Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year-old individuals

The Effects of Smoking on Dental Care Utilization and Its Costs in Japan

Smoking has been established as an important risk factor for periodontal disease and tooth loss. The purpose of this study was a prospective evaluation of the effects of smoking on dental care utilization and its costs, based on data from 5712 males aged 20–59 yrs. Age, dental health behavior, and history of diabetes were adjusted in a multivariate analysis. Current smokers accrued 14% higher dental care costs than never-smokers over a five-year period. This difference in annual dental care costs was mainly attributable to the increased percentage of participants in the ‘higher dental care cost’ category among current smokers. There was no clear trend identified for the dose-dependent effects of smoking on dental care utilization and its costs. Past smokers incurred lower dental care costs compared with current smokers. Smoking may have played a key role in the increment of dental care utilization and its costs via deterioration in oral conditions.

Tobacco habits and oral health status in selected Indian population

This cross-sectional study was aimed at possible relationships between tobacco habits and selected behavior characteristics in an adult sample from India. Contemporaneous clinical examination comprised an intra-oral examination with specific emphasise to dental caries status in the form of DMFT (Decayed, Missing, and Filled Teeth) index. The study comprised 805 subjects in the age group from 30 to 69 years (72% of males and 28% of females). The participants were divided into regular smokers, occasional smokers, ex-smokers, tobacco chewers and non-tobacco users. The highest prevalence of oral mucosal lesions were found in tobacco chewers (22.7%) followed by regular smokers (12.9%), occasional smokers (8.6%), ex-smokers (5.1%) and non tobacco users (2.8%) (p < 0.001). The mean number of decayed teeth was highest in tobacco chewers (6.96) followed by regular smokers (6.44) and ex-smokers (5.5) (p < 0.001). The mean number of missing teeth was highest in the group of regular smokers (1.9) and lowest in non-tobacco users (1.53), but the results were not statistically significant (p = 0.529). The mean number of filled teeth were highest in the group of tobacco chewers (3.67) followed by regular smokers (3.29) (p < 0.001). DMFT value of tobacco chewers, regular smokers and ex-smokers is higher when compared to non-tobacco users (p < 0.001). The study documents that chewing tobacco and smoking can present significant risk factors for dental caries. However, the conclusions are burdened by some limitations. Further studies for investigation of the effect of tobacco using on dental caries are needed.

Periodontal Disease: Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers

OBJECTIVE

This study was undertaken in order to test the hypothesis that the consequences of tobacco smoking may include increased synthesis of toxic volatile sulphur compounds in diseased periodontal pockets.

DESIGN

A cross-sectional, parallel study comparing groups of smokers and non-smokers with periodontitis and the level of volatile sulphur compounds in the gingival sulci of these subjects.

PATIENTS AND METHODS

Levels of volatile sulphur compounds were measured in diseased periodontal sites of 12 smokers and 11 non-smokers using a portable sulphide monitor. Anaerobic and aerobic counts of the total cultivable subgingival microflora of both groups were also determined.

RESULTS

The percentage of sites per subject with high levels of sulphides (> or = 10 units) detected in moderate (4-6 mm) and deep (> or = 7 mm) periodontal pockets was found to be significantly higher in smokers, compared to non-smokers (P = 0.040 and P = 0.005, respectively). No significant difference in the microbiological parameters tested were observed between the two groups.

CONCLUSIONS

Increased production of volatile sulphur compounds may represent a further mechanism of increased susceptibility to periodontitis in smokers and also help to explain the reported association between smoking and halitosis.

Clinical and microbiological determinants of ailing dental implants

BACKGROUND

The failure of the host tissue to establish or maintain osseointegration around dental implants is due to either occlusal or parafunctional forces, premature loading, ill-directed stress, or microbial infection. The long-term failure rate of dental implants is generally 5-10%. Although a variety of etiologies of early peri-implant bone loss (from implant placement to 1-year post-loading) have been proposed, factors associated with late implant failures are less well understood but are probably related to both the peri-implant microbial environment and host factors. Discriminating between causes of implant failure is of importance for instituting a successful implant therapy.

PURPOSE

The objective of this cross-sectional split-mouth study was to identify clinical, radiographic, and bacterial characteristics of peri-implant disease sites.

MATERIALS AND METHODS

Fifteen patients with bilateral implants (Brånemark, Nobel Biocare AB, Göteborg, Sweden; and 3i implant systems, Implant Innovations Inc., Palm Beach Gardens, FL, USA) participated in the study. Sites with peri-implant (radiographic bone loss beyond the third implant thread) and peri-implant healthy tissues (radiographic bone level above the first implant thread) were identified in periapical radiographs using a long-cone paralleling projection technique. Microbiological identification was carried out using established anaerobic culture techniques. A descriptive statistics based on means and standard deviations was reported.

RESULTS

Peri-implant bone loss was associated with the absence of radiographic crestal lamina dura, peri-implant pocket depth, pain on chewing, and the submucosal presence of the putative periodontopathogens Tannerella forsythia, Campylobacter species, and Peptostreptococcus micros. Pain was associated with P. micros, Fusobacterium species, and Eubacterium species.

DISCUSSION AND CONCLUSION

The absence of radiographic crestal lamina dura and the presence of suspected major periodontal pathogens seem to be associated to peri-implantitis.

Commentary: prognosis revisited: a system for assigning periodontal prognosis

Prognosis is an integral part of the periodontal practice because it directly influences treatment planning. However, there is limited direct evidence in the literature regarding the assignment of periodontal prognosis. There are several important concepts to consider in developing a system of periodontal prognosis. Traditional systems are based on tooth loss and may have limited use for patient management. On the other hand, prognosis can be based on stability of the periodontal supporting apparatus, which is influenced by more evidence-based factors and may be more useful for patient management. Other important concepts include the timing of the projection (short and long term) and the consideration of individual teeth versus the overall dentition. Historically, several authors have formulated and investigated their own prognostication systems. Results were variable, but they generally showed that systems based on tooth loss were unpredictable over the long term. Therefore, the purpose of this report is to review relevant literature and propose a new periodontal prognostication system.

Cigarette smoking and tooth loss experience among young adults: a national record linkage study

Background

Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20–39 years using linked data from two national databases in Japan.

Methods

Two databases of the National Nutrition Survey (NNS) and the Survey of Dental Diseases (SDD), which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E.

