Relationship of cigarette smoking to attachment level profiles

Oral microbiome dysbiosis among cigarette smokers and smokeless tobacco users compared to non-users

Tobacco use significantly influences the oral microbiome. However, less is known about how different tobacco products specifically impact the oral microbiome over time. To address this knowledge gap, we characterized the oral microbiome of cigarette users, smokeless tobacco users, and non-users over 4 months (four time points). Buccal swab and saliva samples (n = 611) were collected from 85 participants. DNA was extracted from all samples and sequencing was carried out on an Illumina MiSeq, targeting the V3-V4 region of the 16S rRNA gene. Cigarette and smokeless tobacco users had more diverse oral bacterial communities, including a higher relative abundance of Firmicutes and a lower relative abundance of Proteobacteria, when compared to non-users. Non-users had a higher relative abundance of Actinomyces, Granulicatella, Haemophilus, Neisseria, Oribacterium, Prevotella, Pseudomonas, Rothia, and Veillonella in buccal swab samples, compared to tobacco users. While the most abundant bacterial genera were relatively constant over time, some species demonstrated significant shifts in relative abundance between the first and last time points. In addition, some opportunistic pathogens were detected among tobacco users including Neisseria subflava, Bulleidia moorei and Porphyromonas endodontalis. Overall, our results provide a more holistic understanding of the structure of oral bacterial communities in tobacco users compared to non-users.

Oral health-related quality of life and periodontal status according to smoking status

INTRODUCTION

Studies evaluating smoking and periodontal status show controversial results regarding the impact on oral health-related quality of life (OHRQol). The aim was to evaluate the association between OHRQol and periodontal status in patients according to their smoking habit.

METHODS

Cross-sectional study with a total of 100 patients (31.44 ± 8.50 years, 55% females) answered the short version of Oral Health Impact Profile (OHIP-14) and underwent a periodontal examination. Associations between periodontal status and total mean OHIP-14 scores related with smoking habit were analysed with Kruskal-Wallis test.

RESULTS

Mean percentage of sites with Bleeding on Probing (BOP), Clinical Attachment Loss (CAL) and Number of Teeth were significantly different between current smokers (n = 53) and never (n = 40) or former smokers (n = 7; p < 0.05). There was no significant difference for Periodontal Probing Depth (PPD) in relation to smoking status. A total mean OHIP-14 score of 13.07 was observed for the entire sample. The corresponding total mean OHIP-14 scores, for current smokers, never smokers and former smokers, were 15, 10 and 13 (p = 0.280), respectively. The domains social disability and handicap of the OHIP-14 were worse in current smokers (p = 0.028 and p = 0.026, respectively).

CONCLUSION

Current smoking was associated with a negative influence on OHRQoL in the domain of social disability and handicap. In addition, smokers have worse periodontal status, related to less BOP, greater CAL and fewer teeth than never and former smokers.

Assessment and Correlation of Salivary Ca, Mg, and pH in Smokers and Non-Smokers with Generalized Chronic Periodontitis

Background and Objectives: Diagnostic evaluation with the aid of biomarkers has reached newer heights to assess disease activity. Salivary calcium, magnesium, and pH are one of the biochemical parameters which can be helpful in assessing the progression of periodontal disease. Smokers are at topnotch threat for having oral diseases, predominantly periodontal diseases. The aim of this study was to assess the salivary calcium, magnesium, and pH levels in smokers compared with non-smokers with chronic periodontitis. Materials and Methods: The current study was conducted on 210 individuals affected with generalized chronic periodontitis, with the age group between 25 and 55 years. Based on their smoking habit, an equal number of patients were categorized into two groups; namely, group I consisted of non-smokers and group II consisted of smokers. The clinical parameters that were measured included Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Loss (CAL). The biochemical variables that were evaluated in the current study included salivary calcium, magnesium, and pH using an AVL9180 electrolyte analyzer (Roche, Germany). The gathered data were analyzed with an unpaired t test was using SPSS 20.0. Results: A statistically significant higher PPD (p < 0.01), CAL (p < 0.05), and salivary calcium levels (p < 0.001) were observed in the smokers' compared with their non-smoking counterparts. Among the biochemical parameters, calcium showed a significantly (p < 0.001) higher level in smokers (5.79 ± 1.76) in contrast to non-smokers (3.87 ± 1.03). Additionally, a significant negative correlation (p < 0.05) between calcium and PPD was observed in non-smokers, whereas a non-significant inverse relation (p > 0.05) was seen in smokers. Conclusions: The present study indicates that the salivary calcium level can be a potential biochemical parameter to assess the progression of periodontal disease in smokers and non-smokers. Within the limitations of the current study, the salivary biomarkers appear to have an essential role in the identification and indication of the status of periodontal diseases.

The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy

Tobacco smoking has been implicated in periodontal pathology through various mechanisms, including perturbations of the inflammatory and host responses to putative periodontal pathogens, alterations in the subgingival microbial communities, and a compromised healing potential of the tissues leading to imbalance of tissue homeostasis. This review provides the evidence for the relationship between cigarette smoking and periodontal disease in an attempt to explain possible mechanisms of how tobacco smoking may exert its negative effects on the periodontal tissues via systemic and localized pathways. Early and more recent studies explore cigarette smoking-induced changes in periodontal clinical indices; in subgingival microbial flora by employing traditional detection methods for selected microorganisms, in addition to modern techniques such as deep sequencing and bioinformatics analyses that are able to fully characterize the microbial communities; and in inflammatory and immune responses critically appraising study limitations and differences in study protocol designs. Periodontal treatment outcomes and implant therapy outcomes are reviewed in an attempt to shed light on possible mechanisms for the inferior treatment outcome noted in smokers. The potential harmful effects of passive smoking are also reviewed, providing evidence for the advantages of smoking cessation. Quitting cigarette smoking should be recommended by the dentist, and effort should be made to inform smokers about the negative effects of smoking on the periodontal status and implant therapy outcomes.

Comparison of blood parameters between periodontitis patients and healthy participants: A cross-sectional hematological study

Background

Bacteria and their products involved in periodontitis evoke an immunoinflammatory response in the host tissue. Inflammatory diseases, such as periodontitis, are often not just a local event, but may have systemic ramifications, including elevations in the numbers of circulating leukocytes, acute-phase proteins and oxidative stress markers. It is now emerging that also erythrocytes are affected by chronic inflammatory diseases. This phenomenon, named "anemia of inflammation," is not caused by marrow deficiencies or other diseases. The present study aimed to assess whether there was any relation between chronic periodontitis and hematological parameters.

