SMOKING AND (not only) ORAL HEALTH FOR DENTISTS https://is.muni.cz/www/2422/um WHO: •SMOKING IS THE MOST IMPORTANT •SINGLE • PREVENTABLE RISK FACTOR • of MORBIDITY and • PREMATURE MORTALITY FORMS of TOBACCO PRODUCTS •COMBUSIBLE (cigarettes, cigars, pipes, water pipes •SMOKELESS (chewing, snuf) •VAPORIZING (Electronic Nicotine Delivery Systems ENDS – e-cigarettes… JUUL) •HEATED – NOT BURNED TOBACCO (I Quit Original Smoking iQOS) MORTALITY •TOGETHER 50 % of SMOKERS DIE DUE TO THEIR SMOKING •HALF OF THEM BEFORE the age 70y; •THUS THEY LOST 20-25 YEARS OF THEIR LIFE •THE DIFFERENCES OCCURE AFTER •20 YEARS OF ACTIVE SMOKING CAUSES OF SMOKERS´ DEATH •SMOKING CONTRIBUTES TO 25 DIFFERENT DISEASES; •ANNUAL MORTALITY WORLDWIDE: -CVD ………………… 1,700.000 -CHOPD …………….. 970.000 -LUNG CANCER…… 850.000 CVD-MECHANISMS of ACTION •*Ac.: VASOCONSTRICTION, • HYPOXEMIA (COHb) • ACCELERATED HEART RATE •*Sub.chr: CHANGES IN SERUM LIPIDS • HIGHER THROMBOGENIC • ACTIVITY •*Chr. PROGRESSIVE ATHEROSCLEROSIS • LUNG CANCER •ACTIVE SMOKING …………90 % •PASSIVE SMOKING ……….. 4 % •OCCUPATION ……………… 5 % •(azbest, radiation, nickel, chromium, PAH, additives for ruber industry, … •ENVIRONMENT …………… 1 % SMOKING AND CANCER •HEAD AND NECK – RR 10 – 12 • + ALCOHOL - RR 40 - 135 •URINARY TRACT •CERVIX UTERI •STOMACH,INTESTINE, RECTUM •HEPAR, PANCREAS •LEUKEMIE CANCER AMONG CHILDREN EXPOSED TO PS •LEUKEMIE (ac.lymfatic) RR 2 - 3 •HEPATOBLASTOM •BRAIN CANCER •NEWBORNS OF SMOKING WOMEN have about 1,5 % cells with CHROMOSOMAL ABBERATIONS = like 30y OLD ADULTS CIGARETTE SMOKE: •Cca 5.000 – 7.000 CHEMICALS •67 CONFIRMED or HIGHLY PROBABLE • HUMAN CARCINOGENS (out of the total list of 73 human carcinogens) •33 TOXIC CONTAMINANTS OF • AMBIENT AIR •47 CHEMICALS - TOXIC WASTE CARCINOGENICITY •GENOTOXIC: •DIRECT (from human carcinogens) •INDIRECT (from their biotransformation to oxidative radicals) •EPIGENETIC: reduction of apoptosis, support of pro-carcinogenic factors, revascularization of tumor tissue, lost of cells adherence => metastases TYPES of TOBACCO: •Classic tobacco products: •CIGARETTES •RISK FOR LUNG CANCER •------------------------------------- •CIGARS, PIPES •SMOKELESS (chewing, snus) •RISK FOR HEAD AND NECK CANCER WATER PIPE •Cca 30% TOBACCO, MOLASSES, GLYCERIN, HONEY, FRUIT •SMOKER INHALE 70 l OF SMOKE = • 100-200 times more • than from cigarette •WATER DOES NOT „PURIFICATE“ THE SMOKE, but COOLS IT WATER PIPE CONTAINS: •30-100 time MORE of TAR •17- 50 time MORE of CO •6 time MORE of NICOTINE •And OTHER TOXIC SUBSTANCES FROM EMBERS espec. BENZENE CONSEQUENCES: •DEPENDENCE (nicotine) •CANCER: LUNG …………….OR 2 – 6 • ORAL …………….OR 4 – 5 • OESOPHAG………OR 1.8 •ORAL DYSPLASIA ………… OR 8.3 •PARODONTITIS …………… OR 3 - 5 •POST-EXTRACTION DRY BED 3 • CONSEQUENCES: •RESPIRATORY DIS. …………..OR 2.3 •CARDIOVASCUL. D. …………OR 2.3 •METABOLIC SY. …………….. OR 3.2 •INFECTIONS – common use of mouthpiece •RISK FOR PASSIVE SMOKERS THE RESEARCH •IS QUITE NEW, DUE TO •RISING PREFERENCE IN DEVELOPED COUNTRIES, mainly among •UNIVERSITY