Results

Smoking rates differed greatly in men (53.3%) and women (15.5%). The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women). Tooth loss occurred more frequently among current smokers (40.6%) than former (23.1%) and non-smokers (27.9%). Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40–3.50], P = 0.0007) and women (1.70 [1.13–2.55], P = 0.0111). A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend < 0.0001 and 0.0004 in men and women, respectively). Current smoking was also associated with the prevalence of decayed teeth (1.67 [1.28–2.20], P = 0.0002).

Conclusion

An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to limitations of the available variables in the present databases, further studies including caries experience and its confounders should be conducted to examine whether smoking is a true risk of premature tooth loss in young adults.

Relationship between smoking status and tooth loss: findings from national databases in Japan

Background

A causal association between cigarette smoking and periodontal disease has been established. The present study examined the association between smoking and tooth loss using national databases in Japan.

Methods

Records of the Survey of Dental Diseases and the National Nutrition Survey in 1999 were linked electronically using common identification. Records of 3,999 subjects aged older than 40 years were analyzed using logistic regression models, controlling for confounding factors, such as age, frequency of tooth brushing, body mass index, alcohol consumption, and intakes of vitamin C and E.

Results

Prevalence of tooth loss in terms of having less than 19 existing teeth was 37.3% overall. Smoking rates differed in males (45.6%) and females (7.8%). The prevalence of tooth loss in nonsmokers, former, and current smokers was 28.5%, 38.6%, and 36.9% in males, and 38.6%, 34.3% and 38.9% in females, respectively. Adjusted means of existing teeth controlling for confounders by smoking status were 21.5, 19.7 and 18.2 in males and 19.0, 19.2 and 16.4 in females, respectively. The association of tooth loss was non-significant in former smokers but significant in current smokers: adjusted odds ratios (95% confidence intervals) relative to nonsmokers in males and females were 1.29 (0.92-1.80) and 0.86 (0.46, 1.60) for former smokers and 2.22 (1.61-3.06) and 2.14 (1.45-3.15) for current smokers, respectively. A dose-response relationship between lifetime exposure and tooth loss was seen (P for trend <0.0001).

Conclusion

The findings of this cross-sectional study of a nationwide population of Japanese indicated an association between smoking and tooth loss.

Influence of tobacco use in dental caries development

This review article describes different forms of tobacco usage and its direct relationship with the prevalence of dental caries. Smoking along with co-existing factors like old age, bad oral hygiene habits, food habits, limited preventive dental visits and over all health standards, can be associated with high caries incidence. However, a direct etiological relationship is lacking. Environmental tobacco smoke (ETS) causes dental caries in children but no studies have been reported in adults. Existing findings are not sufficient and conclusive enough to confirm that ETS causes dental caries. Oral use of smokeless tobacco (ST), predominantly tobacco chewing, is presumably a positive contributing factor to higher incidence of dental caries. Unfortunately, published studies are not converging towards one single factor through which tobacco usage can have direct relationship to dental caries.

What are the prevalence and incidence of tooth loss in the adult and elderly population in Europe?

OBJECTIVE

The purpose of this review was to study the prevalence and incidence of edentulism and tooth loss in European countries.

MATERIAL AND METHOD

A literature search was performed by means of Medline/PubMed using various combinations of keywords concerning prevalence and incidence of tooth loss and edentulism, complemented by a hand search. Inclusion criteria were cross-sectional and longitudinal clinical and questionnaire studies of representative or random samples of >/=100 subjects at the initial examination. Sixty articles were identified; the hand search gave 13 more references.

RESULTS

This literature review demonstrated that there is a lack of epidemiological studies on edentulism and tooth loss in many countries in Europe. The quality of available data varied considerably. There is a documented decline of edentulism with still great differences in prevalence between countries, between geographical regions within countries and between groups with various backgrounds. The mean number of lost teeth increases with age. In several countries many dentate subjects aged 60 years and over still have reduced dentitions possibly needing prosthodontic treatment. The incidence of tooth loss is low but with geographical variation between age groups, and there is a trend for decreasing incidence over the last decades. A great number of variables are associated with tooth loss, and there is no consensus whether dental disease related or socio-behavioural factors are the most important risk factors. Institutionalised elderly people have, in general, more compromised oral health, including fewer teeth, than those at the same age living freely.

CONCLUSION

Tooth loss and edentulism are declining at least in those European countries where reliable data are available. However, the WHO goal of retaining at least 20 teeth at the age of 80 years has not yet been met but is being approached in some countries.

Root surface and coronal caries in adults with type 2 diabetes mellitus

OBJECTIVES

To determine the effect of type 2 diabetes mellitus (DM) on coronal and root surface caries and to investigate some factors suspected of being related to or interacting with DM, that may be associated with coronal and root surface caries.

METHODS

A stratified cross-sectional study was conducted in 105 type 2 diabetic patients and 103 non-diabetic subjects of the same age and gender. Coronal and root surface caries, exposed root surfaces, periodontal status, stimulated salivary functions, oral hygiene status, oral health behaviors, and counts of mutans streptococci and lactobacilli were measured.

RESULTS

Type 2 diabetic patients compared with non-diabetic subjects had a higher prevalence of root surface caries (40.0% versus 18.5%; P = 0.001), a higher number of decayed/filled root surfaces (1.2 +/- 0.2 versus 0.5 +/- 0.1; P < 0.01) and a higher percentage of generalized periodontitis (98.1% versus 87.4%; P < 0.01); but the prevalence and decayed/filled surface of coronal caries was not significantly different (83.8% versus 72.8% and 8.0 +/- 9.4 versus 6.3 +/- 7.5 respectively). The factors associated with root surface caries included type 2 DM, a low saliva buffer capacity, more missing teeth, and existing coronal caries; whereas wearing removable dentures, more missing teeth, a high number of lactobacilli, and a low saliva buffer capacity were associated with coronal caries.

CONCLUSION

Type 2 DM is a significant risk factor for root surface, but not for coronal caries. Periodontal disease should be treated early in type 2 diabetic subjects to reduce the risk of subsequent root surface caries.

Using NHANES oral health examination protocols as part of an esophageal cancer screening study conducted in a high-risk region of China

BACKGROUND

The oral health status of rural residents in the People's Republic of China has not been extensively studied and the relationship between poor oral health and esophageal cancer (EC) is unclear. We aim to report the oral health status of adults participating in an EC screening study conducted in a rural high-risk EC area of China and to explore the relationship between oral health and esophageal dysplasia.