Materials and Methods

A total of 80 patients were included in the study and were divided into the healthy and periodontitis groups. Blood sample was obtained from each participant for hematological analysis of leukocytes, erythrocytes, platelets, red blood cell (RBC) distribution width (RDW), mean corpuscular volume (MCV), platelet count and neutrophil-leukocyte ratio (NLR). Further, the values were gathered and subjected to statistical analysis. Unpaired t-test was performed to assess the statistical significance between the groups and P < 0.05 and < 0.001 were considered to be statistically significant.

Results

Results show statistically significant difference seen in leukocytes, lymphocytes, RDW, MCV, platelet count and NLR which was higher in patients with periodontitis, all other parameters are nonsignificant.

Conclusion

Thus, within limitations, it can be concluded that increased levels of leukocytes, lymphocytes, RDW, MCV, platelet count and NLR depict the inflammatory state and destructive nature of periodontitis.

A case-control study on the association between periodontitis and coronavirus disease (COVID-19)

BACKGROUND

Coronavirus disease (COVID-19) and periodontitis share common characteristics, such as an exaggerated inflammatory response. As periodontal diseases were shown to be associated with respiratory diseases, such as pneumonia, it is quite possible that a relationship may exist between periodontitis and COVID-19. Hence, the aim of the present study was to determine whether periodontitis and poor oral hygiene are associated with COVID-19.

METHODS

A case-control study was conducted. Patients who had positive real-time reverse transcription polymerase chain reaction results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were included in the case group (n = 79), and patients with negative results were included in the control group (n = 71). The periodontal examination involved recording the plaque scores, calculus scores, tooth mobility, gingival bleeding, probing depth, recession, and clinical attachment level (CAL).

RESULTS

Logistic regression analysis showed significant associations of mean plaque scores ≥ 1 (odds ratio (OR), 7.01; 95% confidence interval (CI), 1.83 to 26.94), gingivitis (OR, 17.65; 95% CI, 5.95 to 52.37), mean CAL ≥ 2 mm (OR, 8.46; 95% CI, 3.47 to 20.63), and severe periodontitis (OR, 11.75; 95% CI, 3.89 to 35.49) with COVID-19; these findings were more prevalent in the case group.

CONCLUSION

Based on the above mentioned observations, it can be concluded that there is an association between periodontitis severity and COVID-19. Gingival bleeding and dental plaque accumulation are also more frequent among COVID-19 patients. Hence, it is essential to maintain periodontal health and good oral hygiene as an important measure for COVID-19 prevention and management.

Pro-inflammatory cytokine interleukin-6-induced hepcidin, a key mediator of periodontitis-related anemia of inflammation

OBJECTIVES

To investigate whether anemia of inflammation (AI) occurs in periodontitis patients and to further explore underlying pathogenesis of periodontitis-related AI by an experimental periodontitis model.

BACKGROUND

Previous studies have reported periodontitis patients could show a tendency toward AI. However, the relationship between periodontitis and AI remains unclear, and the related pathological mechanisms have not been identified.

MATERIALS AND METHODS

Periodontal clinical parameters, inflammatory markers, and anemia-related indicators were compared between 98 aggressive periodontitis (AgP) patients and 103 healthy subjects. An experimental periodontitis model was induced by ligature placement in mice. The changes in mice inflammatory markers, anemia indicators, hepcidin mRNA expression, and serum hepcidin concentrations were measured. Human and mouse liver cells were treated with interleukin-6 (IL-6) for analyzing the changes in hepcidin expression based on mRNA and protein levels.

RESULTS

AgP patients exhibited higher white blood cell counts, IL-6, and C-reactive protein. Adjusted linear regression analyses showed correlations between AgP and decreased hemoglobin (HGB) and hematocrit (HCT). The ligature-induced periodontitis caused systemic inflammation and elevated IL-6 levels. Lower red blood cell counts, HGB, and HCT were detected, whereas the levels of hepcidin mRNA expression and serum hepcidin concentrations increased. The treatment of hepatocytes with IL-6 induced both hepcidin mRNA expression and hepcidin secretion.

CONCLUSIONS

Systemic inflammation induced by periodontitis leads to an increased risk for AI. IL-6-induced hepcidin could play a central mediator role and act as a key pathologic mechanism. Our results demonstrate periodontitis may be considered as an additional inflammatory disease contributing to the development of AI.

The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis

AIM

Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non-surgical periodontal therapy.

MATERIALS AND METHODS

Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non-smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non-surgical periodontal therapy. Meta-regressions were conducted to evaluate correlations between outcomes and other contributing factors.

RESULTS

Seventeen studies were included. The post-treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: -0.33 mm, 95% confidence interval (CI): [-0.49, -0.17], p < .01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: -0.20 mm, CI: [-0.39, -0.02], p < .01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups.

CONCLUSIONS

Smoking negatively impacts clinical responses to non-surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non-smokers.

Salivary 8-hydroxyguanosine levels in smokers and non-smokers with chronic periodontitis

This case-controlled clinical trial was performed on the salivary 8-hydroxyguanosine (8-OHdG) levels in smokers and non-smokers with chronic periodontitis after non-surgical periodontal therapy. Subjects (N = 40) with periodontitis (smokers and non-smokers) and with clinically healthy conditions (smokers and non-smokers) were assigned to this study. At baseline, clinical periodontal parameters (plaque index, gingival index, pocket probing depth and clinical attachment levels) were evaluated. Saliva samples were obtained pre- and post-treatment to quantify the 8-OHdG levels using Elisa technique. Subjects diagnosed with chronic periodontitis with smoking habit (CPs) and non-smokers (CPns) received scaling and root planing. In clinically healthy subjects with smoking habit (CHs) and non-smokers (CHns), only oral hygiene tutoring was performed. All clinical measurements and salivary collection were repeated in a 3-month recall interval. Data were analyzed using Anova, Tukey post hoc test and Mann-Whitney 'U' tests (P < 0.05). At baseline, CPs and CPns groups showed significantly higher PI, GI, PD and CAL values than those of CHns and CHs (P < 0.001). Baseline salivary levels of 8-OHdG were significantly higher in CPs group (14.775 pg/mL) (P < 0.001) compared to the other groups. All clinical parameters in chronic periodontitis group improved at the 3rd month recall interval, however, with regards to 8-OHdG values, the CP smoker category still had a higher level compared to CP non-smoker. This study reflects an on-going periodontal destructive status in smokers and salivary 8-OHdG levels could be recognized as an oxidative biomarker for determining periodontal tissue destruction.

Types of bone destruction and its severity in chronic periodontitis patients with tobacco smoking habit using periapical radiographs and transgingival probing: A cross-sectional study

BACKGROUND

Tobacco smoking is an independent risk factor for periodontal disease which increases periodontal pocketing, attachment loss, as well as bone loss leading to varied severity and bone destruction in the form of horizontal and vertical patterns.

