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Pitchumani PK, Parekh S, Rachana Hegde, Thomas DC. Systemic Factors Affecting Prognosis in Periodontics: Part II. Dent Clin North Am 2024; 68:603-617. [PMID: 39244246 DOI: 10.1016/j.cden.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2024]
Abstract
This study gives an insight into certain systemic conditions and factors such as nutrition, age, hematological disorders, hypertension, smoking, obesity, and metabolic syndrome that have a notable effect on the periodontium. The review highlights the importance of taking these factors into consideration in periodontal therapy and their impact on the prognosis of periodontal therapies. The other systemic factors are discussed in detail elsewhere in the special issue.
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Affiliation(s)
| | | | | | - Davis C Thomas
- Department of Diagnostic Sciences, Center for Temporomandibular Disorders and Orofacial Pain, Rutgers School of Dental Medicine, Newark, NJ, USA.
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Yang X, Liu P, Fan X, Yu S, Chen C, Pan Y, Lin L, Tang X, Li C. Distribution and influencing factors on residual pockets of the teeth in patients with periodontitis following non-surgical periodontal treatment: a retrospective observational study. BMC Oral Health 2023; 23:736. [PMID: 37814304 PMCID: PMC10561464 DOI: 10.1186/s12903-023-03248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/23/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Periodontitis is a chronic and multi-factorial infectious disease. A notable difference exists in the prognosis of patients with severe periodontitis after non-surgical periodontal treatment. Thus, a retrospective study was conducted to identify common and specific factors that impact the prognosis of patients with periodontitis stage III-IV following non-surgical periodontal treatment at different tooth sites. METHODS A total of 977 teeth were included in the study, comprising 266 patients diagnosed with periodontitis stage III-IV. This sample included 330 anterior teeth, 362 maxillary posterior teeth, and 285 mandibular posterior teeth. Following treatment, the teeth were categorized into two groups based on residual pocket depth [probing depth (PD) ≥ 5 mm] at 3 months post-treatment. The prognosis of periodontitis stage III-IV was assessed through multivariate analysis employing logistic regression to determine the association of various risk factors. RESULTS The PD values of each site and the deepest PD values of each tooth significantly decreased at 3 months post-treatment. Residual pockets were predominantly found in the mesio/disto-buccal and mesio/disto-lingual regions. Multivariate analysis revealed that gender, PD, sulcus bleeding index (SBI) and plaque index (PLI) at baseline, and crown-root ratio in anterior teeth had a significant influence on periodontitis stage III-IV (P < 0.05). Smoking, PD, PLI and furcation involvement (FI) at baseline, PLI at 3 months post-treatment, grades of periodontitis, and crown-root ratio were prediction factors for maxillary posterior teeth. Factors such as PD, PLI and FI at baseline, PLI at 3 months post-treatment, and crown-root were significant in mandibular posterior teeth. CONCLUSIONS The outcome of non-surgical treatment varies depending on the tooth positions for patients with periodontitis stage III-IV. Dentists must accurately identify the affected teeth that have periodontal pockets of more than 5 mm, taking into consideration the positions of the affected teeth, as well as various local and systemic factors. This comprehensive assessment will enable dentists to develop a customized and effective treatment plan.
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Affiliation(s)
- Xue Yang
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
- School of Stomatology, Dalian Medical University, Dalian, Liaoning, China
| | - Peicheng Liu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
- Department of Stomatology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiaomiao Fan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Shiwen Yu
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Chen Chen
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Yaping Pan
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Li Lin
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Xiaolin Tang
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China
| | - Chen Li
- Department of Periodontics, School and Hospital of Stomatology, China Medical University, No.117 Nanjing North Street, Heping District, Shenyang, Liaoning, 110002, China.
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Thiem DGE, Donkiewicz P, Rejaey R, Wiesmann-Imilowski N, Deschner J, Al-Nawas B, Kämmerer PW. The impact of electronic and conventional cigarettes on periodontal health-a systematic review and meta-analysis. Clin Oral Investig 2023; 27:4911-4928. [PMID: 37526741 PMCID: PMC10492702 DOI: 10.1007/s00784-023-05162-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/13/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES This systematic review and meta-analysis examined the effects of electronic cigarettes on periodontal health compared to conventional cigarette smoke and a non-smoking population. MATERIALS AND METHODS MEDLINE, Embase, Web of Science, CENTRAL, and ClinicalTrials.gov were screened for literature. Eligibility criteria included clinical studies published between 2006 and 2022 that compare e-cigarettes and conventional cigarettes on periodontal health (bleeding on probing (BoP), plaque index (PI), probing depth (PD), attachment loss (AL), marginal bone loss (MBL), tooth loss, molecular inflammation markers, salivary flow rate). Meta-regression analysis was used to examine the influence of moderator variables. RESULTS Sixteen studies were found to be eligible for qualitative synthesis. Individual analyses showed that cigarette smokers had significantly higher PI, PD, AL, and MBL and increased concentrations of proinflammatory mediators than e-cigarette users and non-smokers. Meta-analysis revealed a 0.33-fold lower chance for BoP in e-cigarette users compared to smokers (p = 0.03), whereby meta-regression failed to detect any effects regarding the age of users and frequency of smoking. A 0.01-fold decreased chance for positive BoP in e-cigarette users compared with non-smokers was seen (p < 0.01). CONCLUSIONS The current findings suggest that that e-cigarette use might be considered a healthier alternative to cigarette smoking concerning periodontal health. Even so, harmful effects of electronic nicotine delivery system (ENDS) usage on periodontal health were seen as well. However, a definitive decision on this research question remains elusive due to the absence of randomized controlled trials. CLINICAL RELEVANCE Electronic cigarettes, marketed as a safer alternative to traditional cigarettes, are becoming increasingly popular. Evidence on the use of electronic cigarettes as a cessation aid and its beneficial impact compared to cigarette smoke remains inconclusive, so the analysis conducted in this review addresses a recent question of high clinical relevance.
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Affiliation(s)
- Daniel G. E. Thiem
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Phil Donkiewicz
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
- Department of Periodontology and Operative Dentistry, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
- BioHorizons Camlog, Maybachstr. 5, 71299 Wimsheim, Germany
| | - Raha Rejaey
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Nadine Wiesmann-Imilowski
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - James Deschner
- Department of Periodontology and Operative Dentistry, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery, Facial Plastic Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany
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Apatzidou DA. The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy. Periodontol 2000 2022; 90:45-61. [PMID: 35950749 DOI: 10.1111/prd.12449] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
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Affiliation(s)
- Danae Anastasia Apatzidou
- Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Faculty of Health Sciences, Aristotle University of Thessaloniki (AUTh), Thessaloniki, Greece
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Salhi L, Lambert F, Seidel L, Albert A. Predicting probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence and the number of cigarette consumed. Heliyon 2022; 8:e10143. [PMID: 36039129 PMCID: PMC9418199 DOI: 10.1016/j.heliyon.2022.e10143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/08/2022] [Accepted: 07/27/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Smoking is considered as a risk factor for the poor outcomes after periodontitis non-surgical treatment (PNST). The aim of this short communication is to predict probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence (FTND) and the number of cigarette consumed (NCC). Methods This work is a post-hoc study of a prospective controlled study on the effect of oral hygiene instructions and PNST on periodontal outcomes. This short communication focused only on the current conventional smokers (N = 34), based on specific smoking indicators, and on probing depth (PD) parameter that were recorded at baseline (time 0), after oral hygiene instruction (time 1) and 3 months after PNST (time 2). Results The 34 smokers had a mean age 46.5 ± 11.5 years. The NCC- and FTND-based predictions allowed to show in a specific nomogram the PD values 3 months after PNST for each NCC and FTND category. Conclusion Two nomograms are proposed for prognostic purposes and allow patients to understand the impact of smoking on periodontitis according to the number of cigarette consumed and the level of nicotine dependence. These nomograms might be also used for supporting smoking cessation. Clinical significance In smoker patients with periodontitis, there is a need to predict, for both patient and clinicians, the impact of the number of cigarettes consumed and the level of nicotine dependence on probing depth after oral hygiene instructions and debridement. Two nomograms are proposed for prognostic purposes.
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Omer-Cihangir R, Baser U, Kucukgergin C, Aykol-Sahin G, Huck O, Yalcin F. Impact of Smoking on Neutrophil Enzyme Levels in Gingivitis: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158075. [PMID: 34360367 PMCID: PMC8345369 DOI: 10.3390/ijerph18158075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023]
Abstract
Background: The determination of the impact of risk factors such as smoking in periodontal disease development is of importance to better characterize the disease. However, its impact on host response remains unclear. This study aimed to evaluate the effects of tobacco smoking on GCF levels of neutrophil enzymes (myeloperoxidase (MPO), beta-glucuronidase (BGD), neutrophil elastase (NE) and periodontal parameters in healthy young adults with dental plaque biofilm-induced gingivitis. Methods: The study population consisted of 60 systemically healthy young adults (39 smokers (Sm) and 21 non-smokers (n-Sm)) diagnosed with plaque-induced gingivitis. The periodontal examination consisted of a plaque index (PI); gingival index (GI); probing depth (PD); bleeding on probing (BoP), and clinical attachment level (CAL). GCF MPO, BGD, and NE levels were determined by means of an enzyme-linked immunosorbent assay (ELISA). Results: PI, GI, and BoP were significantly increased in the Sm group (p < 0.05). PD and CAL showed no significant difference between Sm and n-Sm groups (p > 0.05). In GCF, MPO, BGD, and NE levels were significantly increased in Sm group (p < 0.05). NE levels showed a significant correlation with GI and BoP (p < 0.05 for both). Moreover, a positive correlation between BGD and NE levels (p < 0.05) was measured. Conclusions: It may be concluded that, even in young patients, tobacco consumption affects the host’s immune response related to gingival inflammation. It is, therefore, mandatory to inform young patients about the risk related to tobacco consumption for their gingival health.
