Influence of tobacco_use_on_caries_development_ppt

PARTHA PRATIM DAS INTERN

BURDWAN DENTAL COLLEGE AND HOSPITAL

Cigarettesmoking

Snuff or Smokeless tobacco

TOBACCO CULTIVATION

INFLUENCE OF TOBACCO USE ON DENTAL CARIES DEVELOPMENT

UNDER THE GUIDANCE OF DR. SANJIB MITRA

ASSOCIATE PROFESSOR DEPARTMENT OF ORAL AND MAXILLOFACIAL

PATHOLOGY BURDWAN DENTAL COLLEGE AND HOSPITAL

HISTORY OF TOBACCO

•Tobacco cultivation has a history of about 8000 years.• Portuguese traders introduced tobacco in India during 1600.• The entry of European colonial powers into India spurred the import of tobacco into India.

(History of Tobacco by Dr. Sanjib Mitra)

TOBACCO PLAYS AN IMPORTANT ROLE IN INDIAN ECONOMY Tobacco plays a significant role in the Indian economy as it contributes substantially in terms of excise revenue, export revenue and employment. India is the world’s second largest producer of tobacco and also the second largest consumer of unmanufactured tobacco. It is a major exporter of unmanufactured tobacco.


Bidi54%

Chewing tobacco30%

Cigarette16%

TYPES OF TOBACCO USED IN INDIA

Smoking Chewing

Cigarettes Gutkha

Bidi Khaini

Hookah Zarda

Dhumti Gudhaku

Chutta Paan (with tobacco)

Chillum Gul

Cigars Mawa ,Mishri


DENTAL CARIESDefined as an irreversible microbial disease of the calcified tissues of the teeth characterized by demineralization of the inorganic portion and destruction of the organic substance of the tooth which often leads to cavitations.

CURRENT TRENDS IN CARIES PREVALENCEThough various studies reveal decrease of caries incidence in the developed countries but the prevalence of caries has been reported to be increasing in certain less developed countries.

(Shafer’s Textbook of Oral Pathology)


STAGES OF TOOTH DECAY

DMF AND DEF INDEXQuantitative and qualitative measure that accurately reflects the extent of dental caries in a population….

D- DECAYED

M- MISSING

F- FILLED

D- DECAYED

E- INDICATED FOR EXTRACTION

F- FILLED (considered in case of pediatric patients

Can be DMF(T) or DMF(S) and DEF(T) or DEF(S)

ETIOLOGY OF DENTAL CARIESMiller’s Chemicoparasitic Theory or Acidogenic TheoryCaries is caused by acids produced by micro organisms in the mouth THE ROLE OF CARBOHYDRATES

THE ROLE OF MICROORGANISMS THE ROLE OF ACIDS THE ROLE OF DENTAL PLAQUE

The Proteolysis Chelation Theory(Schatz et al,1955)

The Sucrose Chelation Theory(Egglers-Lura, 1967)


CURRENT CONCEPTS IN CARIES ETIOLOGY


Type of Caries Microorganisms

Human Disease

Pit & Fissure S. mutansS. sanguisLactobacillus

sp.Actinomyces sp.

Very significantUncertainVery significantBy chance

Smooth surface S. mutansS. salivarius

Very significantBy chance

Root surface A. viscosusB. naeslundiiS. mutansS. sanguis

Very significantVery significantSignificantBy chance

Deep dentinal caries

Lactobacilli sp.A. naeslundiiOther

filamentous rods

Very significantVery significantVery significant


LOCALIZATION

OF

MICRO-

FLORA

RELATED

TO

CARIES

INFLUENCE OF TOBACCO USESmoking and its relation to dental caries is a subject of many opinions. From early reports and a common belief was that smoking actually helps to reduce dental caries.

Schmidt, in 1951, supported this belief when he reported that increase in tobacco smoking was against caries..

The concentration of thiocyanate, a constituent of tobacco smoke and normal saliva with possible caries-inhibiting effect, was found to be higher in smoker’s saliva.

(Influence of tobacco use in dental caries developmentSajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka Shriharsha2)

Thiocyanate molecule

TOBACCO AGGRAVATING DENTAL CARIES

The decreased buffering effect and possible lower pH of smoker’s Saliva. The higher number of Lactobacilli and Streptococcus mutans . In 1952, Ludwick and Massler reported that those who smoked more than 15 cigarettes a day had significantly higher number of decayed, missing, and filled teeth. • In 1990, Zitterbart confirmed association between smoking and the prevalence of dental caries in adult males. Smokers had significantly higher DMFT (Decayed, Missing, and Filled Teeth) score, untreated decayed surfaces, and missing surfaces.


Association between smoking and dental caries is well documentedin older age groups.

Among middle-age (15) oryoung adults (25) results are inconsistent.

Non-smokers reportedmore frequent healthy oral health behavior than did daily smokers


ENVIRONMENTAL TOBACCO SMOKE OR PASSIVE SMOKE AND PEDIATRIC DENTAL CARIES

UK National Diet and Nutrition Survey (1995) suggested maternal smoking as a significant risk factor for predicting caries in preschool children

Work of Aligne and colleagues (2003) has provided strongest evidence yet of an increased risk of dental caries in the deciduous dentition of children who are 4 to 11 years of age and have been exposed to passive smoking or environmental tobacco smoke (ETS)

A recent study done in 2004 also confirmed that children residing in regularly smoking homes had significantly higher prevalence of caries compared to Non regular/nonsmoking homes .

