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Cebu Doctors University

Mandaue City, Cebu

The Nicotine Content of Cigarettes Damaging Effects to the Teeth:One Hundred Pre-dentistry Students A & B

Reconstructive Surgery: 2015

A Research PaperSubmitted in Partial Fulfillment

Of the Requirements forEnglish 12

Submitted by

Jullieanne Arquiza

Kent Cempron

Jan Ellen Chua

Carol Anne Hole

Joanna Remitar

Ramon Saa

Hazel Sarthou

Melissa Joyce Wahing

Submitted to

Mrs. Florecar Arco

AdviserSecond Semester, S.Y. 2014 2015

Table of Contents

Introduction 3Significance of the Study 4Research Design 5Definition of Terms 6 Scope and Limitations of the Study 8Statement of the Problem 9Review of Related Literature 10Appendixes 15Bibliography 17Survey Questionnaire 18IntroductionPeople who smoke are more likely to have gum disease. Smoking may change the type of bacteria in dental plaque, increasing the number of bacteria that are more harmful. It also reduces the blood flow in the gums and supporting tissues of the tooth and makes them more likely to become inflamed. Smokers' gum disease will get worse more quickly than in non-smokers. Because of the reduced blood flow, smokers may not get the warning symptoms of bleeding gums as much as non-smokers. Gum disease is still the most common cause of tooth loss in adults. In fact, one of the effects of smoking is staining on the teeth due to the nicotine and tar in tobacco. It can make the teeth yellow in a very short time, and heavy smokers often complain that their teeth are almost brown after years of smoking.

Tobacco dependence also shows many features of a chronic disease. Regular smokers are addicted to the habit as tobacco use results in true drug dependence. A minority is able to quit in one attempt but the majority may need some assistance to cease tobacco use. Numerous effective treatments are now available, and the dentists, oral physicians and their team members should become actively involved in efforts to reduce smoking. Smoking cessation advice delivered by dentists have shown to be effective. As with other chronic diseases, the most effective treatment of smoking requires multiple approaches in addition to clinician's advice. Pharmacotherapy is proven to be effective, and several products are available; nicotine patches, nicotine gum, nicotine lozenge, nicotine inhaler and nicotine nasal spray.

Significance of the StudyTo Chain Smokers:

This study intends to educate and spread awareness amongst people who are inclined to smoking on a daily basis. It gives them an idea of what nicotine could do that would not only affect the physical health but the oral health in particular.

To Researchers:

This study would also be beneficial to the researchers because it would provide the necessary information of the different threats of nicotine. For future researchers this would serve as a reference for a farther indebt study on nicotine.

To Students, Teachers, and Employees of Cebu Doctors University:

This study would serve as an awareness for the students, Teachers, and Employees of Cebu Doctors University of the harmful effects of nicotine and how it would slowly deteriorate ones oral health.

Research Design

Definition of Terms

NicotineNicotine is a toxic colorless or yellowish oily liquid that is the chief active constituent of tobacco. It acts as a stimulant in small doses, but in larger amounts blocks the action of autonomic nerve and skeletal muscle cells. Nicotine is also used in insecticides. Nicotine is a potent parasympathomimetic alkaloid found in the nightshade family of plants (Solanaceae) and a stimulant drug. It is made in the roots of and accumulates in the leaves of the nightshade family of plants. It constitutes approximately 0.63.0% of the dry weight of tobaccoantiherbivore chemical HYPERLINK "http://en.wikipedia.org/wiki/Nicotine" \l "cite_note-3"

and is present in the range of 27g/kg of various edible plants. It functions as an ; consequently, nicotine was widely used as an insecticide in the past and nicotine analogs such as imidacloprid are currently widely used. Nicotine liquid can be used in vaporizers or electronic cigarettes along with a wide variety of different flavors. Cigarettes