METHODS

National Health and Nutrition Examination Survey (NHANES) oral health examination procedures and the Modified Gingival Index (MGI) were used in a clinical study designed to examine risk factors for esophageal cancer and to test a new esophageal cytology sampling device. This study was conducted in three rural villages in China with high rates of EC in 2002 and was a collaborative effort involving investigators from the National Institutes of Health and the Cancer Institute of the Chinese Academy of Medical Sciences.

RESULTS

Nearly 17% of the study participants aged 40-67 years old were edentulous. Overall, the mean number of adjusted missing teeth (including third molars and retained dental roots) was 13.8 and 35% had 7 contacts or less. Women were more likely to experience greater tooth loss than men. The average age at the time of first tooth loss for those with no posterior functional contacts was approximately 41 years for men and 36 years for women. The mean DMFT (decayed, missing, and filled teeth) score for the study population was 8.5. Older persons, females, and individuals having lower educational attainment had higher DMFT scores. The prevalence of periodontal disease (defined as at least one site with 3 mm of attachment loss and 4 mm of pocket depth) was 44.7%, and 36.7% of the study participants had at least one site with 6 mm or more of attachment loss. Results from a parsimonious multivariate model indicate that participants with poor oral health wemore likely to have esophageal dysplasia (OR = 1.59; 95% CI 1.06, 2.39).

CONCLUSION

This report describes the first use of NHANES oral health protocols employed in a clinical study conducted outside of the United States. The extent and severity of poor oral health in this Chinese study group may be an important health problem and contributing factor to the prevalence of EC.

Correlates of partial tooth loss and edentulism in the Brazilian elderly

BACKGROUND

In South American older adults the association between tooth loss and demographic, predisposing and enabling factors has not been determined. The purpose of this study was to evaluate the association between partial and complete tooth loss and demographic, predisposing, enabling and need factors, and quality of life variables in the Brazilian older adults.

METHODS

In this cross-sectional study, 5349 subjects aged 65-74 years were evaluated using conglomerate random sampling. Data collection included dental examinations and questionnaires evaluating demographic, predisposing, enabling and need factors, and quality of life variables. Multinomial logistic regression was carried out to evaluate correlates of tooth loss. The number of teeth was set as the outcome and categorized as: edentulous, subjects with 1-19 teeth, and subjects with 20 or more teeth.

RESULTS

Predisposing factors including age, female gender and schooling were independently associated with edentulism. Female gender was associated with partial tooth loss. The only enabling factor associated with edentulism was car ownership. Need factors were associated with edentulism and partial tooth loss. Edentulous subjects perceived the need for dental treatment less frequently. Quality of life factors were associated with partial tooth loss and edentulism. Subjects with 1-19 teeth and edentulous subjects were more likely to rate their chewing ability as not good. Edentulous subjects were more likely to rate their speech ability and their dental appearance as good.

CONCLUSIONS

The results indicate that tooth loss and edentulism were complex phenomena, with intricate predisposing, demographic, enabling and need factors playing a role.

Tobacco use and incidence of tooth loss among US male health professionals

Data on the dose-dependent effects of smoking and smoking cessation on tooth loss are scarce. We hypothesized that smoking has both dose- and time-dependent effects on tooth loss incidence. We used longitudinal data on tobacco use and incident tooth loss in 43,112 male health professionals, between 1986 and 2002. In multivariate Cox models, current smokers of 5 to 14 and 45+ cigarettes daily had a two-fold (HR, 1.94; 95% CI, 1.72, 2.18) and three-fold (HR, 3.05; 95% CI, 2.38, 3.90) higher risk of tooth loss, respectively, compared with never-smokers. Risk decreased with increasing time since cessation, but remained elevated by 20% (95% CI, 16%, 25%) for men who had quit 10+ years before. Current pipe/cigar smokers had a 20% (95% CI, 1.11, 1.30) increased risk of tooth loss compared with never- and former smokers of pipes/cigars.

Factors affecting tooth loss among rural Khon Kaen adults: analysis of two data sets

BACKGROUND

Tooth loss is an oral health problem affecting Thai people and people of other nations as well. Not much of epidemiologic evidence concerning factors affecting tooth loss among Thai people has been reported although severity of tooth loss among Thai people has never been decreased.

METHODS

This study employed two existing data sets to evaluate the role of health behaviors such as tobacco smoking and betel quid chewing (a common habit prevalent among rural Thai females), together with other factors in relation to tooth loss among rural Thai people. The study population in the first (phase I) and second (phase II) data sets included 1484 and 3471 male and female adults residing in rural areas of Khon Kaen province, Thailand during 1990-1991 and 1992-1994, respectively. The data were obtained through oral examination and interview. Employing descriptive, bivariate, and multivariable Poisson regression, key risk indicators of tooth loss were identified for both data sets.

RESULTS

The findings from final multivariable Poisson regression models were consistent in that tobacco smoking, betel quid chewing, age, dental caries (defined as decayed plus filled teeth) and periodontitis were significantly related to tooth loss among these rural populations.

CONCLUSION

Therefore, preventive programs aiming at discouraging Thai people from smoking tobacco and/or chewing betel quid should be established so that healthy natural teeth can be maintained.

Relationship between smoking and folic acid, vitamin B12 and some haematological variables in patients with chronic periodontal disease

AIM

The purpose of this study was to investigate the relationship between cigarette smoking and the serum levels of folic acid, vitamin B(12) and some haematological variables in patients with periodontal disease.

PATIENTS AND METHODS

The study base consisted of 88 volunteer patients with periodontal disease, including 45 current smokers in the age range 31-68 years and 43 non-smokers in the range 32-66 years. The clinical parameters included plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD) and clinical attachment loss (CAL). Folic acid, vitamin B(12) and haematological variables were determined from peripheral blood samples.

RESULTS

PI, PD and CAL means were significantly higher in smokers than non-smokers (p<0.05). The serum folic acid concentration of smokers was lower than that of non-smokers (p<0.05), whereas the white blood cell count was higher in smokers than in non-smokers (p<0.05).

CONCLUSION

The results of this study suggest that among patients with periodontal disease the serum folic acid concentration is lower in smokers compared with non-smokers.