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Affiliation(s)
- Rumeysa Omer-Cihangir
- Periodontology Department, Faculty of Dentistry, University of Istanbul, Istanbul 34093, Turkey;
- Correspondence: (R.O.-C.); (U.B.); Tel.: +90-505-369-8644 (U.B.)
| | - Ulku Baser
- Periodontology Department, Faculty of Dentistry, University of Istanbul, Istanbul 34093, Turkey;
- Correspondence: (R.O.-C.); (U.B.); Tel.: +90-505-369-8644 (U.B.)
| | - Canan Kucukgergin
- Department of Medical Biochemistry, Istanbul Faculty of Medicine, University of Istanbul, Istanbul 34093, Turkey;
| | - Gokce Aykol-Sahin
- Periodontology Department, Faculty of Dentistry, Istanbul Okan University, Istanbul 34959, Turkey;
| | - Olivier Huck
- Department of Periodontology, Dental Faculty, University of Strasbourg, 67081 Strasbourg, France;
- INSERM, UMR 1260 Osteoarticular and Dental Regenerative Nanomedicine, 67000 Strasbourg, France
- Pôle de Médecine et de Chirurgie Bucco-Dentaires, Hôpitaux Universitaires de Strasbourg, 67091 Strasbourg, France
| | - Funda Yalcin
- Periodontology Department, Faculty of Dentistry, University of Istanbul, Istanbul 34093, Turkey;
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Silva H. Tobacco Use and Periodontal Disease-The Role of Microvascular Dysfunction. BIOLOGY 2021; 10:441. [PMID: 34067557 PMCID: PMC8156280 DOI: 10.3390/biology10050441] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 12/30/2022]
Abstract
Periodontal disease consists in highly prevalent wide-ranging inflammatory conditions that affect the supporting apparatus of teeth. Tobacco use is the most important risk factor for periodontal disease as it increases disease severity and periodontal surgery complications. Tobacco use is harmful for the vasculature by causing microvascular dysfunction, which is known to negatively affect periodontal disease. To the author's knowledge this paper is the first comprehensive review on the mechanisms by which tobacco use affects oral microcirculation and impacts the pathophysiology of periodontal disease. In healthy subjects, acute nicotine administration or tobacco use (smoking/smokeless forms) increases the blood flow in the oral mucosa due to local irritation and increased blood pressure, which overcome neural- and endocrine-mediated vasoconstriction. Chronic tobacco smokers display an increased gingival microvascular density, which is attributed to an increased capillary recruitment, however, these microcirculatory units show higher tortuosity and lower caliber. These morphological changes, together with the repetitive vasoconstrictive insults, contribute to lower gingival perfusion in chronic smokers and do not completely regress upon smoking cessation. In periodontal disease there is considerable gingival inflammation and angiogenesis in non-smokers which, in chronic smokers, are considerably suppressed, in part due to local immune suppression and oxidative stress. Tobacco exposure, irrespective of the form of use, causes long-term microvascular dysfunction that increases the risk of complications due to the natural disease course or secondary therapeutic strategies.
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Affiliation(s)
- Henrique Silva
- Informetrics Research Group, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam;
- Faculty of Pharmacy, Ton Duc Thang University, Ho Chi Minh City 758307, Vietnam
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Salhi L, Seidel L, Albert A, Lambert F. Fagerström test for nicotine dependence as an indicator in tobacco-related studies in periodontology. J Periodontol 2021; 92:298-305. [PMID: 33480446 DOI: 10.1002/jper.20-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/10/2020] [Accepted: 06/11/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Smoking is considered a risk factor for periodontitis genesis and progression. Numerous clinical studies have demonstrated the negative effect of smoking, in particular the number of cigarettes consumed (NCC), on periodontal clinical parameters. However, smoking addiction assessed by the Fagerström test for nicotine dependence (FTND) has received little attention in periodontal research. METHODS In smoking patients presenting with periodontitis, the periodontal clinical features were measured and correlated with smoking status. The ability of FTND and NCC to predict periodontitis severity was assessed and compared. RESULTS Thirty-four smoking patients aged 46.5 ± 11.5 years were included. The means of NCC and FTND were 16.6 ± 5.5 and 5.2 ±1.8, respectively. NCC and FTND were correlated with each other (r = 0.57, P < 0.001). Patients had stage III (44.1%) or stage IV (55.9%) periodontitis and 73.5% presented a generalized extension of periodontitis. The combination of FTND and NCC in discerning disease severity (ROC curve analysis: AUC = 0.746, P = 0.027) was superior to each indicator separately. A discriminant score based on both indicators (D = -0.42 - 0.15 × NCC + 0.63 × FTND) derived by logistic regression showed the opposite role of the indicators and the greater relevance of FTND (P = 0.031) compared to NCC (P = 0.084) in the relationship. CONCLUSION This study shows that FTND could substantially complement NCC as an indicator of smoking status in periodontal research.
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Affiliation(s)
- Leila Salhi
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liege, Belgium
| | - Laurence Seidel
- Department of Biostatistics, University Hospital, University of Liège, Liege, Belgium
| | - Adelin Albert
- Department of Public Health Sciences, University of Liège, Liege, Belgium
| | - France Lambert
- Dental Biomaterials Research Unit, Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liege, Belgium
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Saha M, Dremin V, Rafailov I, Dunaev A, Sokolovski S, Rafailov E. Wearable Laser Doppler Flowmetry Sensor: A Feasibility Study with Smoker and Non-Smoker Volunteers. BIOSENSORS-BASEL 2020; 10:bios10120201. [PMID: 33297337 PMCID: PMC7762214 DOI: 10.3390/bios10120201] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/01/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
Novel, non-invasive wearable laser Doppler flowmetry (LDF) devices measure real-time blood circulation of the left middle fingertip and the topside of the wrist of the left hand. The LDF signals are simultaneously recorded for fingertip and wrist. The amplitude of blood flow signals and wavelet analysis of the signal are used for the analysis of blood perfusion parameters. The aim of this pilot study is to validate the accuracy of blood circulation measurements recorded by one such non-invasive wearable LDF device for healthy young non-smokers and smokers. This study reveals a higher level of blood perfusion in the non-smoker group compared to the smoker group and vice-versa for the variation of pulse frequency. This result can be useful to assess the sensitivity of the wearable LDF sensor in determining the effect of nicotine for smokers as compared to non-smokers and also the blood microcirculation in smokers with different pathologies.
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Affiliation(s)
- Mou Saha
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (S.S.); (E.R.)
- Correspondence: (M.S.); (V.D.)
| | - Viktor Dremin
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (S.S.); (E.R.)
- Research & Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia;
- Correspondence: (M.S.); (V.D.)
| | - Ilya Rafailov
- Aston Medical Technology Ltd., Birmingham B7 4BB, UK;
| | - Andrey Dunaev
- Research & Development Center of Biomedical Photonics, Orel State University, 302026 Orel, Russia;
| | - Sergei Sokolovski
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (S.S.); (E.R.)
| | - Edik Rafailov
- Aston Institute of Photonic Technologies, Aston University, Birmingham B4 7ET, UK; (S.S.); (E.R.)
- Saratov State University, 410012 Saratov, Russia
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Sankethguddad S, Abbayya K, Suragimath G, Kamala KA, Sujith SG. An epidemiological study to assess periodontal status among sugar factory workers of Karad taluka using community periodontal index. J Family Med Prim Care 2020; 9:3480-3486. [PMID: 33102317 PMCID: PMC7567184 DOI: 10.4103/jfmpc.jfmpc_151_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 06/02/2020] [Indexed: 11/07/2022] Open
Abstract
Objectives: Oral health is an integral component of general health. Periodontal disease is one of the most prevalent dental diseases among the population. Researchers have identified an association of various risk factors with periodontal disease. The study aimed to assess the periodontal status among the sugar factory workers of Karad taluka. Materials and Methods: The study was conducted among 1200 subjects in the age group of 25-54 years. Personal and sociodemographic data were recorded in the proforma based on the WHO oral health survey form (1997). Periodontal status was assessed using community periodontal index (CPI). For statistical analyses, Chi-square test and Multiple Logistic Regression analyses was performed. Results: The sociodemographic characteristics (age, sex, and socioeconomic status) and deleterious habits like tobacco chewing and smoking were found to be significantly associated with the CPI and LoA scores for the population (P < 0.00001). Conclusion: The analysis of the results obtained in this epidemiological study evidenced that periodontitis is prevalent among the sugar factory workers of Karad taluka. There is a need for emphasis on the preventive care.