A cigarette is a small cylinder of finely cut tobacco leaves rolled in thin paper for smoking. The cigarette is ignited at one end and allowed to smolder; its smoke is inhaled from the other end, which is held in or to the mouth; in some cases a cigarette holder may be used as well. Most modern manufactured cigarettes (also called "ready rolls") are filtered and include reconstituted tobacco and other additives. The term cigarette, as commonly used, refers to a tobacco cigarette but can apply to similar devices containing other herbs, such as cloves or cannabis. A cigarette is distinguished from a cigar by its smaller size, use of processed leaf, and paper wrapping, which is normally white, though other colors are occasionally available. Cigars are typically composed entirely of whole-leaf tobacco.

Reconstructive Surgery

Reconstructive surgery is a type of surgery done to restore function or normal appearance by remaking defective organs or parts. It is the restoration of appearance and function following injury or disease, or the correction of congenital defects, using the techniques of plastic surgery. Other branches of surgery (e.g., general surgery, gynecological surgery, pediatric surgery, cosmetic surgery, podiatric surgery) also perform some reconstructive procedures. The common feature is that the operation attempts to restore the anatomy or the function of the body part to normal.Scope and Limitations of the Study

Statement of the ProblemThis project addresses to the overall problem of smoking and how it affects the discoloration of the peoples teeth. The research deals with the ill effects of smoking in relation to the teeth or the oral health of a person. 1. The harmful effects of nicotine on the teeth:

1.1. The result of nicotine on the teeth color.

1.2. The propensity of having bad breath caused by nicotine.

2. The antecedent of smoking on peoples oral health:

2.1. The ebbing of the smokers teeth caused by frequent smoking.

2.2. The tampering of taste buds in the tongue caused by frequent smoking.

2.3. The variation of the texture of the lips caused by frequent smoking.

2.4. The contribution of smoking in the swelling of the gums.Review of Related Literature

Second to regular mechanical plaque control, tobacco use cessation has become the most important measure for the treatment of periodontal diseases. In contrast to general medical professionals, dental hygienists are seeing their patients regularly and are therefore available for supporting their patients to quit tobacco use. Tobacco use disease consists of both a physical addiction and a psychological dependence. Therefore, the combination of behavior change support with pharmacotherapy is recommended for tobacco use cessation counseling. The use of brief motivational interviewing for tobacco use short interventions in the dental practice appears to be suitable. In addition to behavioral support, the use for nicotine replacement therapy is the treatment of choice for the dental practice. Following a critical review of the literature on this topic, a step by step approach for tobacco use cessation is presented for the dental hygienists to be implemented in their daily practice routine. (Ramseier, et al., 2009)

The damaging and harmful effects of tobacco usage on oral health are now well recognized, in particular a higher prevalence and severity of periodontal diseases among smokers and the association of tobacco use with candidiasis, and with oral malignancies. Several recent documents have reviewed the scientific evidence relating to the oral disease burden attributable to tobacco use and have highlighted the role and the need for the dental profession to get involved with tobacco intervention.

Smoking can cause the discoloration of teeth and some argue that tobacco in fact might increase dental decay as it lowers salivary pH and the buffering power. Smoking is likely to cause halitosis and may affect smell and taste. Smokers may present with generalized Melanesia of the oral mucosa that often necessitate investigations to exclude other systemic disorders. Wound healing is impaired in tobacco smokers possibly due to local vasoconstriction and poor neutrophil function. There is fair evidence that tobacco use is a major factor in the progression of periodontal disease. Smokers have an increased prevalence of periodontitis, and their disease severity is higher with greater alveolar bone loss resulting in deeper pockets compared with non-smokers. Acute necrotizing ulcerative gingivitis has been shown to be associated with heavy smoking. Periodontal therapy often fails among smokers and it is difficult to halt attachment loss. Possibly for similar reasons dental implant failure is more common in smoking subjects compared with non-smokers. (Ramseier, et al., 2009)

Smoking has a distinctive and lasting impact on oral health in some interesting and alarming ways. The fact that cigarette smoking will kill one in five people from smoking-related illnesses, some of them pretty nasty, should be a big heads up. Your mouth is an interesting spot from which to explore the effects of smoking. Consider it the location where the poison from cigarettes hits the palate and gains access to the rest of you. Because what you smoke passes over your teeth and through your gums, your mouth is nicotine central -- in a very bad way. Destroying your appearance with nicotine-stained teeth and making your breath smell foul are just the superficial aspects of what smoking does to your oral health.

