Rauchen oder parodontale Gesundheit

Zusammenfassung

Ursache destruktiver Parodontalerkrankungen sind einige gramnegative Bakterien, deren bloße Anwesenheit im dentalen Biofilm jedoch nicht ausreicht, die Erkrankung auszulösen. Die immunologische und inflammatorische Wirtsantwort sowie der Bindegewebs- und Knochenmetabolismus stehen unter dem starken Einfluss genetischer, erworbener und verhaltensbedingter Risikofaktoren. Unter Letzteren rangiert der Tabakkonsum an erster Stelle. Sowohl Prävalenz, Ausmaß und Schweregrad der Parodontitis wie Zahnverlust und Zahnlosigkeit werden dosisabhängig von Tabakkonsum beeinflusst. Etwa 50 % der Parodontitis junger Erwachsener geht auf das Konto des Zigarettenkonsums. Therapieresultate bei Rauchern sind deutlich schlechter als bei Nichtrauchern. Konsequenterweise sollte daher die Raucherentwöhnung in das herkömmliche Therapiekonzept mit einbezogen werden.

Smoking or Periodontal Health

The causal agents of destructive periodontal disease are several gram-negative bacteria. The mere presence, however, in the dental biofilm does not guarantee onset of the disease. The immunological and inflammatory host response as well as connective tissue and bone metabolism are strongly influenced by genetic, acquired and behavioural risk factors. Among the last, tobacco consumption holds a primary position. Prevalence, extent and severity of periodontitis as well as tooth loss and edentulism are influenced by tobacco consumption in a dose-dependent manner. About 50 % of periodontal disease in young adults is attributable to cigarette smoking. Postoperative results in periodontally diseased smokers are considerably poorer than those achieved in non-smokers. As a consequence smoking cessation has to be in corporated in traditional treatment concepts for inflammatory periodontal disease.

Key words

Periodontitis - Smoking - Risk Factor - Smoking Cessation - Periodontal Therapy

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Fußnoten

1 Interessanterweise wurde das feste Fundament der kausalen Beziehung zwischen dentaler Plaque und entzündlichen Veränderungen am Zahnfleisch vor über 3 Jahrzehnten von Löe et al. durch das in der Medizin wohl einmalige Modell der „experimentellen Gingivitis” beim Menschen gelegt [6].

2 Vor allem bei Rauchern sollten die Schleimhäute der Mundhöhle systematisch auf verdächtige Läsionen hin untersucht werden 62. Auf Details der oralen Krebsvorsorge kann an dieser Stelle nicht eingegangen werden.

3 Die Mortalität bei Mundkrebs nimmt zwar glücklicherweise bei Männern und Frauen in den letzten Jahrzehnten kontinuierlich ab. Erschreckend hohe relative Risiken für verschiedene Formen des Mundkrebses von mehr als 27 bei rauchenden Männern und etwa 6 bei rauchenden Frauen 118 sollten aber auf jeden Fall ebenfalls zur Sprache gebracht werden.