AIM

The aim of the present study is to determine and measure the types and severity of bone destruction in chronic periodontitis (CP) patients with tobacco smoking habit using intraoral periapical (IOPA) radiographs and transgingival probing.

MATERIALS AND METHODS

A total of 60 male participants with CP were included in the study. Group A comprised 30 heavy cigarette smokers and Group B comprised 30 nonsmokers. Clinical parameters such as plaque index (PI), probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded. Amount and pattern of bone loss were assessed using IOPA and transgingival probing.

RESULTS

The mean values of PI, PPD, and CAL were 2.50 ± 0.28 mm, 9.33 ± 1.42 mm, and 10.2 ± 1.62 mm, respectively, for cigarette smokers, which were found to be higher and statistically significant as compared to nonsmokers. Cigarette smokers showed more bone destruction than nonsmokers in respect to maxillary molars 4.42 ± 1.31 mm and incisors 3.90 ± 1.10 mm as compared to nonsmokers. Types of bone destruction were more of vertical patterns (93.3%) in cigarette smokers.

CONCLUSIONS

Tobacco smoking was associated with severe attachment loss. Tobacco smoking not only affects soft tissues but also hard tissues such as bone. Palatal sides of maxillary molars showed significantly higher bone loss and also had more percentage of vertical patterns of bone loss compared to nonsmokers. IOPA and transgingival probing may be used as noninvasive methods for the determination of types and severity of bone destruction in CP patients with or without tobacco smoking habit.

A brief history of periodontics in the United States of America: Pioneers and thought-leaders of the past, and current challenges

This paper summarizes historical events in periodontology in the United States over the past 200 years. The contributions of some of the key thought-leaders of the past are highlighted. Throughout the 20th century, the evolution of thought, leading to the views currently held regarding the pathogenesis and treatment of periodontal diseases, was significantly influenced by: (1) major changes in health-care education; (2) the emergence of periodontics as a specialty of dentistry; (3) the publication of peer-reviewed journals with an emphasis on periodontology; (4) formation of the National Institute of Dental and Craniofacial Research (NIDCR); and (5) expansion of periodontal research programs by the NIDCR. The two major future challenges facing periodontal research are development of a better understanding of the ecological complexities of host-microbial interactions in periodontal health and disease, and identification of the relevant mechanisms involved in the predictable regeneration of damaged periodontal tissues.

Distribution of Periodontal Pockets Among Smokers and Nonsmokers in Patients with Chronic Periodontitis: A Cross-sectional Study

Context Cigarette smoking is a well-established risk factor for periodontitis and carries an increased risk for loss of periodontal attachment as well as bone loss. Aims The purpose of the present study was to investigate whether disease severity differs between smokers and nonsmokers in a group of chronic periodontitis patients by assessing the periodontal probing depth (PPD) and bleeding on probing (BOP). Materials and methods The study included 150 individuals, 75 smokers and 75 nonsmokers, in the age group of 35-60 years. Subjects with chronic periodontitis were selected and included in the study. Periodontal evaluation, including periodontal probing pocket depths and bleeding on probing, was performed on all four quadrants and at six sites per tooth using the Williams periodontal probe. The data were pooled from the anterior sextant and the posterior sextant as well as from the facial and lingual surfaces. Statistical analysis Comparisons were made between smokers and nonsmokers using the z-test (two-tailed test). Probing pocket depth categories 0-3 mm, 4-5 mm, 6-7 mm, and ≥8 mm and the proportion of sites having a pocket depth of ≥5 mm were used in the analysis. Results The mean percentage of sites that bleed upon probing was higher for nonsmokers as compared with smokers. Smokers had less shallow pockets (0-3 mm) than nonsmokers and more pockets of 4-7 mm (categories 4-5 mm, 6-7 mm). No significant differences were detected in the prevalence of pockets ≥8 mm. In the anterior, premolar, and molar regions, pockets of 6-7 mm were significantly more prevalent in smokers. The buccal and lingual sides also showed that smokers had more sites with deep probing depths ≥5 mm than nonsmokers. The data also showed that in the upper jaw, in the anterior and premolar teeth, the largest differences were found between smokers and nonsmokers. Conclusions From the results, it can be concluded that cigarette smoking results in periodontal tissue destruction in the different areas of the oral cavity, with the maximum periodontal destruction in the maxillary anterior and premolar region.

Influence of Smoking on Gingival Crevicular Fluid Interleukin 1β and Interleukin-8 in Patients with Severe Chronic Periodontitis among a Rural Population in India

Background and Objective:

Smoking is widely prevalent among rural Indian populations. Smoking is considered a significant risk factor for periodontal diseases. The aim of the present study was to evaluate the influence of smoking on the inflammatory cytokines interleukin (IL) IL-1β and IL-8 in gingival crevicular fluid (GCF) and compare these between smokers and nonsmokers with periodontitis in diseased and healthy sites.

Materials and Methods:

A total of thirty patients with severe chronic periodontitis (15 smokers and 15 nonsmokers) participated in this study. Clinical parameters assessed were gingival index, bleeding on probing, probing depth (PD), and clinical attachment level. One diseased and one healthy site from each of the periodontitis patients were selected for GCF collection and assigned to the following four groups: healthy sites in smoker (SH), diseased sites in smoker (SD), healthy sites in nonsmoker (NH), and diseased sites in nonsmoker (ND) and were analyzed by enzyme-linked immunosorbent assay test (Quantikine^®).

Results:

Intragroup comparisons revealed statistically significant levels of IL-1β in ND sites compared to NH sites (P < 0.005) and SD sites showed statistically significantly higher levels of IL-1β compared to SH sites (P < 0.0001). However, there was no significant difference in IL-8 levels between NH and ND sites as well as between SH and SD sites. Intergroup comparisons revealed that SH sites exhibited significantly lower amounts of IL-8 (P < 0.01) compared to NH sites and SD sites showed significantly lower levels of IL-8 compared to ND sites (P < 0.001). However, the comparison of NH and SH sites as well as ND and SD sites showed no significant difference in the levels of IL-1β.

Conclusions:

Cytokine levels were significantly elevated in periodontitis patients. Smokers exhibited a decrease in IL-8 and increase in IL-1β levels. Hence, this reflects the influence of smoking on immunosuppression and its role in the pathogenesis of periodontal disease.