The potential association between smoking and endodontic disease

The aim of this review was to analyse the literature to assess the possibility of an association between smoking and endodontic disease and the prognosis of endodontically treated teeth. The review of the prognosis of endodontically treated teeth involved taking account of any potential associations with smoking and endodontic disease and marginal periodontitis, and smoking and prosthodontic outcomes. In addition, the role of smoking in implant failure and surgical wound healing was analysed with a view to drawing parallels regarding the possible implications of smoking on the outcome of surgical endodontics. A MEDLINE and Cochrane library search including smoking and various endodontic keyword searches identified three papers which discussed the variables, and did not just mention them separately in the text. The literature demonstrates a paucity of evidence relating smoking with endodontic disease and prognosis, but nevertheless presents evidence of a possible influence on the prognosis of endodontically treated teeth in smokers and a likely increase in surgical complications. The possible merits of a smoking cessation protocol prior to surgical endodontics are also discussed.

Percentile curves for present teeth in smokers and non-smokers in an adult male population

The purpose of this study was to obtain percentile curves for present teeth in smokers and non-smokers for use in oral health education. Dental examinations were carried out by two dentists. The number of present teeth in each subject was counted, excluding the third molars. Subjects consisted of 2,283 men aged between 25 and 54 years enrolled in the health insurance union of a bank in Yokohama, Japan. Each subject completed a questionnaire on smoking habits and number of cigarettes smoked. They were classified into two groups: smokers and non-smokers. The mean number of present teeth in both groups was compared with the Mann-Whitney's U test. Smokers had fewer teeth than non-smokers in all age groups (p<0.05). At the age of 50, the 50th percentile for present teeth was 26 for smokers and 27 for non-smokers. However, the 3rd percentile for smokers' present teeth was 20.5 at 40 years of age and 14 at 50 years of age, while for non-smokers it was 22.5 at 40 years of age and 19 at 50 years of age. The 3rd percentile curve for smokers' present teeth decreased in those aged 45 years and over. The percentile curves in this analysis showed a clear difference between the two groups. These data should be made available for use in adult oral health education.

Relationship between smoking status and periodontal conditions: findings from national databases in Japan

BACKGROUND AND OBJECTIVE

The association between cigarette smoking and periodontitis was examined employing two nationally representative samples of adults in Japan.

MATERIAL AND METHODS

Data were derived from the Survey of Dental Diseases (SDD) and the National Nutrition Survey (NNS) in 1999. In the SDD, periodontal conditions were evaluated by calibrated dentists utilizing the Community Periodontal Index (CPI), whereas in the NNS, participants were interviewed on the basis of smoking status by enumerators. Among 6805 records electronically linked via a household identification code, 4828 records of individuals aged 20 yr or older were analyzed.

RESULTS

The prevalence of periodontal disease varied significantly by smoking status (p < 0.0001): 39.3%, 49.5% and 47.3% (CPI > or = 3), and 7.9%, 11.7% and 12.4% (a more severe form of periodontitis, CPI = 4), for nonsmokers, former smokers and current smokers, respectively. In adults aged > or = 40 yr (n = 3493), logistic regression models revealed greater probabilities (approximately 1.4 times higher) of periodontitis [CPI > or = 3, odds ratio = 1.38 (1.12-1.71), p = 0.0024] and a more severe form of periodontitis [odds ratio = 1.40 (1.04-1.89), p = 0.0288] in current smokers compared with nonsmokers, following adjustment for possible confounding factors.

CONCLUSION

Based on the findings of this study and other numerous reports, cigarette smoking leads to deterioration of periodontal conditions in Japanese adults.

Evaluation of the oral health status of the people aged 65 years and over living in near rural district of Middle Anatolia, Turkey

The aim of this study was to assess the oral health status of aged 65 years and over, and evaluate the level of edentulousness and study the factors that could have an influence on edentulism. The participants of this study were 215 patients; 94 males (47.3%) and 121 females (56.3%), aged 65 years and over. Each subject underwent a comprehensive dental and radiographic examination by one examiner. Periodontal attachment loss observed in the panoramic radiographs was divided into three diagnostic categories: infrabony defects, horizontal bone loss, and furcation lesions. The number of teeth with apical periodontitis lesions, the number of carious teeth, and restorations, type of dentures and wear duration, intrabony root remains, impacted teeth, smoking status, educational level and self-reported medical history of the participants were recorded. Extent of tooth loss was significantly higher in females than males and increased with increasing age (p<0.05). Tooth loss was significantly associated with educational levels; lower literacy level was found to be associated with a higher number of missing teeth (p<0.01). Also, as the educational levels of the participants increased, the number of infrabony defects, furcation lesions and number of carious teeth decreased (p<0.05). Low literacy level and female gender are found to be high-risk groups for tooth loss. Community-based oral disease prevention programs should be implemented to reduce the risk for tooth loss in this population.

Dental caries risk in the U.S. Air Force

BACKGROUND

This study describes the dental caries risk in the active duty U.S. Air Force population from October 2000 through September 2004.

METHODS

The authors used data collected from two Air Force databases (personnel and dental files) by cross-referencing Social Security numbers from both databases with date.

RESULTS

During the study period, the percentages of people at high and moderate risk of developing caries decreased by 31 percent and 12 percent, respectively, while the percentage of people at low risk of developing caries increased by 9 percent. Among Air Force members who were enrolled continuously during the study period, the percentages at high and moderate risk of developing caries decreased by 57 percent and 18 percent, respectively, while the percentage at low risk of developing caries increased by 14 percent. The authors observed improvement in caries risk in 83 percent and 73 percent of the people at high and moderate caries risk, respectively, for those continuously enrolled. High caries risk was related inversely to age, rank, education and years in service. Also, tobacco users had an elevated risk of developing caries.

CONCLUSIONS

The Air Force Dental Service has made great strides in improving the oral health of the Air Force population. The results of this study suggest that caries risk is decreasing in the Air Force population, but oral health disparities still exist and require further evaluation.

CLINICAL IMPLICATIONS

This investigation suggests that a caries risk assessment can be conducted successfully, and caries risk can be reduced by using a comprehensive population-based prevention program. This caries risk assessment also can identify factors associated with dental caries disparities in a large-scale population.

The detection of salivary minerals in smokers and non-smokers with chronic periodontitis by the inductively coupled plasma-atomic emission spectrophotometry technique

BACKGROUND

The purpose of this study was to evaluate the effect of smoking on the salivary minerals in subjects with chronic periodontitis by the inductively coupled plasma-atomic emission spectrophotometry (ICP-AES) technique.

METHODS

The study group included 24 subjects-12 smokers and 12 non-smokers-with chronic periodontitis. Clinical measurements and non-stimulated whole saliva were obtained, and the levels of five elements-sodium, potassium, calcium, magnesium, and phosphate-in each specimen were analyzed.