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Affiliation(s)
- S Sankethguddad
- Department of Periodontology, Shivtej Arogya Seva Sanstha's Yogita Dental College and Hospital, Khed, District Ratnagiri, Maharashtra, India
| | - Keshava Abbayya
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, District Satara, Maharashtra, India
| | - Girish Suragimath
- Department of Periodontology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, District Satara, Maharashtra, India
| | - K A Kamala
- Department of Oral Medicine and Radiology, School of Dental Sciences, Krishna Institute of Medical Sciences Deemed to be University, Karad, District Satara, Maharashtra, India
| | - S G Sujith
- Department of Periodontology, Shivtej Arogya Seva Sanstha's Yogita Dental College and Hospital, Khed, District Ratnagiri, Maharashtra, India
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Carroll DM, Stepanov I, O'Connor R, Luo X, Cummings KM, Rees VW, Bickel WK, Berman ML, Ashley DL, Bansal-Travers M, Shields PG, Hatsukami DK. Impact of Cigarette Filter Ventilation on U.S. Smokers' Perceptions and Biomarkers of Exposure and Potential Harm. Cancer Epidemiol Biomarkers Prev 2020; 30:38-44. [PMID: 33093163 DOI: 10.1158/1055-9965.epi-20-0852] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Relationships between cigarette filter ventilation levels, biomarkers of exposure (BOE) and potential harm (BOPH), and harm perceptions were examined. METHODS Filter ventilation levels in cigarette brands were merged with Wave 1 (2013-2014) Population Assessment of Tobacco Use and Health study. Data were restricted to smokers who reported a usual brand and not regular users of other tobacco products. BOEs included nicotine, tobacco-specific nitrosamines, volatile organic compounds (VOC), and polycyclic aromatic hydrocarbons. BOPHs measured inflammation and oxidative stress. Perceived harm was assessed as self-reported risk of one's usual brand compared with other brands. RESULTS Filter ventilation ranged from 0.2% to 61.1% (n = 1,503). Adjusted relationships between filter ventilation and BOE or BOPH were nonsignificant except for VOC N-acetyl-S-(phenyl)-L-cysteine (PHMA) and high-sensitivity C-reactive protein (hsCRP). In pairwise comparisons, PHMA was higher in quartile (Q) 4 (4.23 vs. 3.36 pmol/mg; P = 0.0103) and Q3 (4.48 vs. 3.36 pmol/mg; P = 0.0038) versus Q1 of filter ventilation and hsCRP comparisons were nonsignificant. Adjusted odds of perceiving one's own brand as less harmful was 26.87 (95% confidence interval: 4.31-167.66), 12.55 (3.01-52.32), and 19.18 (3.87-95.02) times higher in the Q2, Q3, and Q4 of filter ventilation compared with Q1 (P = 0.0037). CONCLUSIONS Filter ventilation was not associated with BOE or BOPH, yet smokers of higher ventilated cigarettes perceived their brand as less harmful than other brands compared with smokers of lower ventilated cigarettes. IMPACT Research to understand the impact of this misperception is needed, and remedial strategies, potentially including a ban on filter ventilation, are recommended.
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Affiliation(s)
- Dana M Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota.
| | - Irina Stepanov
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Richard O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Xianghua Luo
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Warren K Bickel
- Fralin Biomedical Research Institute of Virginia Tech, Roanoke, Virginia
| | - Micah L Berman
- College of Public Health and Moritz College of Law, The Ohio State University, Columbus, Ohio
| | - David L Ashley
- Department of Population Health Sciences, Georgia State University, Atlanta, Georgia
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Peter G Shields
- Comprehensive Cancer Center, The Ohio State University and James Cancer Hospital, Columbus, Ohio
| | - Dorothy K Hatsukami
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, Minnesota
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12
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Yılmaz Şaştım Ç, Gürsoy M, Könönen E, Kasurinen A, Norvio S, Gürsoy UK, Doğan B. Salivary and serum markers of angiogenesis in periodontitis in relation to smoking. Clin Oral Investig 2020; 25:1117-1126. [PMID: 32643086 DOI: 10.1007/s00784-020-03411-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Angiogenesis is essential in maintenance of periodontal homeostasis, and it is regulated by growth factors and cytokines, including basic fibroblast growth factor (b-FGF), endoglin, platelet and endothelial cell adhesion molecule (PECAM-1), vascular endothelial growth factor (VEGF), soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular cell adhesion molecule-1 (sVCAM-1). In this study, the salivary and serum concentrations of these angiogenesis-related proteins in relation to smoking and periodontitis were examined. MATERIAL AND METHODS Full-mouth periodontal status together with unstimulated whole saliva and serum samples was collected from 78 individuals, including 40 periodontitis patients (20 smokers and 20 nonsmokers) and 38 periodontally healthy controls (20 smokers and 18 nonsmokers). The Luminex®-xMAP™ technique was used for protein analyses. RESULTS Concentrations of all tested proteins in saliva as well as VEGF in serum were significantly higher in periodontitis patients than in healthy controls. In smokers, serum concentrations of endoglin (p = 0.017) and sICAM-1 (p = 0.001) were elevated in comparison to nonsmokers. After adjusting for smoking and gender, periodontitis associated significantly with salivary concentrations of b-FGF, PECAM-1, VEGF, sICAM-1, and sVCAM-1 (p < 0.01). CONCLUSION Taken together, salivary concentrations of b-FGF, PECAM-1, and VEGF associate with periodontitis. The suppressive effect of smoking on salivary marker levels is limited to periodontitis patients only. CLINICAL RELEVANCE Smoking-related suppression of salivary marker levels is observed only in periodontitis patients.
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Affiliation(s)
- Çiğdem Yılmaz Şaştım
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey
| | - Mervi Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Eija Könönen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
- Oral Health Care, Welfare Division, City of Turku, Turku, Finland
| | - Akseli Kasurinen
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Susanna Norvio
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Ulvi Kahraman Gürsoy
- Department of Periodontology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Başak Doğan
- Department of Periodontology, Faculty of Dentistry, University of Marmara, 34854 Maltepe, Istanbul, Turkey.
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13
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Pinto KP, Ferreira CMA, Guimarães AFC, Lima CO, Pires FR, Sassone LM, Silva EJNL. Effects of alcohol and nicotine consumption on the development of apical periodontitis in rats: a correlative micro-computed tomographic, histological and immunohistochemical study. Int Endod J 2020; 53:1238-1252. [PMID: 32516436 DOI: 10.1111/iej.13344] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/02/2020] [Indexed: 12/17/2022]
Abstract
AIM To evaluate the effects of alcohol and nicotine, when used alone or simultaneously, in the development of apical periodontitis induced in rats, using a correlative analytic approach with micro-CT, histological and immunohistochemical analysis. METHODOLOGY Twenty-eight male Wistar rats were arranged into four groups: Control, Nicotine, Alcohol and Alcohol + Nicotine. The alcohol groups were exposed to self-administration of a 25% alcohol solution, whilst the other groups drunk only filtered water. The nicotine groups received daily intraperitoneal injections of a solution with 0.19 μL of nicotine per mL, whilst the other groups received saline solution. The pulps of the left mandibular first molars were exposed for 28 days to induce periapical lesions. Throughout the experiment, drug administration was maintained, and the animals had their weight and solid and liquid consumption measured. After euthanasia, the mandibles were removed and the area, volume and major diameter of the periapical lesions were measured using micro-computed tomography images. The samples were submitted to histopathological evaluation and immunohistochemistry for RANKL and PTHrP. Statistical analysis was undertaken with a significance level of 5%. Nonparametric data were analysed using the Kruskal-Wallis test followed by Dunn's test, whilst one-way anova followed by Tukey's test was performed for parametric data. RESULTS The alcohol groups had lower solid and liquid consumption and gained less weight when compared to the nonalcohol groups (P < 0.05). The Alcohol + Nicotine group had lesions with significantly larger volume and area when compared to the other groups (P < 0.05), whilst the Alcohol or Nicotine groups had significantly larger lesions than the control group (P < 0.05). There was no significant difference in the largest diameter of the lesions amongst groups (P > 0.05). The experimental groups had greater inflammatory response scores than the control group (P < 0.05), and the representative samples had more pronounced immunoreaction against RANKL and PTHrP antibodies. CONCLUSIONS Alcohol and nicotine consumption exacerbated the inflammatory response and the development of periradicular lesions in rats. The association of both substances enhanced their harmful effects.
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Affiliation(s)
- K P Pinto
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - C M A Ferreira
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - A F C Guimarães
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - C O Lima
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - F R Pires
- Department of Oral Pathology, School of Dentistry, Estácio de Sá University (UNESA), Rio de Janeiro, Brazil
| | - L M Sassone
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil
| | - E J N L Silva
- Department of Endodontics, Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.,Department of Endodontics, Grande Rio University (UNIGRANRIO), Rio de Janeiro, Brazil
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14
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Carroll DM, Murphy SE, Benowitz NL, Strasser AA, Kotlyar M, Hecht SS, Carmella SG, McClernon FJ, Pacek LR, Dermody SS, Vandrey RG, Donny EC, Hatsukami DK. Relationships between the Nicotine Metabolite Ratio and a Panel of Exposure and Effect Biomarkers: Findings from Two Studies of U.S. Commercial Cigarette Smokers. Cancer Epidemiol Biomarkers Prev 2020; 29:871-879. [PMID: 32051195 DOI: 10.1158/1055-9965.epi-19-0644] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/23/2019] [Accepted: 01/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We examined the nicotine metabolite ratio's (NMR) relationship with smoking intensity, nicotine dependence, and a broad array of biomarkers of exposure and biological effect in commercial cigarette smokers. METHODS Secondary analysis was conducted on two cross-sectional samples of adult, daily smokers from Wave 1 (2013-2014) of the Population Assessment of Tobacco Use and Health (PATH) Study and baseline data from a 2014-2017 randomized clinical trial. Data were restricted to participants of non-Hispanic, white race. The lowest quartile of NMR (<0.26) in the nationally representative PATH Study was used to distinguish slow from normal/fast nicotine metabolizers. NMR was modeled continuously in secondary analysis. RESULTS Compared with slow metabolizers, normal/fast metabolizers had greater cigarettes per day and higher levels of total nicotine equivalents, tobacco-specific nitrosamines, volatile organic componds, and polycyclic aromatic hydrocarbons. A novel finding was higher levels of inflammatory biomarkers among normal/fast metabolizers versus slow metabolizers. With NMR modeled as a continuous measure, the associations between NMR and biomarkers of inflammation were not significant. CONCLUSIONS The results are suggestive that normal/fast nicotine metabolizers may be at increased risk for tobacco-related disease due to being heavier smokers, having higher exposure to numerous toxicants and carcinogens, and having higher levels of inflammation when compared with slow metabolizers. IMPACT This is the first documentation that NMR is not only associated with smoking exposure but also biomarkers of biological effects that are integral in the development of tobacco-related disease. Results provide support for NMR as a biomarker for understanding a smoker's exposure and potential risk for tobacco-related disease.