STUDENTS ELECTRONIC NICOTINE DELIVERY SYSTEMS •2003 - China •Now „BIG TOBACCO“ Companies with false advertising of SAFE SMOKING=> •FOR SMOKING ON PUBLIC PLACES •FOR SMOKING CESSATION E-CIGARETTES •BATERY, •CARTRIDGE: NICOTINE, • GLYCEROL, • PROPYLENGLYCOL • ADITIVES (honey, fruit, chocolate, alcohol, ….)more than 7000 •*TEMPERATURE 60o C QUICK PROGRESS: •1st generation – simple, for one use •2nd generation – liquid, self filling •3rd generation – tank = liquid + possibility to enhance the power of batery •APPROX. EVERY MONTHS A NEW PRODUCT - JUUL •MORE THAN 7000 ADDITIVES NICOTINE •MAIN PSYCHOACTIVE DRUG •VOLUME ……………..….5, 10, 20 ml •CONCENTRATION ……… 0 – 20 mg/ml •EVEN THE SMALLEST CARTRIDGE = 100 mg of NICOTINE •LETAL DOSES: 10 mg (children) • 30-60 mg (adults) POISONING: •By transdermal absorption (fillers) •By ingestion (small children) •Nausea, vomiting, palpitations, headache •Number of victims raises annually •51 % children < 6 y •43 % young > 15 y • 6 % children 6 – 15 y EMITED CHEMICALS: •DI- ETHYLEN GLYCOL •NANOPARTICLES (Cr, Ni, Sn, Ag, Al…) •NITROSOAMINES •ACETALDEHYDE, FORMALDEHYDE •PAH •CHLORINATED POLYCYCLIC H. HEALTH CONSEQUENCES: •Ac. Similar as of classic CIGARETTES •Due to NICOTINE •CARRIOGENIC EFFECT OF SWEET ADITIVES •Chr. and late – NOBODY KNOWS •MAY BE DIFFERENT KINETIC and PHYSIOLOGIC PATHWAYS NEW „MYSTERY DISEAS“ •MORE THAN 500 CASES (even >800), •2/3 at age 18-34y, 16% < 18 y •12 deaths in USA, + 1 in Canada •„steril pneumonia“, GIT problems, fever •NOBODY KNOWS THE CAUSE: fruit additives, THC, oil-E vit, black market, home made additives BAN of VAPING •IN SEVERAL STATES and •STRONG WARNING AGAINST ADVERTISING ABOUT SAFETY OF e-CIGARETTES •The use of these products is creating a new generation of young people who are addicted to nicotine and will spend the rest of theor life buying nicotine in some form BURNING •EXPLOSIVE EVENT of LITHIUM BATTERY •FIRES, BURNS, INJURY •Air force recommendations => e-cigarettes as dangerous products (like arms) •In US airlines are banned STATEMENT (WHO, EU, US) •NOT DRUG FOR TREATMENT, but •ANOTHER TOBACCO PRODUCTS •RISK OF POISSONING •KEEPING both PHYSICAL and BEHAVIORAL DEPENDENCE •URGENT NEEDS FOR FURTHER RESEARCH OF CHRONIC OUTCOMES EXPOSURE TO NICOTINE IS OUT OF CONTROL •Some smokers tell about several puffs every 10 minutes •One „pod“ in JUUL => as 20 cigarettes •VERY FAST DEVELOPED ADDICTION REPRODUCTION - MEN •IMPOTENCE (sympaticotonus) •LESS AMOUNT of EJACULATE •LESS COUNT of SPERM •LESS of MOTILE SPERMS => • INFERTILITY/STERILITY •MORE of ANEUPLOID SPERMS => HEREDITARY MALFORMATIONS REPRODUKCTION-WOMEN •HORMONAL DYSBALANCY=> MENSTRUAL DYSREGULATION, EARLIER MENOPAUSE (5-8 y) •INFERTILITY, STERILITY •EXTRAUTERINE GRAVIDITY •PLACENTA PRAEVIA •ABORTION, STILL BIRTHS PRENATAL EXPOSURE •FETAL TOBACCO SYNDROME => •RISK FOR HEALTH IN POSTNATAL, CHILDHOOD and ADULTHOOD (programing) •CONGENITAL MALFORMATIONS •NEUROPSYCHICAL DISORDERS (ADHD, conduct disorders,dependence, criminality) •GENOTOXIC DAMAGES =>CANCER