RESULTS

When the clinical parameters were compared between groups, only plaque index was significantly higher in smokers than non-smokers (P <0.05). The mean plaque index of smokers and non-smokers was 1.93 +/- 0.51 and 1.51 +/- 0.39, respectively. The results of this study showed that there were no significant differences between groups in the mineral content of saliva. In smokers, there were positive correlations between the levels of calcium, sodium, and magnesium and clinical attachment level. There was also a positive correlation between the level of phosphate and the percentage of bleeding on probing. In non-smokers, there was a negative correlation only between the mean level of sodium and plaque index (P <0.05).

CONCLUSIONS

The present study showed that no significant differences were found between the mineral content of saliva of smokers and non-smokers by the ICP-AES technique. It is a useful, fast, and sensitive technique compared to other techniques, and it can be advised for researchers while analyzing the mineral content of saliva.

Investigation of periodontal destruction patterns in smokers and non-smokers

BACKGROUND

Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease.

OBJECTIVE

To test the hypothesis that smokers have more disease in the upper anterior region.

METHODS

A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels.

RESULTS

The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3+/-25.5%, non-smokers: 48.3+/-31.2%, p<0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3+/-6.8%, non-smokers: 9.8+/-8.8%; p=0.050).

CONCLUSION

The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.

Gingival Crevicular Fluid Leptin Levels in Periodontitis Patients With Long-Term and Heavy Smoking

BACKGROUND

The aim of the present study was to evaluate gingival crevicular fluid (GCF) leptin levels and the influence of long-term and heavy smoking on GCF leptin levels in patients with chronic periodontitis.

METHODS

In this study, 143 individuals were divided into three groups: non-smokers (NS), smokers (S), and control (C). Three subgroups of NS and S were grouped as follows: a) probing depth (PD) <or=3 mm; b) PD = 4 to 5 mm; and c) PD >5 mm. For each patient, PD, gingival index (GI), plaque index (PI), gingival bleeding time index (GBTI), and clinical attachment level (CAL) values were recorded. The GCF leptin levels obtained from sampling sites were determined by using enzyme-linked immunosorbent assay kits.

RESULTS

The GCF leptin levels were found significantly lower in the a and b subgroups in the S group than those in the NS group (P <0.05). The inflammatory markers GI and GBTI showed significant correlations with leptin in NS (P <0.05).

CONCLUSIONS

Our results suggest that higher leptin GCF levels in healthy sites in periodontitis patients may play a protective role in periodontal disease. Further studies are needed to determine the cellular origin of the leptin in the gingiva and the effect of plasma leptin levels on GCF leptin concentrations.

Periodontal health and oral mucosal lesions as related to occupational exposure to acid mists

OBJECTIVES

The association between exposure to acid mists and periodontal changes and oral mucosal lesions was measured using data from an Oral Health Promotion Program in a large metal plant. The role of sociodemographic factors, lifestyle, and oral health behavior in relation to these outcomes was also examined.

METHODS

This is a cross-sectional study of 665 active male workers who volunteered to participate in the oral health program. A job exposure matrix was constructed with industrial hygienist scores and job titles to estimate years of exposure to acid mists. Oral health outcomes were identified during standardized dental examinations. Unconditional logistic regression models were utilized in the analysis.

RESULTS

Duration of exposure to acid mists exposure was positively associated with oral mucosal lesions among workers without lip sealing. Only age, low salaries and oral hygiene-related variables were associated with periodontal changes, and estimates varied according to lip sealing.

CONCLUSIONS

Results suggest that long-term occupational exposure to acid mists is associated with oral mucosal lesions, and that absence of lip sealing may increase the intensity of exposure.

The natural history of periodontal disease in humans: risk factors for tooth loss in caries-free subjects receiving no oral health care

AIM

No long-term studies have reported on risk factors for tooth loss in subjects without home or professional dental care. The purpose of this report is to identify potential risk factors for tooth loss among male Sri Lankan tea labourers who participated in a 20-year investigation of the natural history of periodontal disease.

MATERIAL AND METHODS

Data for this report were obtained from the 455 subjects who participated in multiple examinations over the 20-year period from 1970 to 1990. Analyses included data from interim examinations in 1971, 1973, 1977, 1982 and 1985. Oral health assessments included the following: (1) attachment levels in millimetres on all mesial and mesio-buccal surfaces, excluding third molars; (2) plaque index; (3) gingival index; (4) calculus index; (5) caries index; and (6) missing teeth. Other variables included age, history of smoking and betel nut use. Statistical analyses included descriptive statistics and multivariate repeated-measures modelling with generalized estimating equations.

RESULTS

Tooth loss was significantly dependent upon interactions between the mean attachment loss and betel nut use (Z=3.40; p=0.0007) and history of missing teeth (Z=-3.70; p=0.0002). The effect of attachment loss on tooth loss was increased in the presence of betel nut and diminished when teeth were already missing at baseline.

CONCLUSION

History of missing teeth, betel nut use and increasing attachment loss were significant predictors of tooth loss over time. Betel nut use increased the effect of attachment loss on loss of teeth, while history of missing teeth diminished the effect of attachment loss on tooth loss.

Active and passive smoking and tooth loss in Japanese women: baseline data from the osaka maternal and child health study

PURPOSE

Many studies have shown a positive association between cigarette smoking and oral diseases. Few studies, however, have focused on the relationship between passive smoking exposure and oral health in adults. We investigated the association of active and passive smoking exposure with tooth loss in Japan.

METHODS

Study subjects were 1002 pregnant women. Tooth loss was defined as previous extraction of one or more teeth. Adjustment was made for age, gestation, parity, family income, education, and body mass index.

RESULTS

Of the 1002 subjects, 256 women had lost one or more teeth. Current light smoking was independently related to an increased prevalence of tooth loss, showing a significant exposure-related association with smoking status. A significant positive association of 8 or more pack-years of smoking with the prevalence of tooth loss was observed. Also, a significant positive relationship was found between current heavy passive smoking at home and tooth loss, but not with pack-years of passive smoking at home. No measurable association between passive smoking exposure at work and tooth loss was indicated.

CONCLUSIONS

The present findings suggest that passive as well as active smoking may be associated with an increased prevalence of tooth loss in Japanese young adult women.

The effect of cigarette smoking on the severity of periodontal disease among older Thai adults

BACKGROUND

The aim of this study is to determine the effect of cigarette smoking on the severity of periodontitis in a cross-sectional study of older Thai adults.