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Affiliation(s)
- Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota. .,Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Neal L Benowitz
- Clinical Pharmacology Program, Division of Cardiology, Department of Medicine, University of California, San Francisco, California
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Kotlyar
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, Minnesota
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Steve G Carmella
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Sarah S Dermody
- School of Psychological Science, Oregon State University, Corvallis, Oregon
| | - Ryan G Vandrey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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15
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Santhana Krishnan G, Naik D, Uppoor A, Nayak S, Baliga S, Maddi A. Candidal carriage in saliva and subgingival plaque among smokers and non-smokers with chronic periodontitis-a cross-sectional study. PeerJ 2020; 8:e8441. [PMID: 32030324 PMCID: PMC6995268 DOI: 10.7717/peerj.8441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 12/19/2019] [Indexed: 12/11/2022] Open
Abstract
Background and Objectives Studies of gum or periodontal disease have focused mainly on bacterial pathogens. However, information related to fungal species in the saliva and subgingival mileu is particularly lacking in smokers with periodontitis. This cross-sectional study compared the prevalence of various Candida species in saliva and subgingival plaque samples of smokers and non-smokers with periodontal disease. Methodology Study subjects were recruited into three group-Group 1: Smokers with chronic periodontitis (N = 30), Group 2: Non-smokers with chronic periodontitis (N = 30) and Group 3: Healthy controls (N = 30). Clinical parameters recorded included plaque index (PI), gingival index (GI), periodontal probing depth (PPD) and clinical attachment loss (CAL). Saliva and subgingival plaque samples were collected from subjects from the above groups. The collected samples were processed for isolation and identification of various Candida species using CHROMagar chromogenic media. Additionally, antifungal susceptibility tests were performed for the isolated Candida species in order to assess antifungal drug resistance to fluconazole and voriconazole. Results Prevalence of Candida species in saliva samples was quantified as 76.6% in Group 1, 73.3% in Group 2 and 36.6% in Group 3 and statistically significant differences were observed between groups 1 & 3. Prevalence of Candida species in subgingival plaque samples was quantified as 73.3% in Group 1, 66.6% in Group 2 and 60% in Group 3 and no statistically significant differences were observed between groups. Candida albicans was the most frequently isolated species followed by Candida krusei and Candida tropicalis. A positive correlation was observed for smoking exposure, pack years and Candida colonization. A marginally significant positive correlation was observed between Candida colonization and increasing pocket depth and attachment loss. Antifungal drug resistance was mainly observed for Candida krusei in both saliva and subgingival plaque samples. Conclusion Based on the results we can conclude that oral candidal carriage is significantly increased in smokers with periodontal disease. Mechanistic studies are needed to understand the importance of Candida species in periodontal disease.
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Affiliation(s)
- Gayathri Santhana Krishnan
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Dilip Naik
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Ashita Uppoor
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sangeeta Nayak
- Department of Periodontology, Manipal College of Dental Sciences Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Abhiram Maddi
- Periodontics & Endodontics, School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, United States of America
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16
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Gu Z, Singh S, Niyogi RG, Lamont GJ, Wang H, Lamont RJ, Scott DA. Marijuana-Derived Cannabinoids Trigger a CB2/PI3K Axis of Suppression of the Innate Response to Oral Pathogens. Front Immunol 2019; 10:2288. [PMID: 31681262 PMCID: PMC6804395 DOI: 10.3389/fimmu.2019.02288] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/10/2019] [Indexed: 12/18/2022] Open
Abstract
Cannabis use is an emergent risk factor for periodontitis, a chronic bacterial-induced disease of the supporting structures of the teeth. However, the mechanisms by which marijuana exposure predisposes to periodontal tissue destruction have yet to be elucidated. Therefore, we examined the influence of physiologically relevant doses of major marijuana-derived phytocannabinoid subtypes (cannabidiol [CBD]; cannabinol [CBN]; and tetrahydrocannabinol [THC], 1.0 μg/ml) on the interactions of three ultrastructurally variant oral pathogens, Porphyromonas gingivalis, Filifactor alocis, and Treponema denticola with the immune system. CBD, CBN, and THC each suppressed P. gingivalis-induced IL-12 p40, IL-6, IL-8, and TNF release while enhancing the anti-inflammatory cytokine, IL-10, from human innate cells. Similar phenomena were observed in F. alocis- and T. denticola-exposed human monocytes and human gingival keratinocytes. Higher phytocannabinoid doses (≥5.0 μg/ml) compromised innate cell viability and inhibited the growth of P. gingivalis and F. alocis, relative to unexposed bacteria. T. denticola, however, was resistant to all cannabinoid doses tested (up to 10.0 μg/ml). Pharmaceutical inhibition and efficient gene silencing indicated that a common CB2/PI3K axis of immune suppression is triggered by phytocannabinoids in vitro. This pathway does not appear to perpetuate through the canonical GSK3β-dependent cholinergic anti-inflammatory pathway, the predominant endogenous inflammatory control system. In a repetitive, transient oral infection model, CBD also suppressed P. gingivalis-induced innate immune markers in wild-type mice, but not in CB2−/− mice. If such phenomena occur in humans in situ, environmental cannabinoids may enhance periodontitis via direct toxic effects on specific oral bacteria; by compromising innate cell vitality; and/or through a suppressed innate response to periodontal pathogens involving a CB2/PI3K signaling lineage.
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Affiliation(s)
- Zhen Gu
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Shilpa Singh
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Rajarshi G Niyogi
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Gwyneth J Lamont
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Huizhi Wang
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - Richard J Lamont
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
| | - David A Scott
- Oral Immunology and Infectious Diseases, University of Louisville School of Dentistry, Louisville, KY, United States
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17
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Khemiss M, Ben Fekih D, Ben Khelifa M, Ben Saad H. Comparison of Periodontal Status Between Male Exclusive Narghile Smokers and Male Exclusive Cigarette Smokers. Am J Mens Health 2019; 13:1557988319839872. [PMID: 30902035 PMCID: PMC6440045 DOI: 10.1177/1557988319839872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Studies evaluating the effects of narghile use on the periodontium present conflicting conclusions. This study aimed to compare the periodontal status of exclusive narghile smokers (ENSs, n = 74) to that of exclusive cigarette smokers (ECSs, n = 74). Males aged 20-40 years were recruited to participate in this comparative study. Information concerning oral health habits (number of yearly visits to the dentist, daily toothbrushing frequency) and tobacco exposure were obtained. Clinical measurements were performed on all the existing teeth, except the third molars. The number of remaining teeth and decayed/missing/filled teeth (DMFT) were noted. The plaque levels were recorded using the plaque index of Löe and Silness. The gingival index modified by Löe was used to evaluate gingival inflammation. Teeth mobility was measured using bidigital mobility. The probing pocket depth was measured using a periodontal probe. Periodontal disease was defined as the presence of at least 10 sites with a probing depth ≥5 mm. Student's t and chi-square tests were used to compare, respectively, the two groups' quantitative and qualitative data. The two groups were matched for quantities of used tobacco, age, daily toothbrushing frequency, teeth mobility, number of remaining teeth, plaque index, and DMFT. Compared to the ECS group, the ENS group had a significantly lower number of yearly visits to the dentist (mean ± SD: 0.2 ± 0.5 vs. 0.1 ± 0.2), lower probing pocket depth (mean ± SD: 2.33 ± 0.63 vs. 2.02 ± 0.80 mm), and gingival index (median [interquartile]: 0.46 [0.10-0.89] vs. 0.00 [0.00-0.50]), and it included significantly lower percentages of smokers with periodontal disease (24.3% vs. 9.5%). In conclusion, chronic exclusive narghile smoking has fewer adverse effects on the periodontium than chronic exclusive cigarette smoking.
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Affiliation(s)
- Mehdi Khemiss
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia,Research Laboratory N8 LR12SP10: Maxilla Functional and Aesthetic Rehabilitation, Farhat Hached University Hospital of Sousse, Tunisia
| | - Dalila Ben Fekih
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia
| | - Mohamed Ben Khelifa
- Department of Dental Medicine, Fattouma Bourguiba University Hospital of Monastir, Tunisia,Research Laboratory N8 LR12SP10: Maxilla Functional and Aesthetic Rehabilitation, Farhat Hached University Hospital of Sousse, Tunisia
| | - Helmi Ben Saad
- Université de Sousse, Hôpital Farhat Hached, Service de Physiologie et Explorations Fonctionnelles, Tunisia,Heart Failure (LR12SP09) Research Laboratory, Farhat Hached Hospital, Sousse, Tunisia,Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Tunisia,Helmi Ben Saad, Laboratory of Physiology, Faculty of Medicine of Sousse, Rue Mohamed Karoui, Sousse, Tunisia.