A cross-sectional study on the periodontal status and prevalence of red complex periodontal pathogens in a Japanese population

This large-scale study cross-sectionally examined the periodontal status and prevalence of "red complex" bacteria (Porphyromonas gingivalis, Treponema denticola, and Tannerella forsythia) in Japanese adults. A total of 977 participants were enrolled in the study. Probing depth (PD), bleeding on probing (BOP), and bone crest level (BCL) were recorded, and the presence of red complex bacteria in the saliva was examined using polymerase chain reaction. The mean BCL value and the percentage of sites with a PD ≥4 mm or the presence of BOP were significantly higher in older participants. The detection rates of P. gingivalis, T. denticola, and T. forsythia were 46.3%, 76.4%, and 61.1%, respectively. The P. gingivalis detection rate significantly increased with age, while those of T. denticola and T. forsythia were comparably high for all age groups. A close correlation between P. gingivalis and the percentage of sites with PD ≥4 mm was indicated by nonlinear canonical correlation analysis. Current smokers exhibited a more advanced disease condition and a significantly higher P. gingivalis detection rate than non-smokers. In conclusion, periodontal condition worsens with age, and P. gingivalis appears to be the red complex bacterium most closely associated with periodontitis.

Severity and susceptibility: measuring the perceived effectiveness and believability of tobacco health warnings

BACKGROUND

Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them.

METHODS

We examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease.

RESULTS

A 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs.

CONCLUSION

Our findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or 'grotesque' HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.

A pilot study of the gingival response when smokers switch from smoking to vaping

Introduction Tobacco smoking is one of the most important risk factors for periodontitis as it alters the host response to plaque. Although the prevalence of tobacco smoking has declined in recent years, the use of electronic-cigarettes (vaping) has increased. The effect of vaping on the gingiva is unknown and an evidence-base needs to be established before providing dental advice about the use of these products.Objective To compare the gingival health of a group of established smokers before and after substituting vaping for smoking tobacco.Design Pilot.Setting Guy's Dental Hospital (England) from April-December 2015.Materials and methods Twenty established smokers (all staff members at Guy's Hospital) with mild periodontal disease replaced their regular smoking habits with the use of e-cigarettes for two weeks.Main outcome measure The primary outcome measure of gingival inflammation was bleeding on probing. Levels of selected pro-inflammatory cytokines in GCF, saliva and serum samples were also determined.Results and conclusions There was a statistically significant increase in gingival inflammation when tobacco smokers switched from smoking to vaping for two weeks. However, this result must be interpreted with extreme caution since this is only a pilot study. Nonetheless, this study should provide a stepping stone to encourage further investigation of the effects of vaping on periodontal health.

The effect of smoking on inflammatory and bone remodeling markers in gingival crevicular fluid and subgingival microbiota following periodontal therapy

BACKGROUND AND OBJECTIVE

Periodontal health is mediated by suppressing microorganisms inducing a local inflammatory host response. Smoking may impair this process. This study compares gingival crevicular fluid levels of inflammatory and bone remodeling markers in heavy smokers and non-smokers following active and supportive periodontal therapy in patients with chronic periodontitis.

MATERIAL AND METHODS

Gingival crevicular fluid and subgingival plaque were collected from the deepest periodontal pocket in 50 patients, 25 smokers and 25 non-smokers, at baseline (T0), following active (T1) and 12 mo of supportive periodontal therapy (T2). Smoking status was validated measuring serum cotinine levels. Gingival crevicular fluid levels of 27 inflammatory and two bone remodeling markers were analyzed using multiplex and singleplex micro-bed immunoassays, and subgingival plaque samples using checkerboard DNA-DNA hybridization. Amounts of markers in smokers and non-smokers were compared calculating the effect size.

RESULTS

Expression of inflammatory and bone-remodeling markers in smokers demonstrated an overall reduced effect size at T0 and T2 (p < 0.001). In particular, proinflammatory markers (p < 0.001), chemokines (p = 0.007) and growth factors (p = 0.003) at T0, osteoprotegerin (p = 0.003) at T1, proinflammatory markers (p = 0.019) and chemokines (p = 0.005) at T2. At T2, interleukin-8 was detected in significantly higher levels in smokers. Ten different markers in non-smokers and none in smokers responded to periodontal therapy (p < 0.05). An overall negative association was revealed between smoking and subgroups of markers at sites presenting ≥ 10⁵ red complex periodontal microbial species.

CONCLUSION

Except for an upregulation of interleukin-8, smokers exhibited reduced gingival crevicular fluid levels of several inflammatory markers at baseline and following active and supportive periodontal therapy. Only inflammatory responses in non-smokers adapted to periodontal therapy. Apparently, there seems to be an immunosuppressant effect of smoking regulating the local inflammatory response and bone remodeling markers captured in gingival crevicular fluid following periodontal therapy.

Systemic antibiotics in the treatment of periodontitis

Despite the fact that several clinical studies have shown additional benefits when certain systemic antibiotics are used as adjuncts to periodontal treatment, clear guidelines for the use of these agents in the clinical practice are not yet available. Basic questions concerning the use of systemic antibiotics to treat periodontitis remain unanswered, such as: which drug(s) should be used; which patients would most benefit from treatment; which are the most effective protocols (i.e. doses and durations); and in which phase of the mechanical therapy should the drug(s) be administered? Although not all of those questions have been directly addressed by controlled randomized clinical trials, recent concepts related to the ecology of periodontal diseases, as well as the major advances in laboratory and clinical research methods that have occurred in the past decade, have significantly broadened our knowledge in this field. This article endeavored to provide a 'state of the art' overview on the use of systemic antibiotics in the treatment of periodontitis, based on the most recent literature on the topic as well as on a compilation of data from studies conducted at the Center of Clinical Trials at Guarulhos University (São Paulo, Brazil) from 2002 to 2012.

Periodontal status in crack and cocaine addicted men: a cross-sectional study

This cross-sectional study evaluated the association between crack/cocaine addiction and periodontal disease in men. Periodontal examination (probing depth, clinical attachment level, bleeding on probing, and plaque index) and interviews were performed in 160 patients (≥18 years) from the Federal University of Bahia. Crack and cocaine dependence was defined according to the medical records and interviews of each patient; all drug addicted volunteers used both crack and cocaine. T test, Chi-square test, and logistic regression were used to assess the associations between destructive periodontal disease and crack/cocaine dependence (p ≤ 0.05). Probing depth was significantly greater in crack/cocaine addicted individuals (2.84 ± 0.76 mm) compared with non-addicted individuals (2.55 ± 0.73 mm, p = 0.04). After adjusting for covariates, periodontitis was not significantly associated with crack/cocaine addiction (OR = 2.31, 95 % CI = 0.82-6.46, p = 0.11), which was only associated with age ≥35 years (OR = 4.16, 95 % CI = 1.65-10.50, p = 0.003) and higher dental plaque index (OR = 6.46, 95 % CI = 1.95-21.42, p = 0.002). In conclusion, although probing depth was greater in crack/cocaine addicted individuals, destructive periodontal disease was not associated with crack and cocaine addiction in the present population. Destructive periodontal disease was associated with age and dental plaque. Further studies in a larger sample size are required to confirm the results.

