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Cigarette Smoking and Periodontal Health


Part 1. Why smoking is bad for you?

Much has been said about the effect of smoking on Periodontal Health.  Evidence is mounting about the adverse effects of health outcomes in smokers.  Apart from the risk of lung cancer and cardio-vascular diseases, smokers also tend to develop more serious periodontal disease lesions, and if they undertake conventional periodontal treatment, their healing response tends to be slower and the recovery incomplete.  The reasons for this are based on the multifaceted biological responses to the release of NICOTINE in burning tobacco.

Part 2. Biological Effect

Inhalation of tobacco smoke delivers Nicotine into the blood stream very efficiently via the gaseous exchange on the pulmonary alveoli (your lungs). Similar mechanisms are also used when we get oxygen into our blood stream when breathing fresh air.  Nicotine is a powerful vaso-constrictor – meaning a tiny amount in the blood stream can sustain the closing down of capillary vessels (particularly in the terminal branches of the capillary tree- such as finger tips and gum margins).  The slowing down or reduction of blood flow has the net effect of decreasing the supply of oxygen and nutrients into the affected area.  The longer-term effect of diminishing blood flow is that it forces the affected tissue to alter its cellular content in order to survive the biological “Hard Times”.  Typically, such tissue becomes more fibrous (increased collagen content or fibre-to-cell ratio). This would explain why the gingival tissue in long term smokers tend to have more serious (or advanced) periodontal disease, they don’t seem to bleed that much from their gums.  However, if a smoker quits smoking successfully, he/she may find that gum bleeding may resume.  This observation leads to the erroneous conclusion that smoking cessation is bad for you because it makes your gums bleed more.  In effect, smoking masks the major signs of periodontal disease – i.e. gum bleeding.

Part 3. Can full recovery be expected if smoking cessation is successful?

Yes and No.  That would depend on the duration of the smoking habit, the age of the patient etc.  In general terms, the longer the smoking habit, the more fibrotic the gingiva becomes, and the longer it takes for the circulation to return and hopefully, the type and content.

Part 4. Where can I access help or assistance to quit smoking?

NSW Health (department of health) is supporting any genuine effort to quit smoking.  Go to (I can quit) website ( for further information and assistance.




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On the 26th May 2017 Professor Yeung presented a lecture on Peri-Implantitis (infection around dental implants) to a group of general dentists attending a training course on “Periodontics in General Practice (Part 1).” The lecture was very informative and was well received.

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Dental work done overseas? Dental Tourism.

The pitfalls of having dental treatment dental work done overseas while holidaying are many. The most concerning is the lack of care provided once the treatment has been completed and you are back home.  There is no warranty on any of the work (how can there be), and most patients we see have spent money on work that is of poor quality and actually causes other problems in the mouth.

Unfortunately, these patients who showed up at our office were usually in pain, angry and financially worse off than before their trip overseas.  Furthermore, the remedial work required is usually very demanding, time consuming and can only achieve a compromised result.  If you are considering such a trip, think carefully.  If you have already made the journey and is having problems with the result, please come in for an assessment and advice.  We are experienced in remediating unsatisfactory dental work.

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Gingivitis, symptoms to look for.

Gingivitis means inflammation of the gums (gingiva). It commonly occurs because of films of bacteria that accumulate on the teeth – plaque/ or bacterial biofilm; this type is called plaque-induced gingivitis. This is a non-destructive type of periodontal disease. If left untreated, gingivitis can progress to periodontitis, which is more serious and can cause irreversible loss of bone and eventually lead to loss of teeth.

A patient with gingivitis will have red and puffy gums, and they will most likely bleed when they brush their teeth. In mild cases, patients may not even know they have it, because symptoms are mild. However, the condition should be taken seriously and addressed immediately.

Generally, it can be resolved with good oral hygiene – longer and more frequent brushing, as well as flossing. Some people find that using an antiseptic mouthwash, alongside proper tooth brushing and flossing also helps.  However, if gum bleeding remains unresolved with the above measures after one week, it would be wise to seek professional help immediately.