Association of Pediatric Dental Caries With Passive Smoking FREE C. Andrew Aligne, MD, MPH; Mark E. Moss, DDS, PhD; Peggy Auinger, MS; Michael Weitzman, MD

Nicotine has been shown to promote the growth of cariogenic Streptococcus mutans bacteria in vitro thus, mother who smoke may be more likely than non-smokers to transmit these germs to children .

ETS smoke has immunosuppressive properties and is a known risk factor for infections of the cranial organs (e.g. otitis media); thus it is not surprising that it might be risk factor for caries development as well..

In addition ETS is associated with decreased serum vitamin Clevels in children and decreased levels of vitamin C are associatedwith growth of cariogenic bacteria.

Association of Pediatric Dental Caries With Passive Smoking FREE C. Andrew Aligne, MD, MPH; Mark E. Moss, DDS, PhD; Peggy Auinger, MS; Michael Weitzman, MD

COTININE A METABOLITE OF NICOTINE FOUND IN SERUM OF PAEDIATRIC PATIENTS EXPOSED TO PASSIVE SMOKE

Children from 4-11 years with serum cotinine levels more than 0.2ng/ml were detected with an increased prevalence of dental caries

cotinine

SMOKELESS TOBACCO AND DENTAL CARIES

Controlling for cigarette smoking, a dose-response relationship was also shown between caries and the number of years of snuff use.. The types of sweeteners and sugars commonly found in ST are fructose, glucose, sucrose, maltose, and isomaltose. Individuals who chew tobacco appear to have more dental caries than non-users.(Influence of tobacco use in dental caries development

Sajith Vellappally1, Zdeněk Fiala1, Jindra Šmejkalová1, Vimal Jacob1, Pilathadka Shriharsha2)

A wad of tobacco is kept in the oral cavity for 30 minutes on average,there isin vitro evidence of stimulated growth of Streptococcus mutans and Streptococcus sanguis in the presence of smokeless tobacco extracts.

It has been also found that extracts from chewing tobacco with high sugar content increased in vitro growth of Lactobacillus casei , a bacterium implicated in root surface caries.


Forms of tobacco use Biological effects

Tobacco smoking •Concentration of thiocynate found to be higher in smoker’s saliva may have possible caries inhibiting effect .• Decreased buffering effect and possible lower pH of saliva in smokers may indicate increased susceptibility to caries.• Higher number of lactobacilli and Streptococcus mutans in smokers may indicate caries susceptibility

Environmental tobaccosmoke (ETS)

• Biological plausibility of causal role of ETS in caries formation in children .• Immunosuppressive properties of ETS might be a risk factor for dental caries development .• ETS may decrease serum vitamin C level, which may be associated with growth of cariogenic bacteria in children .• ETS may reduce the protective properties of saliva that can operate against caries

Smokeless tobacco • High levels of fermentable sugar and sweeteners in ST can stimulate growth of cariogenic bacteria (55, 56, 59).• Extracts from chewing tobacco with high sugar content increased in vitro growth of Lactobacillus casei (59, 61).• Extracts of ST may serve as a growth substrate for Streptococcus mutans, Streptococcus salivarius and Streptococcussanguis (64).

Summary of major biological effects of tobacco related to dental caries


THE BASIC UNDERLYING MECHANISM BEHIND

Sortase A

ANTIGEN I/ II BINDING OF CARIOGENIC STREPTOCOCCI

INSPITE OF SIGNIFICANTLY HIGHER LEVELS OF IG A & J CHAINS SMOKELESS TOBACCO HAS

IMPAIRED IMMUNE RESPONSES

Nicotine is a major component of tobacco smoke, and signals via nicotinic acetylcholine receptors (nAChR)

nicotine suppresses the cytodifferentiation and mineralization of HDPCs- human dental pulp cells , possibly via nAChR.

Thus inducing caries which is a demineralising process of the calcified tissues of the teeth

OUR ROLE TO CURB THE MENACE OF TOBACCO USE

EducationLegislationRegulationEnforcementTaxationEconomic AlternativesSupport for cessationCommunity MobilizationReduction in demand and supplyTobacco cessation

The 5 A’s 2 A’s and an R

ASK

ADVISE

ASK

ADVISE

REFER

ASSESS

ASSIST

ARRANGE

AS THEY SAY “ WHEN THERE IS A WILL, THERE IS A WAY”

WILL POWER IS DEFINITELYMORE THAN ‘WILLS’ POWER

The smiling teeth reflects a healthy heart& mind

THANK YOURESPECTED JUDGES FRIENDS

DR. SANJIB MITRAAssociate Professor Department of Oral and Maxillofacial PathologyBurdwan Dental College and Hospital

PROFESSOR DR. TAMAL PATRAPrincipalBurdwan Dental College and Hospital

INDIAN DENTAL ASSOCIATION WEST BENGAL STATE BRANCH

Influence of tobacco_use_on_caries_development_ppt

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