THEM PREMATURERLY

• THEY LOST 20-25YEARS OF THE LIFE

• DIFFERENCES ARE SIGNIFICANT AFTER 20 YEARS OF SMOKING

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CASES OF SMOKERS ´ DEATH

• SMOKING ATTRIBUTES TO

• 25 DIFFERENT DISEASES;

• ANUALLY DIE DUE TO SMOKING

- CVD …………………. 1,7 mil

- CHOPD …… ………...970 tis

- LUNG CANCER …… 850 tis

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SMOKING AND CANCER

• HEAD and NECK – RR 10 – 12

+ ALCOHOL - RR 40 - 135

• URINARY ORGANS CANCER

• CERVICAL CANCER

• STOMACH, COLORECTAL CANCER

• HEPATAL, PANCREATIC CANCER

• LEUKEMIE (MYELOID)

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IN CIGARETTE SMOKE

• Cca 5.000 CHEMICALS

• 67 HUMÁN CARCINOGENS

• 33 TOXIC CONTAMINANTS OF AMBIENT AIR

• 47 CHEMICALS REGISTERED AS TOXIC WASTE

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OTHER FORMS of TOBACCO

• SMOKELESS

• PIPES. CIGARS

• ARE THE IMPORTANT CAUSES OF HEAD AND NECK CANCERS

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RISK FOR REPRODUCTION

• IMPOTENCE, INFERTILITY

• HORMONAL DYSBALANCE

• COMPLICATION DURING PREGNANCY

• ABORTS

• PREMATURE DELIVERY

• CONGENITAL MALFORMATIONS

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INTRAUTERINE EXPOSURE

• FETAL TOBACCO SYNDROME =>

• PROGRAMMING

• CONGENITAL MALFORMATIONS

• NEUROPSYCHICAL DYSORDERS (ADHD,conduct dysorders, addiction, criminality)

• GENOTOXICITY =>CANCER

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SMOKING and ORAL HEALTH

• THE MAIN CAUSES OF TEETH LOST ARE CARIES and PARODONTITIS

• SMOKING CONTRIBUTES TO BOTH OF THESE DISEASES

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ORAL HYGIENE

• IS WORSE AMON SMOKERS, EVEN AMONG SMOKING DENTISTRY STUDENTS

• NO-SMOKERS DECLARED 9 times HIGHER FREQUENCY OF DAILY TTETH BRUSH compared with SMOKERS

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NIKOTINOVÁ STOMATITIS

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KUŘÁCKÁ MELANÓZA

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TABÁKOVÉ SKVRNY

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ABRASE ZUBŮ

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CHLUPATÝ JAZYK

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PRENATAL RISKS OF CARIES

• MOTHER´S OBESITY …………1,21

• MOTHER´S SMOKING..………..1,33

• LOW BIRTHWEIGHT

• PREMATURE DELIVERY

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POSTNATAL RISK FACTORS

• PARENTAL LOW EDUCATION….1,38

• LOW SOCIAL POSITION.………...1,35

• MATERNAL AGE UNDER 23 Y... 1,27

• IMIGRANTS…………………….1,7-1,8

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SMOKING and CARIES

• SMOKERS HAVE:

• HIGHER SCORE kpe

• HIGHER SCORE KPE

• In DOSE-RESPONSE ASSOCIATIONS

(salivary cotinine, years of smoking, number cig/day)

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SMOKERS HAVE WORSE:

• NUTRITION

• ORAL HYGIENE

• SECONDARY PREVENTION

• HIGHER BACTERY COLONISATION LAKTOBACILY a Str.MUTANS

• PROTEKTIVE SALIVARY ROLE (lower pH, lower production)

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PASIVE SMOKING:

• PRENATALY: DEVELOPMENTAL DYSORDERS

• INFECTIONS BY MOTHERS in 1st year of the life

• IMMUNOSUPRESION : respiratory inf.• = > breathing by mouth => higher risk of

inf. In oral cavity• MODIFIKATION of IMUNITY Th1 / Th2

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PARODONTAL DISEASES

• G neg., anaerob and mikro-aerofil bakteries = >

• ENHANCES PRO-INFLAMMATORY PROSTAGLANDINS A CYTOKINES =>

• DESTRUKCION OF TISSUE

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VASOCONSTRICTION

• LOWER GUMS OXYGENATION

• BETTER CONDITION FOR ANAEROBES

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AMONG SMOKERS

• 3x – 4x MORE OFTEN SERIOUS PARODONTITIS:

- DEEP LOBES,

- HIGHER BONE LOST

- MORE SUBGINGIVAL DEPOSITS of CALCULUS

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PARODONTAL DISEASES

• ARE MORE OFTEN ALSO AMONG YOUNG SMOKERS

- IZRAEL STUDY

- CARDIFF DENTAL STUDY

- WORSE EFFECTIVENESS OF TREATMENT

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TEETH LOST

• MORE THAN 8 TEETH HAVE NOT (45-69letí):- 30%NON-SMOKERS- 29% EX-SMOKERS (abstinence >31 y)- 33% EX-SMOKERS (abstinence 21-30 y)- 42% EX-SMOKERS (abstinence 11-20 y)- 49% EX-SMOKERS (abstinence < 10 y)- 50% SMOKERS

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LEUKOPLAKIE

• OCCURES 6 times MORE OFTEN AMONG SMOKERS

• SIDES:

- BUCAL – cigarettes smoking

- PALATE – pipes/cigars smoking

- LIPS, BUCAL – smokeless tobacco

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Homogenní leukoplakie

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Verukózní leukoplakie

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Nodulární leukoplakie

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ORAL CANCER

• RELATIVE RISK 2 – 18

• WITH ALCOHOL 100

• WITH OTHER RISKS:

Malnutrition,

chr. Candidosis,

viral infections (human papiloma v., herpes simplex)

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CANCER EPIDEMIOLOGY

• Male:female rate 6:1, now 2:1• More often among patients aged 45 +• Among young smokeless tobacco users• TONGUE – 20%• GUMS – 18%• LOWER ORAL CAVITY + SALIVARY

GLANDS – 20%• LIPS – 11%

Page 33: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

Nádor jazyka

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SMOKING IS A DISEASE

• DEPENDENCE – dg F 17

• FYSICAL PART – NIKOTIN

• BEHAVIORAL PART – AUTOMATIC BEHAVIOR

Page 35: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

LEVEL OF DEPENDENCE

• FAGERSTROM QUESTIONNAIRE:

6 QUESTIONS

10 „PENALTY“ POINTS

4 LEVELS OF DEPENDENCE

Page 36: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

SMOKING CESSATION– 4 A / 4P

• ASK

• ADVICE TO STOP

• ASSIST WITH WITHDRAWAL SYMPTOMES

• ARRANGE FOLLOW UP

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TERAPEUTIC HELP

• NICOTINE REPLACEMENT THERAPY chewing gums, sticks, inhalator, tablets

• Antidepresivum BUPROPION: Zyban, Wellbutrin

• Nicotine Agonis VARENICLIN: Champix

• VAKCINATION

Page 38: SMOKING AND ORAL HEALTH FOR MEDICAL STUDENTS. WHO: SMOKING IS THE MOST IMPORTANT SINGLE PREVENTABLE RISIK FACTOR FOR HIGH LEVEL OF MORBIDITY and PREMATURE.

CONCLUSION

• SMOKING IS AN IMPORTANT HEALTH RISK

• SMOKING DAMAGES ORAL HEALTH

• PROFESSIONAL DENTISTS ARE ACTIVE IN TOBACCO CONTROL IN MANY COUNTRIES


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