The influence of smoking on the levels of matrix metalloproteinase-8 and periodontal parameters in smoker and nonsmoker patients with chronic periodontitis: A clinicobiochemical study

AIMS

Even though worldwide evidences tend to prove that smoking adversely influences periodontal health, there are few studies demonstrating the effect of levels of salivary matrix metalloproteinase-8 (MMP-8) in smokers. This study aimed to compare and quantify the levels of MMP-8 in smokers and also to evaluate the effect of smoking on periodontal indices in smokers and nonsmokers with chronic periodontitis.

METHODS

A total number of 60 subjects were selected for the study and were divided into three groups: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of 20 subjects. Saliva sample was collected for the estimation of MMP-8 by enzyme-linked immunosorbent assay (ELISA) method using Quantikine human total MMP-8 immunoassay kit.

RESULTS

The levels of the salivary MMP-8 of group III was highest followed by group II and group I, the least. The other periodontal indices, viz. plaque index (PI), probing pocket depth (PPD), clinical attachment level (CAL), were highest for group III, except for gingival index (GI).

CONCLUSION

This study suggests that MMP-8 is involved in periodontal destruction associated with smoking. Additionally, smoking exerts disastrous effects on immune response and can affect the pathogenesis of disease; hence, smoking results in increased severity of periodontal destruction.

Assessment of Periodontal Health Status in Smokers and Smokeless Tobacco Users: A Cross-Sectional Study

INTRODUCTION

Oral smokeless tobacco consumption has been considered as a major risk factor for oral cancer, its role as a risk factor for periodontal disease is less well documented when compared to that of relationship between smoking and periodontal disease.

AIM

The aim of the present cross-sectional study was to evaluate the effect of various forms of tobacco consumption i.e., smoking and smokeless tobacco forms on periodontal status.

MATERIALS AND METHODS

The study population included 120 subjects with the habit of tobacco consumption, based on form of tobacco use they were divided into Group 1 (smoking), Group 2 (Smokeless tobacco), and Group 3 (smokers and smokeless tobacco users). The periodontal status for each group was evaluated by measuring Oral Hygiene Index- Simplified (OHI-S) and Community Periodontal Index (CPI) for Probing Depth (CPI-PD) and Attachment Loss (CPI-AL).

RESULTS

OHI-S mean scores in Group 1 (3.53±1.03), Group 2 (3.06±0.92) and Group 3 (3.45±0.96) were similar, which were not statistically significant (p>0.076). The mean values of CPI-PD were 3.75±0.44 in Group 1, 3.65±0.48 in Group 2, 3.80±0.41 in Group 3 with no significant difference between the three Groups (p> 0.309). When the mean values of CPI-AL (0.95±0.75 in Group 1, 1.40±0.74 in group 2, and 1.55±0.60 in Group 3) were compared in between the Groups, a statistically significant difference was observed in Group 3 (p<0.001).

CONCLUSION

The results showed that tobacco consumption in both forms caused poor periodontal status, with smokeless tobacco users having more amount of attachment loss than smokers.

Site-specific treatment outcome in smokers following 12 months of supportive periodontal therapy

Aim

To evaluate the effect of cigarette smoking on periodontal health at patient, tooth, and site levels following supportive therapy.

Materials and Methods

Eighty chronic periodontitis patients, 40 smokers and 40 non‐smokers, were recruited to a single‐arm clinical trial. Periodontal examinations were performed at baseline (T0), 3 months following active periodontal therapy (T1), and 12 months following supportive periodontal therapy (T2). Smoking status was validated measuring serum cotinine levels. Probing depth (PD) ≥ 5 mm with bleeding on probing (BoP) was defined as the primary outcome. Logistic regression analyses adjusted for clustered observations of patients, teeth, and sites and mixed effects models were employed to analyse the data.

Results

All clinical parameters improved from T0 to T2 (p < 0.001), whereas PD, bleeding index (BI), and plaque index (PI) increased from T1 to T2 in smokers and non‐smokers (p < 0.001). An overall negative effect of smoking was revealed at T2 (OR = 2.78, CI: 1.49, 5.18, p < 0.001), with the most pronounced effect at maxillary single‐rooted teeth (OR = 5.08, CI: 2.01, 12.78, p < 0.001). At the patient level, less variation in treatment outcome was detected within smokers (ICC = 0.137) compared with non‐smokers (ICC = 0.051).

Conclusion

Smoking has a negative effect on periodontal health following 12 months of supportive therapy, in particular at maxillary single‐rooted teeth.

Comparison of serum erythropoietin levels in smokers and nonsmokers with periodontitis: A biochemical study

Aims:

This study was carried out to compare serum erythropoietin (Epo) levels in smokers and nonsmokers with periodontitis.

Materials and Methods:

Fifty-one subjects of both sexes (age range: 30–65 years) with chronic periodontitis (CP) participated in this study. Seventeen patients with generalized CP, nonsmokers without anemia were included in Group I (control group), 17 patients with generalized CP, nonsmokers with anemia were included in Group II, and 17 patients who were smokers, having generalized CP were included in Group III. Peripheral blood samples were obtained and assessed for the number of erythrocytes (total red blood cell [TRBC]), hemoglobin (Hb), and Epo levels.

Statistical Analysis Used:

One-way analysis of variance and Tukey–Kramer multiple comparisons test to assess the statistical difference between groups.

Results:

Epo levels varied considerably between the 3 groups. Highest values of Epo were seen in Group III with mean Epo value = 42.81 ± 15, followed by Group II Epo value = 35.21 ± 10.9, then Group I Epo value = 22.06 ± 4.19. Smokers in Group III with CP showed more prevalence toward higher values of Hb% (mean Hb = 12.06 ± 0.84) while there was no statistical difference in the values of TRBC values among the 3 groups (Group I TRBC value = 3.87 ± 0.38, Group II TRBC value = 4.01 ± 0.83, and Group III TRBC value = 3.88 ± 0.45).

Conclusion:

Periodontitis patients were seen to have lower Epo values further strengthening the hypothesis that CP may lead to anemia of chronic disease. In smokers, higher Hb values were seen with higher Epo levels. It indicates that periodontitis individually and along with smoking may affect anemic status of smokers. Thus, Epo levels may be better means to assess anemic status of smokers than relying only on Hb values.

