Dental health and smoking
smokers "over-produce" collagenase (I was once told 4 times more than an individual with normal breakdown
and repair collagenase levels), this leads to rapid bone loss and these individuals usually end up with
furcation blow outs. the anatomy of the furcation certainly lends itself to this scenario. Increased
collagenase = increased osteoclast activity as the body tries to dig out the damaged collagen fibers, the
furcas get bombarded with osteoclasts...as well as all other areas. This is why SDD is recommended for
these individuals, you really can put them back in balance in spite of themselves. smoking is not a
contraindication for non-surgical approach perio. they respond well when SDD is used.
I know perios who will not do sx on smokers too, as these cases don't turn out well generally.
below is a study using SDD in smokers - Judy Carrol (Periotherapist group)
J Clin Periodontol. 2005 Jun;32(6):610-6.
Adjunctive subantimicrobial dose doxycycline in smokers and non-smokers with chronic periodontitis.
Preshaw PM, Hefti AF, Bradshaw MH.
School of Dental Sciences, Newcastle University , UK
OBJECTIVES: Previous studies have demonstrated the clinical benefits of sub-antimicrobial dose doxycycline
(SDD) in the treatment of chronic periodontitis (CP). The aim of this study was to retrospectively evaluate
the role of SDD as an adjunct to scaling and root planing (SRP) in the treatment of smokers and non-smokers
with CP. MATERIAL AND METHODS: A meta-analysis of two previously reported clinical studies was undertaken.
Both were 9-month, double-blind, randomized, placebo-controlled, multi-centre clinical trials that
investigated the efficacy of SDD (20 mg doxycycline twice daily) in combination with SRP in subjects with
moderate-severe CP. 36.9% of the combined study population were smokers. Three hundred and ninety-two
subjects were included in the meta-analysis, which evaluated per-subject mean changes in clinical attachment
level (CAL) and probing depth (PD) from baseline and the total number of sites with attachment gains and PD
reductions > or =2 and > or =3 mm from baseline in four subgroups:
smokers/SDD; smokers/placebo;
non-smokers/SDD; non-smokers/placebo.
RESULTS: A hierarchical treatment response was observed, with non-smokers who received SDD demonstrating the
greatest CAL gains and PD reductions. Smokers who received placebo demonstrated the smallest clinical
improvements following treatment. Smokers who received SDD demonstrated an intermediate treatment response
that was broadly equivalent to that seen in non-smokers who received placebo. In sites with baseline
PD 4-6 mm, month 9 CAL gains were 19-45% better in non-smokers who received SDD compared with all other
subgroups (p<0.05), and were 21% greater in smokers who received SDD compared with smokers who received
placebo (p<0.05). Furthermore, month 9 PD reductions were 21-53% greater in non-smokers who received SDD
compared with all other subgroups (p<0.01), and were 26% greater in smokers who received SDD compared with
smokers who received placebo (p<0.05).
CONCLUSION: Adjunctive SDD enhances therapeutic outcomes compared with SRP alone, resulting in clinical
benefit in both smokers and non-smokers with CP .
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