1952 first paper published linking smoking to cancer (sir richard doll)

4000-6000 chemicals, 60-70 known carcinogens, nicotine addictive element.

no difference in flora (same bacteria), formation rates are the same, increased amounts found plaque and calculus (thicker sub and supra) - many different factors contribute.

mostly common lower anteriors and palatal stain, pts ofter over brush and use abrasive t/p = recession, sensitivity and abrasion.

seen more frequently in smokers, smokers have greater risk.

greater healing times both surgical and non surgical treatment. increased risk of peri-implantitis- osseointergration - 48% failure rate in smokers, 2% failure rate in non smokers

difficult to prove as multi-factorial but: poorer OH, buffering effect of saliva reduced, may increase numbers of L.bacilli and s. mutans, smokers often eat sweets/gum/mints to mask smell, may not be so worried about health in general.

most frequent tobacco related keratosis orally, white skin/keratin produced caused by heat. produced for protection

smelly breath

unknown aetiology maybe associated with candida, due to lack of papilla (99% of smokers), possibly cancerous, referral needed as biopsy may need to be done. (centre of tongue redness)

(red patches) 5-10% cancerous. most cases associated with smoking, 5-10% may transform into malignancy, some may be speckled white and red speckled erythoplakia (15% cancerous). always refer

most cases seen in smoker 5 x increased risk, 1-2% may transform into malignancy in 5 yrs

1st aetiology is tobacco (alcohol increases risk), majority not preceded with pre malignant lesion (just appear), dose/time relationship

periodontium is affected by tobacco and nicotine (systemic affect), reduced bleeding on BOP & BOB (vasoconstriction due to heat and nicotine), less gingival crevicular fluid (less dilution of toxins), PMNL's reduced workload/effect x3 (reduced immunity locally where ever infection is. fail to: follow chemotaxis, reduced motility, reduced phagocytosis), Reduced healing post tx (less blood supply to gingiva, masks symptoms of disease still may have active pockets that do not bleed need rads) more likely to be caught late.

greater pocket depths, have fewer teeth, increased boneless, increased no of pockets, increased levels of mobility, reduced healing: non smokers after RSD 1-3mm of reduced pocket depth, non 0-1mm reduced pocket depth.