Genome-wide association study of biologically informed periodontal complex traits offers novel insights into the genetic basis of periodontal disease

Genome-wide association studies (GWAS) of chronic periodontitis (CP) defined by clinical criteria alone have had modest success to-date. Here, we refine the CP phenotype by supplementing clinical data with biological intermediates of microbial burden (levels of eight periodontal pathogens) and local inflammatory response (gingival crevicular fluid IL-1β) and derive periodontal complex traits (PCTs) via principal component analysis. PCTs were carried forward to GWAS (∼2.5 million markers) to identify PCT-associated loci among 975 European American adult participants of the Dental ARIC study. We sought to validate these findings for CP in the larger ARIC cohort (n = 821 participants with severe CP, 2031-moderate CP, 1914-healthy/mild disease) and an independent German sample including 717 aggressive periodontitis cases and 4210 controls. We identified six PCTs with distinct microbial community/IL-1β structures, although with overlapping clinical presentations. PCT1 was characterized by a uniformly high pathogen load, whereas PCT3 and PCT5 were dominated by Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis, respectively. We detected genome-wide significant signals for PCT1 (CLEC19A, TRA, GGTA2P, TM9SF2, IFI16, RBMS3), PCT4 (HPVC1) and PCT5 (SLC15A4, PKP2, SNRPN). Overall, the highlighted loci included genes associated with immune response and epithelial barrier function. With the exception of associations of BEGAIN with severe and UBE3D with moderate CP, no other loci were associated with CP in ARIC or aggressive periodontitis in the German sample. Although not associated with current clinically determined periodontal disease taxonomies, upon replication and mechanistic validation these candidate loci may highlight dysbiotic microbial community structures and altered inflammatory/immune responses underlying biological sub-types of CP.

An In Vitro Model for Oral Mixed Biofilms of Candida albicans and Streptococcus gordonii in Synthetic Saliva

As a member of the normal human oral microbiota, the fungus Candida albicans is often found in association with Streptococcus gordonii, a member of dental plaque forming bacteria. Evidence suggests that S. gordonii serves as a facilitator of C. albicans adherence to dental tissues, which represents a clinically relevant problem, particularly for immunocompromised individuals that could subsequently develop fungal infections. In this study we describe the development of a relatively simple and economical in vitro model that allows for the growth of mixed bacterial/fungal biofilms in 96-well microtiter plates. We have applied this method to test and compare the growth characteristics of single and dual species biofilms in traditional microbiological media versus a synthetic saliva medium (basal medium mucin, BMM) that more closely resembles physiological conditions within the oral cavity. Results indicated a synergistic effect for the formation of biofilms when both microorganisms were seeded together under all conditions tested. The structural and architectural features of the resulting biofilms were further characterized using scanning electron microscopy and confocal scanning laser microscopy. We also performed drug susceptibility assays against single and mixed species biofilms using commonly used antifungals and antibacterial antibiotics, both in monotherapy and in combination therapy, for a direct comparison of resistance against antimicrobial treatment. As expected, mixed species biofilms displayed higher levels of resistance to antimicrobial treatment at every dose tested in both traditional media and BMM synthetic saliva, as compared to single-species biofilms.

Hidden truth of circulating neutrophils (polymorphonuclear neutrophil) function in periodontally healthy smoker subjects

Context:

Tobacco smoking is considered to be a major risk factor associated with periodontal disease. Smoking exerts a major effect on the protective elements of the immune response, resulting in an increase in the extent and severity of periodontal destruction.

Aims:

The aim of the present study was to assess viability and phagocytic function of neutrophils in circulating blood of the smokers and nonsmokers who are periodontally healthy.

Settings and Design:

Two hundred subjects in the mean range of 20–30 years of age were included in the study population. It was a retrospective study carried out for 6 months.

Materials and Methods:

Two hundred subjects were divided into four groups: 50 nonsmokers, 50 light smokers (<5 cigarettes/day), 50 moderate smokers (5–15 cigarettes/day), and 50 heavy smokers (>15 cigarettes/day). Full mouth plaque index, sulcus bleeding index, and probing depths were measured. Percentage viability of circulating neutrophils and average number of phagocytosed Candida albicans were recorded.

Statistical Analysis Used:

Means and standard deviations were calculated from data obtained within the groups. Comparison between the smokers and nonsmokers was performed by Kruskal–Wallis ANOVA analysis. Comparison between smoker groups was performed using Mann–Whitney–Wilcoxon test.

Results:

Percentage viability of neutrophils was significantly less in heavy smokers (66.9 ± 4.0), moderate (76.6 ± 4.2), light smokers (83.1 ± 2.5) as compared to nonsmokers (92.3 ± 2.6) (P < 0.01). The ability of neutrophils to phagocytose, i.e., mean particle number was significantly less in light smokers (3.5 ± 0.5), moderate smokers (2.3 ± 0.5), and heavy smokers (1.4 ± 0.5) compared to nonsmokers (4.9 ± 0.7) (P < 0.01) with evidence of dose-response effect.

Conclusions:

Smoking significantly affects neutrophils viability and phagocytic function in periodontally healthy population.

Periodontal disease status and associated risk factors in patients attending a Dental Teaching Hospital in Rawalpindi, Pakistan

BACKGROUND

Investigators have identified an association of socio-demographic and medical factors with periodontal risk. This study observed status and association of periodontal disease and associated risk factors/indictors.

MATERIALS AND METHODS

All patients attending a dental teaching hospital were interviewed for socio-demographic and medical information through a structured questionnaire. Participants were examined for periodontal status using the community periodontal index (CPI), by a single examiner during September to November 2012. An association of age, gender, smoking habit, systemic conditions, and oral hygiene measures with periodontal status ([periodontitis CPI score ≥3]/nonperiodontitis [CPI score ≤2]) was analyzed by applying Chi-square test and forward selection stepwise regression analysis.

RESULTS

One thousand nine hundred and eighteen patients were examined during the study period. The findings revealed that 63.5% of the subjects had CPI score ≤2 (nonperiodontitis), while 34.5% were found with CPI score ≥3 (periodontitis). Age, gender, occupation, smoking, diabetes, arthritis, cardiovascular disease, kidney disease, stress, medications, and oral hygiene habits of using tooth powder or tooth brushing were significantly (P ≤ 0.037) associated with periodontal status. Regression analysis showed a significant association of age, occupation, and smoking with periodontitis.

CONCLUSION

This study observed prevalence of periodontitis in one-fourth of study sample. The study confirmed various socio-demographic risk factors/indictors associated with increased risk of periodontitis.

Site-specific treatment outcome in smokers following non-surgical and surgical periodontal therapy

Aim

To evaluate the effect of smoking at patient, tooth, and site level following non‐surgical and surgical periodontal therapy.