OTHER DISEASES •GASTRIC ULCER, POLYPOSIS, CROHN´s DISEASE •IMMUNITY IMPAIRMENT: INFECTIOUS DIS., ALERGIC DIS. •VISUS (catharact, macular degeneration) •SKIN DIS. •PSYCHIATRIC DIS. (suicides, depression,) x protective in Parkinson dis. •LOST OF MEMORY AND COGNITION =>senile demetia, AD • SMOKING AND ORAL HEALTH •LONGER HUMAN LIFE EXPECTANCY NEEDS LONGER WELL-PRESERVED HEALTH TEETH •Food intake, speaking, mimicking •THE MAIN CAUSE OF TEETH LOST ARE CARRIES and PARODONTITIS THE RISK FACTORS •MALNUTRITION (DEFICIT Ca, F, vit. C) •ALCOHOL, SWEETS •Body Mass Index (overweight, obesity) •POOR DENTAL HYGIENE •SMOKING •SOCIAL DETERMINANTS (education) SMOKERS ARE OFTEN: •LESS EDUCATED •WITH POORER NUTRITION •WITH ABUSE OF ALCOHOL •WITH POOR ORAL HYGIENE ORAL HYGIENE •IS WORSE EVEN AMONG HIGHLY MOTIVATED SMOKERS – DENTISTS STUDENTS : •9 times MORE NO-SMOKERS DECLARED HIGHER DAILY FREQUENCY OF TEETH BRUSHING than THEIR SMOKING COLEAGUES NIKOTINOVÁ STOMATITIS 13 KUŘÁCKÁ MELANÓZA 14 TABÁKOVÉ SKVRNY 17 ABRASE ZUBŮ 18 CHLUPATÝ JAZYK 27 JAPANESE STUDY •EXPOSURE TO SMOKING AND CARIES AT THE AGE 3 YEARS: •- Only during 1st trimester……..OR 1.37 •- During the whole pregnancy…..OR 1.70 -Postnataly …………………….OR 1.23 -Prenataly + postnataly ………. OR 1.62 •Tanaka K. et al. Environ Res 2015; 143:148-153 - POSIBLE MECHANISMS •Mineralization of primary teeth at 13th week; NICOTINE: •-affects cells proliferation and differentiation •-inhibites odontoblasts´mineralizzation •-promotes biofilm formation and •-metabolic aktivity of Str-mutans •-vit.D deficiency (due to poor smoker´s diet) SMOKING and CARRIES •HIGHER KPE (DMFt) SCORE AMONG SMOKERS •HIGHER kpe (dmft) SCORE (AMONG EXPOSED CHILDREN to PS •DOSE-RESPONSE ASSOCIATIONS (salivary cotinine, years of active smoking, number of cigarettes/day) PATHWAYS: •POORER NUTRITION HABITS •POORER ORAL HYGIENE •POORER SECONDARY PREVENTION •HIGHER AMOUNT of LACTOBACILs a Str.MUTANS •LOWERED PROTECTIVE SALIVARY FUNCTION (lower pH, lower production) PRIMARY PREVENTION •OF DENTAL CARIES STARTS PRENATALY: •- RIGHT MATERNAL NUTRIRION •-PREVENTION OF STR.MUTANS TRANSFER (kissing, common spoon) •- GOOD CHILD´S NUTRITION •- DENTAL HYGIENE •-EARLY VISITS IN DENTIST´S OFFICE WHO GUIDELINES • •dmft 0 among at least 60 % of children aged 5-6 years •RESTORATIVE INDEX near 100 % PARODONTAL DISEASES •ORIGIN: G neg., anaerobe and micro-aerofil bacteries = > •ENHANCING of PRO-INFLAMMATORY PROSTAGLANDINS and CYTOKINS => •DESTRUCTION of TISSUES VASOCONSTRICTION •LOWER GUMs OXIDATION => • •BETTER CONDITIONS FOR GROWTH of ANAEROBES SMOKERS HAVE •3 – 4 times MORE OFTEN SEVERE FORMS of PARODONTITIS: -DEEPER TRUNKS, -HEAVIER LOST of BONE MASS -MORE SUBGINGIVAL DEPOZITS of DENTAL CALCULUS -QUICK PROGRESSION of LOST of TEETH FIXATION (27 years) PARODONTAL DISEASES: •OCCURE MORE OFTEN EVEN AMONG SMOKING YOUTH and YOUNG ADULTS •- IZRAEL STUDY -CARDIFF DENTAL STUDY - -LESS SUCCESSFUL TREATMENT of SMOKERS PARODONTITIS •Can serve as a risk factor for Alzheimer´s disease due to dissemination