METHODS

The study population consisted of 1,960 subjects (age 50 to 73 years old). All subjects received both medical and dental examinations. Periodontal examinations, including plaque score, probing depth, and clinical attachment level, were done on all teeth present in two diagonal quadrants. Sociodemographic characteristics and smoking status were obtained by questionnaires. Multinomial logistic regression was used to address the association between cigarette consumption and mean clinical attachment level.

RESULTS

In this study population, 48.7% were non-smokers, 14.4% were current smokers, and 36.9% were former smokers. Current smokers had higher percentage of sites with plaque, deeper mean probing depth, and greater mean clinical attachment level than former smokers and non-smokers. The odds of having moderate and severe periodontitis for current smokers were 1.7 and 4.8 times greater than non-smokers, respectively. Former smokers were 1.8 times more likely than non-smokers to have severe periodontitis. Quitting smoking reduced the odds of having periodontitis. For light smokers (<15 packyear), the odds for severe periodontitis reverted to the level of non-smokers when they had quit smoking for > or =10 years. For moderate and heavy smokers (> or =15 packyear), the odds of having severe periodontitis did not differ from those of non-smokers when they had quit smoking for > or =20 years.

CONCLUSIONS

There was a strong association between cigarette smoking and the risk of periodontitis among older Thai adults. Quitting smoking appears to be beneficial to periodontal health.

Dental caries in HIV-seropositive women

Reports that compare dental caries indices in HIV-seropositive (HIV+) subjects with HIV-seronegative (HIV-) subjects are rare. The objective of this study was to determine if there was an association between HIV infection and dental caries among women enrolled in the Women's Interagency HIV Study. Subjects included 538 HIV+ and 141 HIV- women at baseline and 242 HIV+ and 66 HIV- women at year 5. Caries indices included DMFS and DFS (coronal caries) and DFSrc (root caries). Cross-sectional analysis of coronal caries data revealed a 1.2-fold-higher caries prevalence among HIV+ women compared with HIV- women. Longitudinally, DMFS increased with increasing age and lower average stimulated salivary volume. Root caries results were not significant except for an overall increased DFSrc associated with smoking. Anti-retroviral therapy was not identified as a risk factor for dental caries.

Ten-year cross-sectional and incidence study of coronal and root caries and some related factors in elderly Swedish individuals

OBJECTIVE

The 10-year incidence of dental caries was related to some associated factors in a random sample of 65, 75 and 85-year-old inhabitants of Gothenburg.

SUBJECTS

Of the 208 persons examined at baseline, 102 (49%) participated in the follow-up examination; 56, 37 and nine, respectively, in the different age groups. For the purpose of time-trend comparisons, a new random sample of 98 individuals aged 55 years was examined.

RESULTS

Ninety-five per cent of the participants had developed one or more carious lesions during the 10-year period and the incidence of coronal and root caries increased with age. In the 65-year-olds, 9% of the root surfaces had decayed during the period, compared with 25% in the 85-year-olds. Secondary caries predominated over primary caries and prosthetic crowns accounted for 70% of the restored tooth surfaces. Twenty per cent of the individuals were daily smokers and 61% were taking drugs with hyposalivatory side-effects. The mean saliva secretion rates were lower in the older groups compared with the 'younger' ones. The overall salivary counts of mutans streptococci and lactobacilli had increased during the period and the values were highest in the oldest age groups. Salivary levels of lactobacilli and mutans streptococci, number of teeth, daily numbers of cigarettes and drugs and oral hygiene were the best predictors of the incidence of caries.

CONCLUSION

The findings indicate that there is an increased risk of dental caries with age owing to unfavourable caries-related factors.

Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study

OBJECTIVE

The aim of this 10-year prospective study of 50-year-old individuals was to analyze the incidence of periodontal bone loss and potential risk factors for periodontal bone loss.

METHODS

The subject sample was generated from an epidemiological survey performed in 1988 of subjects living in the County of Värmland, Sweden. A randomized sample of 15% of the 50-year-old inhabitants in the county was drawn. At the 10-year follow-up in 1998, 320 (75%) of the 449 individuals examined at baseline were available for re-examination, out of which 4 had become edentulous. Full-mouth clinical and radiographic examinations and questionnaire surveys were performed in 1988 and 1998. Two hundred and ninety-five individuals (69%) had complete data for inclusion in the analysis of radiographic bone changes over 10 years. Non-parametric tests, correlations and stepwise multiple regression models were used for statistical analysis of the data.

RESULTS

The mean alveolar bone level (ABL) in 1988 was 2.2 mm (0.05) and a further 0.4 mm (0.57) (p=0.000) was lost over the 10 years. Eight percent of the subject sample showed no loss, while 5% experienced a mean bone loss of >/=1 mm. Smoking was found to be the strongest individual risk predictor (RR=3.2; 95% CI 2.03-5.15). When including as smokers only those individuals who had continued with the habit during the entire 10-year follow-up period, the relative risk was slightly increased (3.6; 95% CI 2.32-5.57). Subjects who had quit smoking before the baseline examination did not demonstrate a significantly increased risk for disease progression (RR=1.3; 95% CI 0.57-2.96). Stepwise multiple regression analysis revealed that smoking, % approximal sites with probing pocket depth >/=4 mm, number of teeth and systemic disease were significant explanatory factors for 10-year ABL loss (R(2)=0.12). For never smokers, statistically significant predictors were number of teeth, mean ABL, % periodontally healthy approximal sites and educational level (R(2)=0.20).

CONCLUSION

The inclusion of smokers in risk analysis for periodontal diseases may obstruct the possibility to detect other true risk factors and risk indicators.

The influence of tobacco smoking on the onset of periodontitis in young persons

This paper reviews the evidence for cigarette smoking as a risk factor for the development of severe destructive periodontal disease in young adults. A high prevalence of cigarette smoking has been identified among young individuals with aggressive periodontitis and tobacco usage increases the risk of periodontal destruction most significantly in young populations. The effect appears to be dose related and is independent of levels of plaque accumulation. Young smokers have more alveolar bone loss and attachment loss than non smoking equivalents. Prolonged and heavy smoking can reduce gingival bleeding and therefore mask the clinical marker of bleeding on probing often used by dentists to monitor periodontal health. This has implications for potential misdiagnosis and failure to detect periodontitis at an early stage. Nicotine metabolites concentrate in the periodontal tissues and can have local effects as well as the potential to affect the systemic host response. Dentists are well placed to assess the smoking status of their young patients and have a role to play in the delivery of smoking cessation advice especially as it pertains to periodontal health. In this way the dental profession can also make a significant contribution to the general health and well being of our youth and future generations.