Material and Methods

Eighty chronic periodontitis patients, 40 smokers and 40 non‐smokers, were recruited to this single‐arm clinical trial. Smoking status was validated by measuring serum cotinine levels. Periodontal examinations were performed at baseline (T0) and 3 months following non‐surgical and surgical periodontal therapy (T1). At T0 and T1, subgingival plaque samples were collected from the deepest periodontal pocket in each patient and analysed using checkerboard DNA–DNA hybridization. Probing depth (PD) ≥ 5 mm with bleeding on probing (BoP) was defined as the primary outcome. Unadjusted and adjusted logistic regression analyses, corrected for clustered observations within patients and teeth, were conducted comparing smokers with non‐smokers.

Results

Clinical parameters significantly improved in both groups (p < 0.001). An association was revealed between smoking and PD ≥ 5 mm with BoP (OR= 1.90, CI: 1.14, 3.15, p = 0.013), especially for plaque‐positive sites (OR= 4.14, CI: 2.16, 7.96, p < 0.001). A significant reduction of red complex microbiota was observed for non‐smokers only (p = 0.010).

Conclusion

Smokers respond less favourably to non‐surgical and surgical periodontal therapy compared with non‐smokers, in particular at plaque‐positive sites.

Comparative Evaluation of Clinical, Hematological and Systemic Inflammatory Markers in Smokers and Non-Smokers with Chronic Periodontitis

Context:

Systemic conditions, especially chronic infections, have a direct impact on the general health and well-being of an individual. Similarly, the long-standing inflammatory changes seen during periodontitis have been associated with the altered diabetic control, preterm, low birth weight infants, and cardiovascular disease. Being a low-grade infection, the signs may not be as severe as seen in other systemic conditions, but they definitely cannot be ignored.

Aims:

The present study was designed to compare clinical, hematological, and systemic inflammatory markers in patients with chronic periodontitis.

Subjects and Methods:

A total of 90 chronic periodontitis patients were selected for the present study from the outpatient department of the Department of Periodontology, and the various clinical and hematological parameters were then assessed.

Statistical Analysis Used:

Z-test was used to compare the probing depth, clinical attachment loss, hematological parameter, and interleukin-6 values between Group A and Group B. Mann–Whitney U-test was used to compare gingival index, plaque index, and bleeding on probing between Group A and Group B.

Results:

The results of the study were based on the comparison of the clinical, hematological, and systemic inflammatory markers in smokers and nonsmokers with chronic periodontitis and came out to be statistically highly significant.

Conclusions:

With the resurgence of emphasis on significance of oral diseases related to systemic health, the medical professionals also need to familiarize themselves with the oral cavity and the oral-systemic inter-relationships to treat or reduce the morbidity of the underlying medical condition. Furthermore, the oral health care professionals must reach out to the medical community and the general public to improve patient care through education and communication about the oral health-systemic health link.

Subgingival bacterial recolonization after scaling and root planing in smokers with chronic periodontitis

BACKGROUND

The aim of this study was to compare subgingival bacterial recolonization patterns after scaling and root planing in current smokers and non-smokers.

METHODS

15 smokers and 15 non-smokers with chronic periodontitis received scaling and root planing in six visits lasting one hour each, over a period of 21 days. Clinical monitoring was performed at baseline and 180 days, and microbiological monitoring was performed at baseline, immediately after scaling and root planing (Day 0) and at 42, 63 and 180 days post-therapy. Subgingival plaque samples were analysed by checkerboard DNA-DNA hybridization.

RESULTS

An improvement in clinical condition was observed for smokers and non-smokers; however, non-smokers showed a greater reduction in mean clinical attachment level in intermediate sites in comparison with smokers (p < 0.05). At Day 0, there was a significant reduction in the mean counts of the three pathogens from the red complex, Eubacterium nodatum and Parvimonas micra only in non-smokers (p < 0.05). There was a significant increase in the proportion of host-compatible species in non-smokers and smokers from baseline to 180 days post-therapy (p < 0.05). However, a significant decrease in the pathogenic species was observed only in non-smokers.

CONCLUSIONS

Smokers were more susceptible to the re-establishment of a pathogenic subgingival biofilm than non-smokers.

Associations between Periodontal Disease Parameters and Coronary Heart Disease in Greek Adults: A Cross-sectional Study

Aim

Several forms of periodontal disease have been associated with the development of coronary heart disease. The current retrospective study was conducted to investigate the possible relationship between periodontal disease parameters and defined coronary heart disease (CHD) in Greek adult patients.

Materials and methods

The study sample consisted of 880 individuals, 400 males and 480 females, aged 40 to 78 years. Data were collected by means of an interviewer administered questionnaire and an oral clinical examination. Statistical analysis of the questionnaire items was performed by using multiple regression analysis model in order to assess possible associations between coronary heart disease as dependent variable and epidemiological variables, biomarkers and periodontal disease parameters as independent variables.

Results

The occurrence of hypertension (OR = 0.01, 95% CI = 0.09-1.33), high level of triglycerides (OR = 0.08, 95% CI = 0.06-2.27) and total cholesterol (OR = 0.08, 95% CI = 0.07- 1.27), low level of high-density lipoprotein (OR = 0.12, 95% CI = 0.09-3.70) and smoking (OR = 1.83, 95% CI = 0.38-8.88) were significantly associated with the presence of coronary heart disease, whereas the periodontal parameters examined were not associated with the occurrence of it.

Conclusion

No associations were observed between periodontal disease parameters and defined coronary heart disease. However, the recorded associations strengthen the role of hypertension, lipids and smoking as causative risk factors of coronary heart disease.

How to cite this article

Chrysanthakopoulos NA, Oikonomou AA, Chrysanthakopoulos PA, Saini R. Associations between Periodontal Disease Parameters and Coronary Heart Disease in Greek Adults: A Cross-sectional Study. Int J Experiment Dent Sci 2015;4(1):4-10.

Association between indices of clinically-defined periodontitis and self-reported history of systemic medical conditions

AIM

The aim of the current research was to investigate whether possible associations exist between indices of clinically-defined periodontitis and several systemic medical conditions in outpatients referred to a special hospital clinic.

METHODS

The study sample consisted of 3360 outpatients aged 45-65 years. Data were collected by means of an oral clinical examination and a self-administered questionnaire. Statistical analysis of the questionnaire items was done with Fisher's exact test and the logistic regression model to assess possible associations between systemic medical conditions as independent variables, and the relative frequency of periodontal pockets ≥5 mm and clinical attachment loss (CAL) of ≥6 mm as dependent variables.

RESULTS

The depth of periodontal pockets was significantly associated with male sex, the presence of vascular disease, hypertension, stroke, heart attack, diabetes mellitus, other endocrine diseases, thyroid disease, respiratory allergies, and rheumatoid arthritis. CAL was significantly associated with the mentioned conditions, and also infective endocarditis and chronic obstructive pulmonary disease, but not other endocrine and thyroid disease.