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18
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Bunaes DF, Mustafa M, Mohamed HG, Lie SA, Leknes KN. The effect of smoking on inflammatory and bone remodeling markers in gingival crevicular fluid and subgingival microbiota following periodontal therapy. J Periodontal Res 2017; 52:713-724. [PMID: 28306142 DOI: 10.1111/jre.12438] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- D F Bunaes
- Faculty of Medicine and Dentistry, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - M Mustafa
- Faculty of Medicine and Dentistry, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - H G Mohamed
- Faculty of Medicine and Dentistry, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - S A Lie
- Faculty of Medicine and Dentistry, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - K N Leknes
- Faculty of Medicine and Dentistry, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
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19
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Rouabhia M, Park HJ, Semlali A, Zakrzewski A, Chmielewski W, Chakir J. E-Cigarette Vapor Induces an Apoptotic Response in Human Gingival Epithelial Cells Through the Caspase-3 Pathway. J Cell Physiol 2016; 232:1539-1547. [PMID: 27808425 DOI: 10.1002/jcp.25677] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/01/2016] [Indexed: 12/21/2022]
Abstract
Electronic cigarettes represent an increasingly significant proportion of today's consumable tobacco products. E-cigarettes contain several chemicals which may promote oral diseases. The aim of this study was to investigate the effect of e-cigarette vapor on human gingival epithelial cells. Results show that e-cigarette vapor altered the morphology of cells from small cuboidal form to large undefined shapes. Both single and multiple exposures to e-cigarette vapor led to a bulky morphology with large faint nuclei and an enlarged cytoplasm. E-cigarette vapor also increased L-lactate dehydrogenase (LDH) activity in the targeted cells. This activity was greater with repeated exposures. Furthermore, e-cigarette vapor increased apoptotic/necrotic epithelial cell percentages compared to that observed in the control. Epithelial cell apoptosis was confirmed by TUNEL assay showing that exposure to e-cigarette vapor increased apoptotic cell numbers, particularly after two and three exposures. This negative effect involved the caspase-3 pathway, the activity of which was greater with repeated exposure and which decreased following the use of caspase-3 inhibitor. The adverse effects of e-cigarette vapor on gingival epithelial cells may lead to dysregulated gingival cell function and result in oral disease. J. Cell. Physiol. 232: 1539-1547, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mahmoud Rouabhia
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Hyun Jin Park
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Abdelhabib Semlali
- Department of Biochemistry, Genome Research Chair, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew Zakrzewski
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Witold Chmielewski
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada
| | - Jamila Chakir
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada
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20
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Kubota M, Yanagita M, Mori K, Hasegawa S, Yamashita M, Yamada S, Kitamura M, Murakami S. The Effects of Cigarette Smoke Condensate and Nicotine on Periodontal Tissue in a Periodontitis Model Mouse. PLoS One 2016; 11:e0155594. [PMID: 27203240 PMCID: PMC4874667 DOI: 10.1371/journal.pone.0155594] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 05/02/2016] [Indexed: 11/18/2022] Open
Abstract
Cigarette smoking is a major lifestyle-related risk factor for periodontal diseases. However, the pathophysiological role of cigarette smoking in periodontal disease has yet to be fully elucidated. Here we report that the systemic administration of cigarette smoke condensate or nicotine, which is the major ingredient of cigarette smoke, augmented alveolar bone loss. Concomitantly, the number of osteoclasts in periodontal tissues increased and the expression of receptor activator of nuclear factor κB ligand was upregulated at the ligated side in mice with periodontitis. Nicotine also attenuated alveolar bone repair after ligature removal. These observations highlight the destruction of periodontal tissue by smoking and the unfavorable clinical course of periodontal disease in patients with a cigarette smoking habit. The present study demonstrates that periodontal disease models are useful for elucidating the pathogenesis of cigarette smoking-related periodontal diseases.
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Affiliation(s)
- Mikiko Kubota
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Manabu Yanagita
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
- * E-mail:
| | - Kenta Mori
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Shiori Hasegawa
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Motozo Yamashita
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Satoru Yamada
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Masahiro Kitamura
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
| | - Shinya Murakami
- Division of Oral Biology and Disease Control, Department of Periodontology, Osaka University, Suita, Osaka, Japan
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21
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Javed F, Al-Kheraif AA, Salazar-Lazo K, Yanez-Fontenla V, Aldosary KM, Alshehri M, Malmstrom H, Romanos GE. Periodontal Inflammatory Conditions Among Smokers and Never-Smokers With and Without Type 2 Diabetes Mellitus. J Periodontol 2015; 86:839-46. [PMID: 25879874 DOI: 10.1902/jop.2015.150120] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND There is a dearth of studies regarding the influence of cigarette smoking on periodontal inflammatory conditions among patients with type 2 diabetes mellitus (T2DM). The aim of the present study is to assess periodontal inflammatory conditions among smokers and never-smokers with and without T2DM. METHODS One hundred individuals (50 patients with T2DM [25 smokers and 25 never-smokers] and 50 controls [25 smokers and 25 never-smokers]) were included. Information regarding age, sex, duration and daily frequency of smoking, duration and treatment of diabetes, and oral hygiene was recorded using a questionnaire. Periodontal parameters (plaque index [PI], bleeding on probing [BOP], probing depth [PD], clinical attachment loss [AL], and marginal bone loss [MBL]) were measured. Hemoglobin A1c (HbA1c) levels were also recorded. RESULTS Mean age, monthly income status, and education levels were comparable among smokers and never-smokers with and without T2DM. Mean HbA1c levels were significantly higher among patients with T2DM (8.2% ± 0.1%) compared with controls (4.4% ± 0.3%) (P <0.05). Smokers in the control group were smoking significantly greater numbers of cigarettes (15.5 ± 2.5 cigarettes daily) compared with smokers with T2DM (6.2 ± 2.1 cigarettes daily) (P <0.05). Periodontal parameters were comparable among smokers and never-smokers with T2DM. Among controls, periodontal parameters (PI [P <0.05], AL [P <0.05], PD ≥4 mm [P <0.05], and MBL [P <0.05]) were significantly higher in smokers than never-smokers. Never-smokers with T2DM had worse periodontal status than smokers and never-smokers in the control group (P <0.05). CONCLUSIONS Periodontal inflammatory conditions are comparable among smokers and never-smokers with T2DM. Among controls, periodontal inflammation is worse among smokers than never-smokers.
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Affiliation(s)
- Fawad Javed
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Abdulaziz A Al-Kheraif
- Dental Biomaterials Research Chair, Dental Health Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Karem Salazar-Lazo
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Virginia Yanez-Fontenla
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Khalid M Aldosary
- Dental Department, King Khalid University Hospital, King Saud University
| | - Mohammed Alshehri
- Dental Department, King Khalid University Hospital, King Saud University
| | - Hans Malmstrom
- Division of General Dentistry, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook University, Stony Brook, NY
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Kolakovic M, Held U, Schmidlin PR, Sahrmann P. An estimate of pocket closure and avoided needs of surgery after scaling and root planing with systemic antibiotics: a systematic review. BMC Oral Health 2014; 14:159. [PMID: 25529408 PMCID: PMC4531502 DOI: 10.1186/1472-6831-14-159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 12/09/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Relevant benefits of adjunctive medication of antibiotica after conventional root surface debridement in terms of enhanced pocket depth (PD) reduction have been shown. However, means and standard deviations of enhanced reductions are difficult to translate into clinical relevant treatment outcomes such as pocket resolution or avoidance of additional surgical interventions. Accordingly, the aim of this systematic review was to calculate odds ratios for relevant cut-off values of PD after mechanical periodontal treatment with and without antibiotics, specifically the combination of amoxicilline and metronidazol, from published studies. As clinical relevant cut-off values "pocket closure" for PD ≤ 3mm and "avoidance of surgical intervention" for PD ≤ 5 mm were determined. METHODS The databases PubMed, Embase and Central were searched for randomized clinical studies assessing the beneficial effect of the combination of amoxicillin and metronidazole after non-surgical mechanical debridement. Titles, abstracts and finally full texts were scrutinized for possible inclusion by two independent investigators. Quality and heterogeneity of the studies were assessed and the study designs were examined. From published means and standard deviations for PD after therapy, odds ratios for the clinically relevant cut-off values were calculated using a specific statistical approach. RESULTS Meta-analyses were performed for the time points 3 and 6 month after mechanical therapy. Generally, a pronounced chance for pocket closure from 3 to 6 months of healing was shown. The administration of antibiotics resulted in a 3.55 and 4.43 fold higher probability of pocket closure after 3 and 6 months as compared to mechanical therapy alone. However, as the estimated risk for residual pockets > 5 mm was 0 for both groups, no odds ratio could be calculated for persistent needs for surgery. Generally, studies showed a moderate to high quality and large heterogeneity regarding treatment protocol, dose of antibiotic medication and maintenance. CONCLUSION With the performed statistical approach, a clear benefit in terms of an enhanced chance for pocket closure by co-administration of the combination of amoxicillin and metronidazole as an adjunct to non-surgical mechanical periodontal therapy has been shown. However, data calculation failed to show a benefit regarding the possible avoidance of surgical interventions.
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Affiliation(s)
- Mirela Kolakovic
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Ulrike Held
- Horten Center, University Hospital Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.
| | - Patrick R Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
| | - Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, 8032, Zurich, Switzerland.
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Visvanathan R, Mahendra J, N A, Pandisuba, Chalini. Effect of smoking on periodontal health. J Clin Diagn Res 2014; 8:ZC46-9. [PMID: 25177637 PMCID: PMC4149143 DOI: 10.7860/jcdr/2014/8359.4597] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 04/16/2014] [Indexed: 11/24/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to assess and compare the effect of smoking on mRNA expression of MMP -8 and TIMP-1 in patients with untreated chronic periodontitis and in periodontally healthy subjects and to examine the correlation of MMP-8 and TIMP-1 levels with clinical parameters. MATERIALS AND METHODS Out of 60 subjects, 40 were selected subjects for the study, and were divided into Group I (periodontitis subject) and Group II (healthy subjects). Each group was further subdivided into subgroups I-A (chronic periodontitis smokers CPS), and I-B (chronic periodontitis non-smokers CPN), subgroup II-A (healthy smokers HS) and II B (healthy non-smokers HS). Both the groups underwent periodontal examination and clinical parameters were recorded. Tissue samples from both groups were subjected to the isolation of RNA which was then followed by qRT-PCR and the expression of the mRNA levels of MMP-8 and TIMP-1 were analyzed. RESULTS The mRNA expression of MMP-8 and TIMP-1 was further compared with the periodontal status of all the four groups. The mRNA expression of MMP-8 was compared between the groups and showed that Group I-A (CPS) had higher expression of MMP-8 compared to group I-B (CPN). Group I-B (CPN) vs Group I-A (CPS) showed statistically significant difference in MMP-8/TIMP-1 with higher values for Group I-A (CPS) than Group I-B (CPN). A positive correlation was found between MMP-8 expression and probing depth and clinical attachment level (CAL) among Group I-B (CPN) and Group I-A (CPS) subjects. A significant correlation was also found between MMP-8 and TIMP-1 expression with probing depth and CAL among Group II B(HN) group subjects. TIMP-1 also showed a positive correlation with gingival index (GI) among group II A (HS) subjects. CONCLUSION It is concluded that smoking has an impact on the periodontal status and mRNA expression of MMP-8 and TIMP-1 in chronic periodontitis patients. The earlier evaluation of MMP-8 and TIMP-1, can be used as a biomarker in predicting periodontal disease susceptibility.
