The effect of cigarette smoking on

gingival blood flow in Humans

Presented By :Dr. Abhishek Gaur

INTRODUCTIONCigarette smoking has been associated with

increased calculus formation and periodontitis (Solomon et al. 1968, Bergstrom & Floderus-Myrhed 1983, Feldman et al. 1983).This association between poorer periodontal health and smoking remains after taking account of age. oral hygiene, sex. race and socioeconomic status (Ismail et al. 1983).

An even stronger relationship exists between smoking and acute necrotizing ulcerative gingivitis (ANUG). Patients treated for this disease are almost invariably smokers (Pindborg 1951, Kowoiik & Nisbet 1983).In addition, the incidence of ANUG rises with increasing tobacco consumption (Pindborg 1949. Goldhaber & Giddon 1964).

Material and Methods12 healthy subjects, 6 men and 6 women, volunteered for the study.The subjects' ages ranged from 19 to 25 years (mean = 22.4).All were college students who habitually smoked cigarettes, consuming 5 to 15 per day(mean= 10.8) for the past 2 to 8 years (mean = 4.7). Informed consent was obtainedbefore each experiment using a form approved by the hospital's Human Subjects Committee.

The experiments took place during the Swedish Fall and Winter in a room maintained at 22-23''C.Volunteers were excluded who lacked an intact buccal surface of the upper left canine and first molar {nos. 23 and 26), or who reported a history of hypertension, angina or emphysema.Marginal gingiva appeared healthy at the test tooth; pocket depth was < 3 mm and attachment loss < 1 mm.

Each experiment had 4 phase';: resting, sham smoking, smoking and recovery.During the first phase, the subject rested quietly in the dental Chair for 5 min. During sham smoking, the subject puffed on an unlighted filter cigarette every 30 s for 5 min, A filter tip cigarette was used to prevent the subjects" contacting nicotine before smoking, and yet simulate smoking's hyperventilation.The interval between inhalations was standardized for both sham smoking and smoking phases to control the effects of hyperventilation on blood flow.The subjects were instructed to inhale as they would if they were actually smoking. An audible signal was provided every 30 s to prompt the subjects when to puff.

ResultsRelative blood flow to the gingiva (GBF) increased slightly during sham smoking by 2,8%.

As expected, smoking raised both the systolic and diastolic blood pressures. Mean resting values of 110.5/70.5 mmHg remained unchanged during sham smoking, increased to 119.0/75.7 mmHg during smoking, and returned to 113.6/73.3 mmHg 25 min later.

DISCUSSIONThis study indicated that relative gingival blood flow (GBF) immediately rose during smoking and rapidly returned toward baseline within 10 min.Great variability in GBF was observed between smokers' responses to nicotine in cigarette stroke. Placing the probe into the sulcus resulted in a nearly linear rise in GBF during the experiment.This phenomenon was not observed when the probe was removed from the sulcus and placed external to the crestal gingiva

Our findings confirmed those of others regarding the profound cardiovascular effects of cigarette smoking, LDF skin blood flow to the forearm has been shown to decrease during and immediately after smoking, but only in those subjects who had high levels of plasma vasopressin (Waeber et al, 1984),

Our study also showed that 50% of the subjects' SBF dropped during smoking; the other 50%'s SBF remained relatively unchanged. Heart rate and BP also increased significantly with smoking, thus confirming findings of others.

(Coffman & Javett 1963, Trap-Jenson et al, 1979. Lehtovirta & Forss 1980)

CONCLUSIONIn conclusion, this study indicated that cigarette smoking caused a

significant increase, rather than a decrease, in human gingival

circulation.

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