CONCLUSIONS

The findings confirm the results from previous investigations in which a number of systemic medical conditions were significantly associated with probing pocket depth and/or CAL.

Interrelationship between chronic periodontitis and anemia: A 6-month follow-up study

Background:

In India, anemia is a common and serious health disorder among both sexes and all age groups, with anemia of chronic disease (ACD) being the second most prevalent anemia. Periodontitis is an inflammatory disease of the supporting tissues of the tooth caused by specific microorganisms. An immune response to bacteria and their products induces a major vascular response, offering explanatory mechanisms for the interactions between periodontal infection and a variety of systemic disorders. Therefore, periodontitis results in low-grade systemic inflammation, which may cause lower number of erythrocytes and, consequently, lower hemoglobin concentration.

Materials and Methods:

A total of 100 systemically healthy male patients visiting the outpatient department participated in the study. Of these, 50 patients had healthy periodontium and 50 patients had chronic periodontitis. Clinical parameters and red blood cell parameters of all the patients were assessed at baseline and 6 months after non-surgical periodontal therapy. Statistical analysis using Student's t-test was performed.

Results:

Data analysis revealed that patients with chronic periodontitis showed an improvement in both clinical and red blood cell parameters from baseline to 6 months after non-surgical periodontal therapy.

Conclusion:

From the present study, it can be concluded that like any other chronic condition, chronic periodontitis can lead to ACD. It also provides evidence that non-surgical periodontal therapy can improve the anemic status of patients with chronic periodontitis.

Smoking effect on chemokines of the human chronic periodontitis

AIM

Evaluate the effects of smoking on chemokines of the human chronic periodontitis (CP).

MATERIALS AND METHODS

Gingival samples were obtained from 23 smokers (S) and 20 non-smokers (NS) diagnosed with CP. Periodontal examination was performed. The CCL2, CCL3, CCL5, CCL19, CCL20, and CXCL8 chemokine levels were measured in gingival tissues using enzyme-linked immunosorbent assay. Chemokines were compared between S and NS, and were correlated with the number of cigarettes per day (C/day) and time of the smoking habit in years (SH/years).

RESULTS

CCL3 and CXCL8 of S were significantly smaller than that found in NS subjects, whereas the CCL5 levels increased in the S group. Negative correlations could be observed between CCL19 levels and SH/year.

CONCLUSION

Smoking suppresses the immune response which may contribute to an increased susceptibility to periodontal disease in smokers.

Risk factors for periodontal disease

Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors for periodontal disease, such as smoking, diabetes and obesity, and osteoporosis in postmenopausal women, are relatively common and can be expected to affect most patients with periodontal disease seen in clinics and dental practices. Hence, risk factor identification and management has become a key component of care for periodontal patients.

The influence of cigarette smoking on gingival bleeding and serum concentrations of haptoglobin and alpha 1-antitrypsin

The objectives of this study were to evaluate the influence of cigarette smoking on gingival bleeding and serum concentrations of cotinine, haptoglobin, and alpha 1-antitrypsin in Malaysian smokers. A total of 197 male smokers and nonsmokers were recruited for this study. Plaque index, bleeding on probing (BOP), and levels of serum cotinine, haptoglobin, and alpha 1-antitrypsin were evaluated. The data were analyzed using SPSS version 20.0, with the significance level set at α ≤ 0.05. Linear regression analyses were performed. The mean cigarette consumption per day was 13.39 ± 5.75 cigarettes; the mean duration was 16.03 ± 8.78 years. Relatively low BOP values (26.05 ± 1.48) and moderate plaque indexes (51.35 ± 11.27) were found. The levels of serum cotinine (106.9 ± 30.71 ng/dL), haptoglobin (76.04 ± 52.48 mg/dL), and alpha 1-antitrypsin (141.90 ± 18.40 mg/dL) were significantly higher in smokers compared to non-smokers. Multiple logistic regression models for all variables and smokers demonstrated observed differences between BOP, the number of cigarettes per day, and duration of smoking, while serum cotinine, haptoglobin and alpha-1 antitrypsin levels showed no significant differences. Duration of smoking (years) and the cotinine level in serum showed a significant correlation with plaque index. The present analysis demonstrated that the duration of smoking in years, but not the number of cigarettes smoked per day, was associated with reduced gingival bleeding in smokers.

Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study

A case-control study was done to assess the influence of smoking on clinical, microbiological, and histopathological parameters. Methods. Two hundred dentate male patients (100 smokers and 100 nonsmokers) ranging between 25 and 50 years were enrolled in the study. Periodontal parameters were recorded. Plaque samples were collected for microbial analysis for BANA test. Gingival biopsies were obtained from selected site for assessing histopathological changes. Results. Both groups showed almost similar plaque levels (P=0.258), but smokers had reduced gingival (0.62 ± 0.31) and bleeding indices (28.53 ± 17.52) and an increased calculus index (1.62 ± 0.36). Smokers had an increased probing depth of 4-7 mm (P=0.009) and overall increased CAL. No difference in microbiota was found between the two groups. Histopathologically smokers showed a decreased blood vessel density (8.84 ± 0.96) and inflammatory cells (52.00 ± 9.79). Conclusions. It is quite possible that many of the pathogenic mechanisms involved in tissue degradation in periodontitis in smokers could be quite different from those in nonsmokers.

Prevalence and risk indicators of gingivitis and periodontitis in a multi-centre study in North Jordan: a cross sectional study

Background

There are limited data about the epidemiology and risk factors/indicators of gingivitis, aggressive periodontitis (AgP) and chronic periodontitis (CP) in Jordan. The aim of this study was to assess the prevalence and risk indicators of gingivitis, AgP and CP.

Methods

A sample of 595 subjects was randomly selected from subjects escorting out-patients attending a Medical Center, a Dental Teaching Hospital, and 2 private dental clinics. The socio-demographic variables, oral hygiene habits, income, smoking and Body Mass Index (BMI) were recorded. Full mouth periodontal examination was performed, and radiographs were taken for sites with probing depth > 3 mm.

Results

About 76% had gingivitis, 2.2% had AgP and 5.5% had CP. Periodontitis was more frequent among males than females with a M: F ratio of 1.6:1 and the prevalence increased with age. Subjects who reported not using a tooth brush, smokers and subjects with BMI > 30 kg/m² had significantly higher prevalence of periodontitis. The risk for periodontitis was greater among subjects who reported positive family history and subjects with ≤ 12 years of education.

Conclusions

This is the first study to report on the prevalence of gingivitis, CP and AgP in North Jordanian. Age, low education, low frequency of tooth brushing and family history were significantly associated with increased risk of periodontitis.