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Affiliation(s)
- Rahul Visvanathan
- P.G Student, Department of Periodontology, Meenakshi Ammal Dental College Maduravoyal, Chennai, India
| | - Jaideep Mahendra
- Professor, Department of Periodontology, Meenakshi Ammal Dental College Maduravoyal, Chennai, India
| | - Ambalavanan N
- Professor & Hod , Department of Periodontology, Meenakshi Ammal Dental College Maduravoyal, Chennai, India
| | - Pandisuba
- Lecturer and Biotechnologist, Central Research Laboratory, Meenakshi Ammal Dental College Maduravoyal, Chennai, India
| | - Chalini
- Research Assistant, Central Research Laboratory, Meenakshi Ammal Dental College Maduravoyal, Chennai, India
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Sayardoust S, Gröndahl K, Johansson E, Thomsen P, Slotte C. Implant Survival and Marginal Bone Loss at Turned and Oxidized Implants in Periodontitis-Susceptible Smokers and Never-Smokers: A Retrospective, Clinical, Radiographic Case-Control Study. J Periodontol 2013; 84:1775-82. [DOI: 10.1902/jop.2013.120608] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Orekhova LY, Barmasheva AA. Doppler flowmetry as a tool of predictive, preventive and personalised dentistry. EPMA J 2013; 4:21. [PMID: 23981527 PMCID: PMC3846663 DOI: 10.1186/1878-5085-4-21] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/20/2013] [Indexed: 12/19/2022]
Abstract
Periodontal lesions are considered a major problem in the global burden of oral diseases due to their high frequency and negative impact on quality of life. Periodontal inflammation is accomplished by a breakdown of microcirculatory function. Early detection of gingival microvessel dysfunction helps diagnose and prevent the progression of initial periodontal pathology. Doppler flowmetry is a useful tool in the diagnosis, monitoring, prognosis and management of periodontal patients which allows access not only of gingival blood flow but also of pulpal microcirculation. Doppler flowmeters might help to realise the ultimate target of predictive, preventive and personalised periodontology tailored with respect to the particular patient. This article highlights the main working principles of laser Doppler flowmeters and the ultrasonic Doppler flowmeters. The advances in blood flow measurement by ultrasonic flowmetry are discussed.
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Affiliation(s)
- Liudmila Yu Orekhova
- Therapeutic Dentistry Department, I,P, Pavlov Saint-Petersburg State Medical University, 6/8 Lev Tolstoy Street, Saint Petersburg 197022, Russia.
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Faveri M, Rebello A, de Oliveira Dias R, Borges-Junior I, Duarte PM, Figueiredo LC, Feres M. Clinical and microbiologic effects of adjunctive metronidazole plus amoxicillin in the treatment of generalized chronic periodontitis: smokers versus non-smokers. J Periodontol 2013; 85:581-91. [PMID: 23826648 DOI: 10.1902/jop.2013.130278] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The aim of the present study is to evaluate the clinical and microbiologic effects of the adjunctive use of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of smokers and non-smokers with generalized chronic periodontitis (CP). METHODS Thirty-two smokers and 32 non-smokers were selected and received scaling and root planing (SRP) combined with MTZ (400 mg three times daily) and AMX (500 mg three times daily) for 14 days. Clinical and microbiologic examinations were performed at baseline and 3 months after SRP. Nine subgingival plaque samples per patient were analyzed using checkerboard DNA-DNA hybridization. RESULTS Both groups presented a significant improvement in all clinical parameters at 3 months after therapy (P <0.05). Non-smokers showed lower mean number of sites with probing depth (PD) ≥5 mm after therapy. Fewer non-smokers exhibited at least nine of these sites at 3 months after treatment. Non-smokers also presented the greatest reductions in mean PD and gain in clinical attachment between baseline and 3 months after therapy at initially deep (PD ≥7 mm) sites (P <0.01). The most beneficial changes in the microbial profile were also observed in the non-smoker group, which showed the lowest proportions of the orange complex at 3 months, as well as a significant increase in the proportions of Actinomyces species after treatment. CONCLUSION Smokers with CP benefit less than non-smokers from treatment by the combination of SRP, MTZ, and AMX.
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Affiliation(s)
- Marcelo Faveri
- Department of Periodontology, Dental Research Division, Guarulhos University, Guarulhos, São Paulo, Brazil
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Periodontal disease in habitual cigarette smokers and nonsmokers with and without prediabetes. Am J Med Sci 2013; 345:94-8. [PMID: 22688499 DOI: 10.1097/maj.0b013e31824d5337] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION : Prediabetes and habitual cigarette smoking are significant risk factors contributing to periodontal disease. The aim was to assess the clinical and radiological markers of periodontal disease in habitual cigarette smokers and nonsmokers with and without prediabetes. METHODS Sixty-eight individuals with prediabetes (test group; 34 smokers and 34 nonsmokers) and 68 medically healthy individuals (control group; 34 smokers and 34 nonsmokers) were included. Sociodemographic information, duration of smoking habit and number of cigarettes smoked daily were recorded through a questionnaire. Fasting blood glucose levels and periodontal inflammatory conditions (plaque index [PI], bleeding on probing [BOP] and probing pocket depth [PPD] of 4 to <6 mm and ≥6 mm) were recorded. In both groups, marginal bone loss (MBL) was measured on digital panoramic radiographs. RESULTS Cigarette smokers and nonsmokers in the test group had significantly higher fasting blood glucose level when compared with cigarette smokers in the control group (P < 0.001). In the test group, there was no significant difference in PI, BOP, PPD (4 to <6 mm and ≥6 mm) and MBL among cigarette smokers and nonsmokers. Cigarette smokers in the control group had significantly higher PI (P < 0.001), PPD (4 to <6 mm; P < 0.001), PPD ≥6 mm (P < 0.01) and MBL (P < 0.05) than nonsmokers. BOP was significantly reduced in smokers when compared with nonsmokers in the control group (P < 0.001). CONCLUSIONS Cigarette smokers without prediabetes exhibit significantly severe periodontal disease than nonsmokers. In subjects with prediabetes, the severity of periodontal disease seems to be over shadowed by the hyperglycemic state, obscuring the effect of habitual smoking.
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Anil S, Preethanath RS, Alasqah M, Mokeem SA, Anand PS. Increased levels of serum and gingival crevicular fluid monocyte chemoattractant protein-1 in smokers with periodontitis. J Periodontol 2013; 84:e23-8. [PMID: 23368946 DOI: 10.1902/jop.2013.120666] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Smoking alters the host response, including vascular function, neutrophil/monocyte activities, adhesion molecule expression, antibody production, and cytokine and inflammatory mediator release. Monocyte chemoattractant protein-1 (MCP-1) is involved in the activation and recruitment of inflammatory and immune cells to infected sites, thereby mediating a variety of pathophysiologic conditions. Estimation of serum and gingival crevicular fluid (GCF) MCP levels could be a reliable indicator of periodontal disease activity. Hence, the objective of this study is to analyze the serum and GCF MCP-1 levels of smokers and never-smokers with periodontitis and compare them with those in periodontally healthy individuals. METHODS A total of 90 participants (30 periodontally healthy individuals, 30 non-smoking individuals with periodontitis, and 30 smokers with periodontitis) formed the study group. Serum and GCF samples were collected, and MCP-1 levels were estimated using enzyme-linked immunosorbent assay. RESULTS Mean MCP-1 levels in serum and GCF were found to be highest in smokers with periodontitis, followed by the periodontitis group, and then by the healthy controls. The values were statistically significant (P <0.001). CONCLUSIONS It can be concluded that the high levels of both serum and GCF MCP-1 found in smokers could explain the severity of periodontitis in smokers. More longitudinal, prospective studies will help to verify the observations of the present study. Further research in this direction could reveal reliable markers to forecast the progression of periodontitis in high-risk groups.
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Affiliation(s)
- Sukumaran Anil
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.
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Romanos GE, Javed F, Romanos EB, Williams RC. Oro-facial manifestations in patients with eating disorders. Appetite 2012; 59:499-504. [PMID: 22750232 DOI: 10.1016/j.appet.2012.06.016] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/17/2012] [Accepted: 06/22/2012] [Indexed: 12/29/2022]
Abstract
Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician.
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Affiliation(s)
- Georgios E Romanos
- School of Dental Medicine, Stony Brook University, 160 Rockland Hall, Stony Brook, NY 11794-8700, USA.
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Laky M, Assinger A, Esfandeyari A, Bertl K, Haririan H, Volf I. Decreased phosphorylation of platelet vasodilator-stimulated phosphoprotein in periodontitis – a role of periodontal pathogens. Thromb Res 2011; 128:155-60. [DOI: 10.1016/j.thromres.2011.02.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 02/07/2011] [Accepted: 02/21/2011] [Indexed: 01/22/2023]
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Malhotra R, Kapoor A, Grover V, Kaushal S. Nicotine and periodontal tissues. J Indian Soc Periodontol 2010; 14:72-9. [PMID: 20922084 PMCID: PMC2933534 DOI: 10.4103/0972-124x.65442] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/24/2009] [Accepted: 12/04/2009] [Indexed: 11/17/2022] Open
Abstract
Tobacco use has been recognized to be a significant risk factor for the development and progression of periodontal disease. Its use is associated with increased pocket depths, loss of periodontal attachment, alveolar bone and a higher rate of tooth loss. Nicotine, a major component and most pharmacologically active agent in tobacco is likely to be a significant contributing factor for the exacerbation of periodontal diseases. Available literature suggests that nicotine affects gingival blood flow, cytokine production, neutrophil and other immune cell function; connective tissue turnover, which can be the possible mechanisms responsible for overall effects of tobacco on periodontal tissues. Inclusion of tobacco cessation as a part of periodontal therapy encourages dental professionals to become more active in tobacco cessation counseling. This will have far reaching positive effects on our patients' oral and general health.