Periodontal disease is a group of disorders that affect the gums. In a healthy mouth, the gums stay snug up around the base of the teeth, providing protection to the roots. Smoking irritates gum tissue and reduces blood flow to the gums, causing damage that can result in the gums pulling away from the teeth. Smoking may account for around 75 percent of periodontal disease (gum disease) experienced by adults. If you smoke, you have a seven times greater chance of developing periodontal disease than a nonsmoker. Even if you're not a smoker but are exposed to secondhand smoke, you may be at risk for smoke-related periodontal disease.

One of the first and most noticeable indicators of periodontal disease is receding gums. Gum recession exposes the roots of teeth, leaving them vulnerable to tooth decay. This can be exacerbated by the loosening of the gums themselves, which form pockets below and between teeth that trap decaying food particles. Bacteria inside the mouth nestle into the pockets to feed on decaying food and create localized infections. Before that happens, though, the exposed roots of affected teeth become sensitive to hot or cold and may cause severe enough discomfort to warrant a trip to the dentist -- or at least a few dietary changes (as in no hot beverages or frozen treats).

As the gums continue to deteriorate, bacterial growth leads to bad breath, cavities, mouth sores, infections and the rampant plaque growth. Plaque is the whitish, slimy film that develops on your teeth when you don't brush. If plaque remains in the mouth long enough, it contributes to the development of biofilm, a destructive bacterial coating on teeth that resists brushing. Eventually, plaque hardens into tartar, a hard, cement-like layer around the gums and between teeth. Tartar makes the gum situation worse, causing additional irritation, bleeding and pain. That's not all. Smoking can cause bone loss in the jaw, inflammation of the salivary glands and delayed healing from oral and other surgeries. Smokers are also more prone to oral cancers than nonsmokers. There's something else to consider, too. In recent years, researchers have begun to see a correlation between oral health and whole body health. Although studies are ongoing, there's likely a connection between poor oral health and infections, inflammation and other problems throughout the body. Heart disease, rheumatoid arthritis, respiratory infections and some cancers may be linked to bacteria introduced through the mouth. (Sara Elliot, 2013)

Tobacco is one of the major toxic agents in our civilization. It is one of the most important risk factor for oral diseases including oral cancer, oral mucosal lesions, periodontal diseases, wound healing failure, dental implants failure, gingival inflammation, acute necrotizing ulcerative gingivitis, and apthous ulcers (Vellappally et al., 2007; Jacob et al., 2007). There is substantial evidence suggesting that the risk of oral diseases increase with frequent use of tobacco and that quitting smoking results in reduced risk (Winn, 2001).

Smoking and its relation to dental caries is a subject of many opinions. From early reports in literature and in accordance with common belief smoking was thought to actually help to reduce dental caries (Hart, 1899; Gibbs, 1952). Schmidt, in 1951, reported that the increase in tobacco smoking was followed by a decrease in caries rate. Smoking increases thiocyanate level in saliva. Thiocyanate, a normal constituent of saliva, was found to have caries inhibiting effect (Riebel, 2003; Johnson & Bain, 2000). On the other hand, studies showed that smoking is associated with lower salivary cystatin activity and output of cystatin C is also reduced during gingival inflammation. Cystatins are thought to contribute to maintaining oral health by inhibiting certain proteolytic enzymes (Lie et al., 2001). In addition, studies have confirmed by earlier results that there were no significant differences in salivary flow rate between smokers and non-smokers (Reibel, 2003). To date, several investigators have discovered a correlation between an increased smoking level and dental caries (Axelsson et al., 1998; Bruno-Ambrosius et al., 2005).