of infectious agens in circulatory system, release of pro-inflamating cytokines and CRPs; •The inflamatory is also characteristic for AD (not only amyloid plaques and neurofibrillary tangles). TEETH LOST •MORE THAN 8 TEETH HAVE NOT AT AGE 45-69 YEARS: -30% NO - 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% CURRENT SMOKERS - LEUKOPLAKIE •6 times MORE OFTEN AMONG SMOKERS •SIDE: -BUCCAL – CIGARETTES -PALATAL – PIPES, CIGARES -LIPS, BUCCAL – SMOKELESS TOB. - Homogenní leukoplakie 04 Verukózní leukoplakie 05 Nodulární leukoplakie 06 ORAL CANCER •RELATIVE RISK 2 – 18 •ALCOHOL + SMOKING even 100 •OTHER RISKs ASSOCIATED with SMOKING: •Malnutrition, •chr. Candidosis, •viral infections (human papiloma v., herpes simplex) EPIDEMIOLOGY •MEN:WOMEN RATE 6:1, NOW 2:1 •MOST OFTEN AMONG 45 + y •AMONG YOUNG SMOKELESS TOBACCO USERS •TONGUE – 20% •GUMS – 18% •LOWER ORAL LAYER + SALIVARY GLANDS – 20% •LIPS – 11% Nádor jazyka 02 SMOKING IS A DISEASE •DEPENDENCE = PSYCHIC and BEHAVIOURAL DISORDERS as CONSEQUENCES OF USING TOBACCO – dg F 17 •PHYSICAL PART – NICOTINE •BEHAVIORAL PART – AUTOMATIC MANNERS • SMOKING as STRONG DRUG •80 – 85 % of daily smokers will be dependent •Like regular users of heroine/coccaine •Even 30 % of occassional smokers will develop addiction on smoking PATHWAYS: •ACTIVATION of BRAIN ACETYLCHOLINE RECEPTORS => •RELEASE OF NEUROTRANSMITTERS (dopamine, serotonine) and •HORMONES (ACTH, adrenaline) SMOKER´S REWARD •PLEASURE MOOD (dopamine) •COPING THE STRESS (ACTH) •BETTER SHORT-TERM PERFORMANCE (adrenaline) ALL THESE STIMULS •FOR THE RECEPTORS´ ACTIVATION •CAN OFFER MANY DAILY EVENTS: •FOOD, SEX, MUSIC •TRAINING, WORKING, PHYSICAL ACTIVITIES, •FRIENDLY ENVIRONMENT, SELF-SATISFACTION DEPENDENCE on SMOKING •IS A PEDIATRIC PROBLEM •MAJORITY OF SMOKERS STARTED IN CHILDHOOD AGE •VERY OFTEN AS UNHAPPY – UNSUCCESSFUL PEOPLE or •CURIOSITY SEEKING, LAZY PEOPLE CHARACTERISTICS •FOR DEPENDENCE – PSYCHIATRIC SOCIETIES – 9 markers •TOLERABILITY (needs for higher doses) •WITHDRAWAL SYMPTOMS during the abstinence LEVEL OF ADDICTION: •FAGERSTROM´s QUESTIONNAIRE: 6QUESTIONS 10„PENALTY “ POINTS 11 •4 LEVELS OF DEPENDENCE SMOKING CESSATION – 5 A •ASK •ASSESS •ADVICE •ASSIST •ARRANGE FOLLOW-UP THERAPEUTIC HELP: •NICOTINE REPLACEMENT THERAPY gums, patches, inhalator, tablets •Antidepresive drug BUPROPION: Zyban, Wellbutrin •Nicotine Agonist VARENICLIN: Champix •VACCINATION INVOLUNTARY SMOKING •MAIN STREAM and SIDE STREAM of TOBACCO SMOKE: different burning conditions: perfect/imperfect => higher chemicals levels in side stream •DANGER FOR NO-SMOKERS, esp. Children (respirátory and CV diseases, cancer) POLICY •BAN OF SMOKING IN PUBLIC PLACES •EDUCATION •SMOKE-FREE HOMES/ CARS = voluntary decision of smokers to do not smoke when children are present (secondhand smoke) and •Where children are present (thirdhand smoke) IN JAPAN CONCLUSSIONS: •SMOKING IS A SERIOUS RISK •IT DAMAGES ALSO ORAL HEALTH •IN MANY COUNTRIES • DENTISTS ARE ACTIVE IN MAKING • BARRIERS • LIMITING TOBACCO PANDEMY