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Affiliation(s)
- Ranjan Malhotra
- Department of Periodontology and Oral Implantology, National Dental College & Hospital, Derabassi, Punjab, India
| | - Anoop Kapoor
- Department of Periodontology and Oral Implantology, National Dental College & Hospital, Derabassi, Punjab, India
| | - Vishakha Grover
- Department of Periodontology and Oral Implantology, National Dental College & Hospital, Derabassi, Punjab, India
| | - Sumit Kaushal
- Department of Periodontology and Oral Implantology, National Dental College & Hospital, Derabassi, Punjab, India
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Affiliation(s)
- K-Y Zee
- Westmead Centre for Oral Health and Faculty of Dentistry, The University of Sydney, New South Wales, Sydney, Australia.
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Khaira N, Palmer RM, Wilson RF, Scott DA, Wade WG. Periodontal Disease: Production of volatile sulphur compounds in diseased periodontal pockets is significantly increased in smokers. Oral Dis 2008; 6:371-5. [PMID: 11355269 DOI: 10.1111/j.1601-0825.2000.tb00129.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
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.
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Affiliation(s)
- N Khaira
- Department of Periodontology and Preventive Dentistry, Guy's, King's and St Thomas' Dental Institute, King's College London, UK
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Koshi R, Sugano N, Orii H, Fukuda T, Ito K. Microarray analysis of nicotine-induced changes in gene expression in a macrophage-like human cell line. J Periodontal Res 2008; 42:518-26. [PMID: 17956464 DOI: 10.1111/j.1600-0765.2007.00976.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVE Cigarette smoking has been suggested as a risk factor for periodontitis. Thousands of components are present in cigarette smoke, including nicotine, which may play an important role in the observed effects of smoking on cell metabolism. However, the mechanisms underlying these effects are unclear. Using DNA microarrays, we monitored differentially expressed genes, responsive to nicotine, in a macrophage-like human cell line. MATERIAL AND METHODS Human U937 cells were treated for 1 h, with or without 1.0 microg/ml of nicotine. For differentiation, cultures were incubated with 10 nm phorbol myristate acetate for 48 h. Analysis of gene expression was performed using a DNA microarray of 8500 genes. RESULTS The expression of 4914 genes was detected. Screening was carried out on those genes whose expression in three separate experiments showed an average change of twofold or greater, and 118 up-regulated genes and 97 down-regulated genes were identified. Among these were genes related to inflammation and other immune responses, such as phospholipase A2 and interferon. Consistent with the array findings, we found similar changes in mRNA expression after analysis using the real-time polymerase chain reaction. CONCLUSION The results suggest that nicotine causes excess inflammation and disturbs host defense mechanisms against pathogens.
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Affiliation(s)
- R Koshi
- Nihon University Graduate School of Dentistry, Tokyo, Japan
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Zhou J, Olson BL, Windsor LJ. Nicotine increases the collagen-degrading ability of human gingival fibroblasts. J Periodontal Res 2007; 42:228-35. [PMID: 17451542 DOI: 10.1111/j.1600-0765.2006.00937.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The objective of this study was to determine the effects that nicotine and the combination of nicotine and Porphyromonas gingivalis supernatant have on human gingival fibroblast-mediated collagen degradation. MATERIAL AND METHODS Human gingival fibroblasts were cultured with 25-500 microg/ml of nicotine in collagen-coated six-well plates. On days 1-5, the conditioned media was collected for zymography and western blot analyses of matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). The cells were then removed and the collagen cleavage visualized by Coomassie blue staining. To examine the combined effect, 250 microg/ml of nicotine and 10% v/v culture supernatant of P. gingivalis ATCC 33277 were added to the human gingival fibroblasts. The mRNA levels of multiple MMPs and TIMPs were monitored. RESULTS Nicotine increased the human gingival fibroblast-mediated collagen cleavage. The MMP-14 and MMP-2 produced by the nicotine-treated human gingival fibroblasts more readily underwent zymogen activation. Nicotine treatment resulted in TIMP-2 redistribution to the cell surface. The mRNAs of multiple MMPs and TIMPs were unaltered by nicotine. An additive collagen cleavage effect was observed when the human gingival fibroblasts were treated with both nicotine and P. gingivalis. CONCLUSION Nicotine increased human gingival fibroblast-mediated collagen degradation, in part through the activation of membrane-associated MMPs. Nicotine and P. gingivalis had an additive effect on human gingival fibroblast-mediated collagen degradation.
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Affiliation(s)
- J Zhou
- Department of Oral Biology, Indiana University School of Dentistry, Indianapolis, IN, USA.
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Needleman I, Suvan J, Gilthorpe MS, Tucker R, St George G, Giannobile W, Tonetti M, Jarvis M. A randomized-controlled trial of low-dose doxycycline for periodontitis in smokers. J Clin Periodontol 2007; 34:325-33. [PMID: 17324155 PMCID: PMC2637798 DOI: 10.1111/j.1600-051x.2007.01058.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/AIM Tobacco use reduces the effect of non-surgical periodontal therapy. Host-modulation with low-dose doxycycline (LDD) might favour repair and promote an improved treatment response. The aim of this study was to investigate the effect of LDD in smokers on non-surgical periodontal therapy. MATERIAL AND METHODS This was a parallel arm, randomized, identical placebo-controlled trial with masking of examiner, care-giver, participant and statistician and 6 months of follow-up. Patients received non-surgical therapy and 3 months of test or control drug. Statistical analysis used both conventional methods and multilevel modelling. RESULTS Eighteen control and 16 test patients completed the study. The velocity of change was statistically greater for the test group for clinical attachment level -0.19 mm/month (95% CI=-0.34, 0.04; p=0.012) and probing depth 0.30 mm/month (95% CI=-0.42, -0.17; p<0.001). However, no differences were observed for absolute change in clinical or biochemical markers at 6 months. CONCLUSIONS This study does not provide evidence of a benefit of using LDD as an adjunct to non-surgical periodontal therapy in smokers.
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Affiliation(s)
- Ian Needleman
- Department of Periodontology and International Centre for Evidence-Based Oral Health, UCL Eastman Dental Institute, London, UK.
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Abstract
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.
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Affiliation(s)
- H F Duncan
- Department of Conservative Dentistry, Dental Institute, King's College London, Guy's Hospital, London, UK.
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Pimentel SP, Sallum AW, Saldanha JB, Casati MZ, Nociti FH, Sallum EA. Enamel matrix derivative versus guided tissue regeneration in the presence of nicotine: a histomorphometric study in dogs. J Clin Periodontol 2006; 33:900-7. [PMID: 16970622 DOI: 10.1111/j.1600-051x.2006.00989.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The goal of this histometric study was to compare the healing process of dehiscence-type defects treated by enamel matrix derivative (EMD) or guided tissue regeneration (GTR) under the effect of nicotine in the dog model. MATERIALS AND METHODS Eight mongrel dogs were used. Buccal osseous dehiscences were surgically created on the mesial roots of the mandibular third and fourth pre-molars. The defects were exposed to plaque accumulation for 3 months. After this period, the defects were randomly assigned to one of the treatments: open flap debridement (OFD), EMD or GTR with a resorbable membrane. During 4 months, the dogs received subcutaneous administration of nicotine (2 mg/kg twice a day with a 12 h interval between the applications). After this period, the animals were killed and the blocks were processed. The histometric parameters evaluated included gingival recession, epithelial length, connective tissue adaptation, new cementum and new bone. RESULTS A superior length of new cementum was observed in the sites treated by EMD in comparison with OFD (p< or =0.05). No statistically significant differences were observed between GTR and the other groups. CONCLUSIONS In the presence of nicotine, EMD may promote more new cementum formation than OFD while GTR failed to provide a significant difference.
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Affiliation(s)
- Suzana Peres Pimentel
- Department of Prosthodontics and Periodontics, Division of Periodontics, School of Dentistry at Piracicaba, State University of Campinas (UNICAMP), Av. Limeira 901, Areião, São Paulo, Brazil
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Baharin B, Palmer RM, Coward P, Wilson RF. Investigation of periodontal destruction patterns in smokers and non-smokers. J Clin Periodontol 2006; 33:485-90. [PMID: 16820036 DOI: 10.1111/j.1600-051x.2006.00934.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Badiah Baharin
- Department of Periodontology, King's College London, Dental Institute at Guy's, King's and St Thomas' Hospital, London, UK
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Scott DA, Singer DL. Suppression of overt gingival inflammation in tobacco smokers - clinical and mechanistic considerations. Int J Dent Hyg 2006; 2:104-10. [PMID: 16451473 DOI: 10.1111/j.1601-5037.2004.00079.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gingivitis is a reversible inflammatory disease of the periodontal tissues. Periodontitis, in addition, involves destruction of the supporting structures of teeth. Diagnoses of gingivitis and periodontitis are predominantly dependent on clinical measurements of key inflammatory indices. Smokers are more susceptible to developing periodontal diseases, yet smoking masks overt signs of inflammation, presenting dental professionals with a clinical conundrum. We review the evidence that tobacco smoke may (i) cause acute periodontal vasoconstriction, (ii) inhibit periodontal angiogenesis in response to inflammatory stimuli, and/or (iii) suppress the production of pro-inflammatory mediators. It is clear that the mechanisms by which cigarette smoking dampens the periodontal inflammatory response are not yet fully understood. Further research into inflammatory suppression is warranted and should point to improved methods of diagnosis, not only in smokers, but also in non-smokers.
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Affiliation(s)
- D A Scott
- Department of Oral Biology, University of Manitoba, Manitoba Institute of Child Health, Canada.