Smokers had a significantly higher DMFT (Decayed, Missing, and Filled Teeth) score, untreated decayed surfaces, and missing surfaces. More cigarettes consumed per day resulted in more missing tooth surfaces in a smokers mouth.

Most of the studies mentioned above have taken into consideration other contributing factors to dental caries development, such as age, tobacco habits other than smoking, oral hygiene habits, eating habits, preventive visits to dentist (dental recalls) and overall health standards. Therefore elucidating the exact strength of dental caries in relation to smoking is difficult to identify. (Smejkalova et al., 2012)Appendixes

-Laser Teeth Whitening

-Surgery

-Oral Surgery and Tooth Extraction

-Cosmetic Gum Surgery

Bibliography

Richards, Derek. Nicotine Replacement Gum Found to Improve Tooth Staining

Cause by Smoking. The Dental Elf. 14 July 2012.

Malhotra R, Kapoor A, Grover V, Kaushal S. Nicotine and Periodontal Tissues.

US National Library of Medicine National Institutes of Health. Jan-March 2010.

Bansal R, Singh J.K, Singh D.D.N. Deleterious Effects of Nicotine Containing

Dentrifices on Human Saliva and Teeth: A Novel Study. ScienceDirect. 1 December 2012.

Davis, Karen. Tobacco Cessation with a Twist. RDH. 7 May 2012

Mecklenburg, Robert. Tobacco Effects in the Mouth. Diane Publishing Co., 2004

www.ash.org.uk. How Smoking Affects the Way you Look, February 2014.

Ramseier CA, Fundak A. Tobacco Use Cessation Provided by Dental Hygienists.

25 August 2008Survey QuestionnaireName: _____________________________________ Age: _____ Sex: _____________

Put a check mark (() on your chosen answer.

1. Do you smoke?

( ) Yes

( ) No

2. How long have you been smoking?

( ) less than a month

( ) Two Five months

( ) More than five months

( ) Others, Specify: _______________

3. How many times do you smoke in a day?

( ) Once a day

( ) Twice a day

( ) Thrice a day

( ) Others, Specify: _______________

4. How many boxes of cigarettes do you consume in a day?

( ) one

( ) two

( ) three

( ) Others, Specify: _______________

5. What kind of cigarette do you use?

( ) Filters

( ) Ultra-lights( ) Menthol

( ) Cloves( ) Long and Skinny( ) Others, Specify: _______________

6. Have you ever been hospitalized because of smoking?

( ) Yes

( ) No

7. How often do you brush your teeth?

( ) Once a day

( ) Twice a day

( ) Thrice a day

( ) Others, Specify: _______________

8. Through regular smoking, teeth and gums are damaged. Are you undergoing any treatment to cure the damages caused by smoking?

( ) Yes

( ) No9. Have you ever tried having any kind of pain in the oral cavity?

( ) Yes

( ) No

10. How often do you experience toothaches?

( ) Once a month

( ) Twice a month

( ) Thrice a month

( ) Others, Specify: _______________

11. What dental treatments have you tried so far?

( ) Teeth Whitening

( ) Pasta

( ) Cleaning

( ) Others, Specify: _______________

12. If possible, are you willing to undergo reconstructive surgery on the teeth to fix the damages smoking has caused to your teeth?

( ) Yes

( ) No

13. Have you noticed any changes in your oral cavity since the time you started using cigarettes?

( ) Yes

( ) No

14. Does smoking affect your study habits?( ) Yes

( ) No15. How often do you visit the dentist?( ) Once a month

( ) Twice a month

( ) Thrice a month

( ) Others, Specify: _______________