The relation of tobacco smoking to tooth loss among young adults

Earlier studies have associated smoking with a higher rate of dental caries, periodontal disease and tooth loss. The aim of this cross-sectional study was to determine whether smoking is associated with tooth loss among young adults. The data consist of the 1966 birth cohort of Northern Finland, which is an unselected general population birth cohort (n = 12 058). The data were collected using a postal questionnaire in 1997-98 (n = 8690). Prevalence odds ratios and confidence intervals were estimated by applying a logistic regression model. It was found that smoking was associated with tooth loss in an exposure-dependent manner. The odds for those who smoked 16 or more pack-years were 5.30 (CI = 2.35-11.2) after adjustment for socio-economic and behavioral factors. Differences in socio-economic or health behavior are not likely to explain the findings since an exposure-response pattern was seen even when data was stratified according to sex, education and health-oriented lifestyle. A possible explanation for this association is a combination of treatment decisions and dental diseases, which are most likely associated with smoking in an exposure-dependent manner.

Effects of smoking on clinical parameters and the gingival crevicular fluid levels of IL-6 and TNF-alpha in patients with chronic periodontitis

OBJECTIVE

Smoking is an important environmental risk factor for the initiation and progression of periodontal diseases. The aim of this study was to evaluate the effects of smoking on clinical parameters and the gingival crevicular fluid (GCF) contents of the pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-alpha) levels in patients with chronic periodontitis.

MATERIAL AND METHODS

The study base consisted of 41 patients including 22 volunteer current smokers with an age range of 32-59 (44.41+/-7.88) years and 19 volunteer non-smokers with an age range of 36-59 (46.94+/-6.07) years. The first month after non-surgical periodontal therapy was accepted as the baseline of the study. The clinical parameters including plaque index (PI), gingival index (GI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL) were recorded and GCF samples were collected for analysis of GCF contents of IL-6 and TNF-alpha levels. At the 3rd and 6th months, all of these procedures were repeated.

RESULTS

In smokers, only CAL was significantly higher at the 3rd month compared with non-smokers (p<0.05). GI and BOP were higher in non-smokers than smokers in both periods (p<0.05). PI showed increases from the initial to the 6th month in smokers (p<0.05). Although the differences between two groups with regard to IL-6 and TNF-alpha were not significant (p>0.05), the total amount of TNF-alpha in GCF decreased from the initial to the 6th month in smokers (p<0.05). There were no significant correlations between the mean total amount of IL-6 and TNF-alpha in GCF and clinical parameters in both evaluation periods in smokers (p>0.05).

CONCLUSION

The present study demonstrated that cigarette smoking increases the amount of dental plaque over time in smokers and does not influence GCF contents of IL-6 and TNF-alpha.

Cigarette Smoking and the Periodontal Patient

Evidence from cross-sectional and case-control studies in various populations demonstrates that adult smokers are approximately three times as likely as non-smokers to have periodontitis. The association between smoking and attachment loss is even stronger when the definition of periodontitis is restricted to the most severely affected subjects. Smokers have a diminished response to periodontal therapy and show approximately half as much improvement in probing depths and clinical attachment levels following non-surgical and various surgical modalities of therapy. Implant failures in smokers are twice those of non-smokers, with a higher failure rate in the maxillary arch accounting for the majority of the difference. Tobacco-induced alterations in microbial and host factors contribute to these deleterious effects of smoking on the periodontium. In longitudinal studies, the rate of periodontal disease progression is increased in smokers, but decreases to that of a non-smoker following tobacco cessation. Likewise, recent non-smokers respond to periodontal therapy in a manner similar to patients who have never smoked. Data regarding the impact of smoking on periodontal status included in this review will be helpful to dental health professionals as they counsel their patients regarding tobacco use. The role of dental health professionals in tobacco cessation is discussed, including the use of the five A's: ask--identify tobacco users; advise--advise them to quit; assess--evaluate the patient's readiness to quit; assist--offer assistance in cessation; and arrange--follow up on the patient's cessation efforts. The addition of pharmacotherapy to behavioral therapy, including nicotine replacement therapy and bupropion, can increase cessation rates. The most popular form of nicotine replacement therapy is the patch, and its use has been shown to double cessation rates compared to behavioral therapy alone. Use of bupropion in combination with nicotine replacement therapy may be particularly helpful for heavy smokers or smokers who have experienced multiple failed attempts at cessation. The American Academy of Periodontology Parameters of Care include tobacco cessation as a part of periodontal therapy, and the 2000 Surgeon General's Report on Oral Health in America encourages dental professionals to become more active in tobacco cessation counseling. Doing so will have far-reaching positive effects on our patients' oral and general health.

The Effect of Cigareté Smoking on Gingival Bleeding

BACKGROUND

The purpose of this study was to investigate the dose-dependent effect of cigarette smoking upon gingival bleeding on probing (BOP) in a large representative sample of the United States population (National Health and Nutrition Examination Survey III).

METHODS

Weighted multiple logistic regression was used to model bleeding on probing of 141,967 mesio-buccal sites in 12,385 individuals with complete case records on all covariates. Adjustments were made for age, gender, race/ethnicity, number of missing teeth, tooth type/jaw, root caries, full crown coverage, socioeconomic status (poverty/income ratio), and survey characteristics. The model stratified by presence of calculus (CALC) and increased probing depth (PD > or = 4 mm). Generalized estimating equations were used to account for dependence of sites within subjects.

RESULTS

Smoking had a strong suppressive effect on gingival bleeding. The effect was strongest in heavier smokers (> 10 cigarettes/day) and smallest in former smokers. In healthy sites (no CALC, PD < or = 3 mm), the odds ratio (OR) of bleeding for sites in heavier smokers compared to never-smokers was 0.56 (95% CI: 0.45-0.70). Sites with CALC and/or PD > or = 4 mm were more likely to bleed in never-smokers (OR: 5.7; 95% CI: 4.3-7.6). This relationship was less evident among heavier smokers (OR: 1.3; 95% CI: 0.8-1.9). The effect of smoking did not differ between maxillary and mandibular molars, premolars, or incisors.

CONCLUSION

Smoking exerts a strong, chronic, and dose-dependent suppressive effect on gingival bleeding on probing.

