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WHO:
• SMOKING IS THE MOST IMPORTANT
• SINGLE
• PREVENTABLE
• RISIK FACTOR
• FOR HIGH LEVEL OF MORBIDITY and PREMATURE MORTALIRY
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
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
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)
IN CIGARETTE SMOKE
• Cca 5.000 CHEMICALS
• 67 HUMÁN CARCINOGENS
• 33 TOXIC CONTAMINANTS OF AMBIENT AIR
• 47 CHEMICALS REGISTERED AS TOXIC WASTE
OTHER FORMS of TOBACCO
• SMOKELESS
• PIPES. CIGARS
• ARE THE IMPORTANT CAUSES OF HEAD AND NECK CANCERS
RISK FOR REPRODUCTION
• IMPOTENCE, INFERTILITY
• HORMONAL DYSBALANCE
• COMPLICATION DURING PREGNANCY
• ABORTS
• PREMATURE DELIVERY
• CONGENITAL MALFORMATIONS
INTRAUTERINE EXPOSURE
• FETAL TOBACCO SYNDROME =>
• PROGRAMMING
• CONGENITAL MALFORMATIONS
• NEUROPSYCHICAL DYSORDERS (ADHD,conduct dysorders, addiction, criminality)
• GENOTOXICITY =>CANCER
SMOKING and ORAL HEALTH
• THE MAIN CAUSES OF TEETH LOST ARE CARIES and PARODONTITIS
• SMOKING CONTRIBUTES TO BOTH OF THESE DISEASES
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
PRENATAL RISKS OF CARIES
• MOTHER´S OBESITY …………1,21
• MOTHER´S SMOKING..………..1,33
• LOW BIRTHWEIGHT
• PREMATURE DELIVERY
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
SMOKING and CARIES
• SMOKERS HAVE:
• HIGHER SCORE kpe
• HIGHER SCORE KPE
• In DOSE-RESPONSE ASSOCIATIONS
(salivary cotinine, years of smoking, number cig/day)
SMOKERS HAVE WORSE:
• NUTRITION
• ORAL HYGIENE
• SECONDARY PREVENTION
• HIGHER BACTERY COLONISATION LAKTOBACILY a Str.MUTANS
• PROTEKTIVE SALIVARY ROLE (lower pH, lower production)
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
PARODONTAL DISEASES
• G neg., anaerob and mikro-aerofil bakteries = >
• ENHANCES PRO-INFLAMMATORY PROSTAGLANDINS A CYTOKINES =>
• DESTRUKCION OF TISSUE
AMONG SMOKERS
• 3x – 4x MORE OFTEN SERIOUS PARODONTITIS:
- DEEP LOBES,
- HIGHER BONE LOST
- MORE SUBGINGIVAL DEPOSITS of CALCULUS
PARODONTAL DISEASES
• ARE MORE OFTEN ALSO AMONG YOUNG SMOKERS
- IZRAEL STUDY
- CARDIFF DENTAL STUDY
- WORSE EFFECTIVENESS OF TREATMENT
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
LEUKOPLAKIE
• OCCURES 6 times MORE OFTEN AMONG SMOKERS
• SIDES:
- BUCAL – cigarettes smoking
- PALATE – pipes/cigars smoking
- LIPS, BUCAL – smokeless tobacco
ORAL CANCER
• RELATIVE RISK 2 – 18
• WITH ALCOHOL 100
• WITH OTHER RISKS:
Malnutrition,
chr. Candidosis,
viral infections (human papiloma v., herpes simplex)
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%
SMOKING IS A DISEASE
• DEPENDENCE – dg F 17
• FYSICAL PART – NIKOTIN
• BEHAVIORAL PART – AUTOMATIC BEHAVIOR
LEVEL OF DEPENDENCE
• FAGERSTROM QUESTIONNAIRE:
6 QUESTIONS
10 „PENALTY“ POINTS
4 LEVELS OF DEPENDENCE
SMOKING CESSATION– 4 A / 4P
• ASK
• ADVICE TO STOP
• ASSIST WITH WITHDRAWAL SYMPTOMES
• ARRANGE FOLLOW UP
TERAPEUTIC HELP
• NICOTINE REPLACEMENT THERAPY chewing gums, sticks, inhalator, tablets
• Antidepresivum BUPROPION: Zyban, Wellbutrin
• Nicotine Agonis VARENICLIN: Champix
• VAKCINATION