Effect of triclosan on healing following non-surgical periodontal therapy in smokers

BACKGROUND

Tobacco smoking is an established risk factor for periodontitis, and is associated with periodontal attachment and tooth loss. Clinical studies have indicated that smoking may adversely affect and impede healing following periodontal therapy. Adjunctive antimicrobials, on the other hand, have been shown to enhance the effect of non-surgical periodontal therapy. The objective of this study was to evaluate the effect of a triclosan/copolymer/fluoride dentifrice on healing following non-surgical periodontal therapy in smokers.

METHODS

Sixty smokers (aged 35-59 years; 23 females) with chronic periodontal disease volunteered to participate in a double-blind, randomized, controlled, clinical trial. The subjects were randomly assigned to use a triclosan/copolymer/fluoride (30 subjects) or a standard fluoride (30 subjects) dentifrice and received detailed information on proper techniques for self-performed plaque control. The participants then received non-surgical periodontal therapy followed by periodontal maintenance care every 6 months over 24 months. Clinical recordings included evaluation of oral hygiene standards, gingival health, and periodontal status.

RESULTS

Subjects using the triclosan/copolymer/fluoride dentifrice exhibited significantly improved oral hygiene conditions, gingival health, and periodontal status compared with those using the standard fluoride dentifrice over the 24-month maintenance interval.

CONCLUSIONS

The results suggest that an oral hygiene regimen including a triclosan/copolymer/fluoride dentifrice may sustain the short-term effect of non-surgical periodontal therapy in smokers.

Lifestyle and Psychosocial Factors Associated with Chronic Periodontitis in Taiwanese Adults

BACKGROUND

The development of chronic periodontitis (CP) is a multifactorial process and variation in severity cannot be explained by just a few risk factors. The aims of this study were: 1) to explore the lifestyle and psychosocial factors of CP patients and 2) to estimate the proportion of total CP cases attributable to one or more risk factors considered.

METHODS

A case-control study of 250 cases of CP patients and 250 controls were matched by age (within 3 years) and gender. Complete dental examinations were performed based on the clinical criteria for CP for both groups. Structured questionnaires were conducted to collect lifestyle and psychosocial factors. Multivariate logistic regression was applied to assess the association between risk factors and chronic periodontitis.

RESULTS

Conditional multivariable logistic regression analysis showed that toothbrushing frequency (odds ratio [OR]: 5.77, if rarely; OR: 3.50, if once a day), mental illness (OR: 5.32, if Chinese Health Questionnaire scores were > or = 6), and smoking (OR: 3.93, if pack years smoked was > 21) are significantly and independently associated with chronic periodontitis. In addition, all these variables reflected a dose-response effect (P trend = <0.001, 0.004, and 0.005, respectively).

CONCLUSIONS

For Taiwanese adults, 36.10% of CP cases were presumably attributable to toothbrushing frequency, mental illness, and smoking. These three factors should be the first priorities in establishing a preventive program to improve the periodontal health status.

Association between level of education and oral health status in 35-, 50-, 65- and 75-year-olds

AIM

The aim of the present study was to evaluate the association between educational level and dental disease, treatment needs and oral hygiene habits.

MATERIAL AND METHODS

Randomized samples of 35-, 50-, 65- and 75-year-olds, classified according to the educational level: [low (LE): elementary school or higher (HE)], were identified. In 1091 subjects, a number of characteristics such as (i) number of teeth, (ii) periodontal attachment levels (PAL), (iii) caries and (iv) occlusal function were recorded. Educational level, oral hygiene and dietary habits were self-reported. Non-parametric variables were analyzed by chi2, Mann-Whitney U-Wilcoxon's rank sum tests, and parametric variables by Student's t-test (level of significance 95%). A two-way anova was performed on decayed, missing and filled surfaces to investigate the interaction between age and educational level. All statistical procedures were performed in the SPSS statistical package.

RESULTS

The number of remaining teeth was similar for LE and HE in the 35-year olds (25.8 versus 26.6), but in the older age groups LE had significantly a larger number of missing teeth. The LE groups (except in 65-year olds) exhibited significantly more PAL loss. LE had significantly fewer healthy gingival units in all but the 75-year age group. In all age groups, LE had fewer intact tooth surfaces and a significantly poorer occlusal function. The frequency of tooth cleaning measures and dietary habits did not differ between LE and HE.

CONCLUSION

Educational level was shown to influence the oral conditions and should be considered in assessing risk, and in planning appropriate preventive measures.

Effect of smoking and periodontal treatment on the subgingival microflora

BACKGROUND

The effect of smoking on the prevalence of periodontal pathogens after periodontal treatment is still not clear. Some studies found no effect of the smoking status on the prevalence of periodontal pathogens after therapy, whereas others did. The aim of this retrospective study was to investigate the influence of smoking on the treatment of periodontitis and the composition of the subgingival microflora.

METHOD

The study included 59 periodontitis patients (mean age 41.5 years): 30 smokers and 29 nonsmokers. The treatment consisted of initial periodontal therapy and, if necessary, surgery and/or antibiotics. Clinical and microbiological data were obtained before and after treatment at the deepest site in each quadrant. A pooled sample was analysed for the presence of Actinobacillus actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotalla intermedia (Pi), Bacteroides forsythus (Bf), Fusobacterium nucleatum (Fn) and Peptostreptococcus micros (Pm).

RESULTS

For smokers and nonsmokers a significant improvement of the clinical condition was found after treatment. A decrease could be assessed for bleeding on probing (smokers: 0.46; nonsmokers: 0.52) and probing pocket depth (PPD) (smokers: 1.64 mm; nonsmokers: 2.09 mm). Furthermore, both groups showed gain of attachment (smokers: 0.68 mm; nonsmokers: 1.46 mm). No significant difference in bleeding on probing and PPD reduction was found between smokers and nonsmokers. In contrast, nonsmokers showed significantly more gain of attachment than smokers. The microbiological results revealed no differences in the prevalence of the various bacteria between smokers and nonsmokers before treatment. After treatment in nonsmokers, a significant decrease was found in the prevalence of Aa (11-3), Pg (17-7), Pi (27-11), Bf (27-11), Fn (28-20) and Pm (27-17). In smokers, a significant decrease could be shown only for the prevalence of Pg (15-5).

CONCLUSIONS

Nonsmokers showed more gain of attachment and a greater decrease in the prevalence of periodontal bacteria as compared to smokers. The phenomenon that among smokers, more patients remain culture positive for periodontal pathogens after therapy, may contribute to the often observed unfavourable treatment results in smoker periodontitis patients.