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Razali M, Palmer RM, Coward P, Wilson RF. A retrospective study of periodontal disease severity in smokers and non-smokers. Br Dent J 2005; 198:495-8; discussion 485. [PMID: 15849588 DOI: 10.1038/sj.bdj.4812253] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 04/07/2004] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis. METHODS A random sample of patients with at least 20 teeth, stratified for smoking and age (5-year blocks, 35 to 55 years), was selected from an original referral population of 1,221 subjects with chronic adult periodontitis. Adequate records for 59 never-smokers and 44 subjects who smoked at least 20 cigarettes per day were retrieved. The percentage of alveolar bone support was measured from dental panoramic radiographs with a Schei ruler at x3 magnification with the examiner unaware of the smoking status. Probing depths at six sites per tooth were obtained from the initial consultation. RESULTS There was no significant difference in age between groups. Smokers had fewer teeth (p<0.001), fewer shallow pockets (p<0.001) and more deep probing depths (p<0.001). The differences were greater in subjects 45 years of age and over. In this age group, smokers had approximately 13% more bone loss, 15% more pockets in the 4-6 mm category and 7% more pockets in the >/= 7 mm category than the never-smokers. CONCLUSIONS This study confirmed that smokers had evidence of more severe periodontal disease than never-smokers. The differences increased with age confirming an exposure-related response.
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Affiliation(s)
- M Razali
- Dental Faculty, Universiti Kebangsaan Malaysia, Kuala Lumpur
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42
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Balatsouka D, Gotfredsen K, Lindh CH, Berglundh T. The impact of nicotine on bone healing and osseointegration. An experimental study in rabbits. Clin Oral Implants Res 2005; 16:268-76. [PMID: 15877746 DOI: 10.1111/j.1600-0501.2005.01122.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the short-term effect of nicotine on bone healing and osseointegration. MATERIAL AND METHODS Sixteen female rabbits were divided into two groups. The test group was exposed to nicotine tartrate for 8 weeks and the control group was exposed to placebo. Nicotine or placebo was administered via a miniosmotic pump and plasma cotinine levels were measured weekly. The pump delivered 15 mg of nicotine/day for the animals in the test group. All rabbits had three tibial bone preparations. In the proximal and distal bone bed, implants were placed after 4 weeks (right tibia) and after 6 weeks (left tibia). Thus, 2- and 4-week healing groups were created. Removal torque test (RMT) was performed at the distal implants. Ground sections were made from the proximal and the central bone beds. The fraction of mineralized bone in contact to the implant (BIC) and the bone density within the implant threads (BD-i) were determined for the bone-implant specimens. For the central bone beds without implants the bone density (BD-c) in the bone defects was determined. RESULTS No significant difference in RMT values was found between the test and the control group. Histomorphometric measurements of the BIC and the peri-implant BD-i showed no significant differences between the test and the control group after 2 or 4 weeks. Significant differences were, however, found between the 2- and 4-week samples. In the central bone beds, there was no significant difference in BD-c between the test and the control group. CONCLUSION Nicotine exposure in a short period of time did not have a significant impact on bone healing or implant osseointegration in rabbits.
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Affiliation(s)
- Dimitra Balatsouka
- Department of Prosthetic Dentistry, School of Dentistry, Health Science Faculty, University of Copenhagen, Nørre Allé 20, 1200 N Copenhagen, Denmark.
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Arredondo J, Chernyavsky AI, Marubio LM, Beaudet AL, Jolkovsky DL, Pinkerton KE, Grando SA. Receptor-mediated tobacco toxicity: regulation of gene expression through alpha3beta2 nicotinic receptor in oral epithelial cells. THE AMERICAN JOURNAL OF PATHOLOGY 2005; 166:597-613. [PMID: 15681842 PMCID: PMC1602318 DOI: 10.1016/s0002-9440(10)62281-x] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/02/2004] [Indexed: 11/23/2022]
Abstract
Tobacco is a known cause of oral disease but the mechanism remains elusive. Nicotine (Nic) is a likely culprit of pathobiological effects because it displaces the local cytotransmitter acetylcholine from the nicotinic receptors (nAChRs) expressed by oral keratinocytes (KCs). To gain a mechanistic insight into tobacco-induced morbidity in the oral cavity, we studied effects of exposures to environmental tobacco smoke (ETS) versus equivalent concentration of pure Nic on human and murine KCs. Both ETS and Nic up-regulated expression of cell cycle and apoptosis regulators, differentiation marker filaggrin, and signal transduction factors at both the mRNA and protein levels. These changes could be abolished in cultured human oral KCs transfected with anti-alpha3 small interfering RNA or treated with the alpha3beta2-preferring antagonist alpha-conotoxin MII. Functional inactivation of alpha3-mediated signaling in alpha3-/- mutant KCs prevented most of the ETS/Nic-dependent changes in gene expression. To determine relevance of the in vitro findings to the in vivo situation, we studied gene expression in oral mucosa of neonatal alpha3+/+ and alpha3-/- littermates delivered by heterozygous mice soon after their exposures to ETS or equivalent concentration of pure Nic in drinking water. In addition to reverse transcriptase-polymerase chain reaction and Western blot, the ETS/Nic-dependent alterations in gene expression were also detected by semiquantitative immunofluorescence assay directly in KCs comprising murine oral mucosa. Only wild-type mice consistently developed significant (P < 0.05) changes in the gene expression. These results identified alpha3beta2 nAChR as a major receptor mediating effects of tobacco products on KC gene expression. Real-time polymerase chain reaction demonstrated that in all three model systems the common genes targeted by alpha3beta2-mediated ETS/Nic toxicity were p21, Bcl-2, NF-kappaB, and STAT-1. The expression of the nAChR subunits alpha5 and beta2 and the muscarinic receptor subtypes M(2) and M(3) was also altered. This novel mechanism offers innovative solutions to ameliorate the tobacco-related cell damage and intercede in disease pathways, and may shed light on general mechanisms regulating and driving tobacco-related morbidity in human cells.
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Affiliation(s)
- Juan Arredondo
- Department of Dermatology, University of California Davis Medical Center, 4860 Y St., Suite #3400, Sacramento, CA 95817, USA
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Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors--tobacco smoking. J Clin Periodontol 2005; 32 Suppl 6:180-95. [PMID: 16128837 DOI: 10.1111/j.1600-051x.2005.00786.x] [Citation(s) in RCA: 310] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To review the potential biological mechanisms underlying the effects of tobacco smoking on periodontitis. MAIN FINDINGS Smoking has major effects on the host response, but there are also a number of studies that show some microbiological differences between smokers and non-smokers. Smoking has a long-term chronic effect on many important aspects of the inflammatory and immune responses. Histological studies have shown alterations in the vasculature of the periodontal tissues in smokers. Smoking induces a significant systemic neutrophilia, but neutrophil transmigration across the periodontal microvasculature is impeded. The suppression of neutrophil cell spreading, chemokinesis, chemotaxis and phagocytosis have been described. Protease release from neutrophils may be an important mechanism in tissue destruction. Tobacco smoke has been found to affect both cell-mediated immunity and humoral immunity. Research on gingival crevicular fluid has demonstrated that there are lower levels of cytokines, enzymes and possibly polymorphonuclear cells in smokers. In vitro studies have shown detrimental effects of nicotine and some other tobacco compounds on fibroblast function, including fibroblast proliferation, adhesion to root surfaces and cytotoxicity. CONCLUSION Tobacco smoking has widespread systemic effects, many of which may provide mechanisms for the increased susceptibility to periodontitis and the poorer response to treatment.
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Affiliation(s)
- Richard M Palmer
- King's College London, Guy's Hospital Campus, London Bridge, London SE1 9RT, UK.
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Otis LL, Piao D, Gibson CW, Zhu Q. Quantifying labial blood flow using optical Doppler tomography. ACTA ACUST UNITED AC 2004; 98:189-94. [PMID: 15316546 DOI: 10.1016/j.tripleo.2004.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Changes in the oral microvasculature occur in a variety of diseases. Optical Doppler tomography (ODT) combines laser Doppler flowmetry with optical coherence tomography (OCT) to produce high-resolution tomographic images of biological tissues that also detect the velocity and direction of blood flow. The objective of this study was to determine the feasibility of ODT to image labial blood flow. A prototype ODT imaging system was constructed that characterized and measured labial blood flow in healthy subjects. MATERIALS AND METHODS A prototype ODT instrument was constructed using a diode light source with a central wavelength of 1300 nanometers, a 40-nanometer spectral width and 2.4 microwatts output power. To verify the accuracy of the system, the flow rates of a phantom material (Intralipid) pumped through a capillary tube at various speeds was measured. To evaluate the clinical feasibility of the ODT prototye, the mucosal aspect of the upper and lower lips at the midline was imaged in 9 healthy volunteers. The sample arm of the instrument consisted of a fiberoptic probe with a 2-mm in diameter polished glass lens attached to the end. The probe was placed approximately 3 mm from the mucosal surface of the lip and oriented perpendicular to the surface. A motorized translation stage moved the fiber in a superior to inferior direction while the subject's head was stabilized by placing the chin into a chin rest. Imaging time for a 12-mm x 2.5-mm scan was approximately 64 seconds. RESULTS The phantom experiments revealed that accuracy of this novel ODT prototype to measure flow was within 5%. In vivo labial blood flow velocity ranged from 11.8 to 43.1 mm/second in the upper lip and 8.2 to 53.2 mm/second in the lower lip. There were no statistically significant differences between flow rates in the upper and lower lips. OCT images and Doppler velocity signals were successfully integrated producing in vivo images of labial blood in all of the subjects (15 images). The resulting cross-sectional images revealed microscopic details of labial structures and, to the best of our knowledge, are the first ODT images of the labial microvasculature. CONCLUSIONS The results of this in vivo study prove the feasibility of ODT to quantify labial blood flow and produce high spatial resolution images specifically localizing vessels anatomically. ODT provides both flow speed and flow direction information. ODT is noninvasive and offers the advantages of high volumetric flow sensitivity.
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Affiliation(s)
- Linda L Otis
- Department of Oral Medicine, The University of Pennsylvania School of Dental Medicine, Philadelphia 19104-6030, USA.
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Paulander J, Wennström JL, Axelsson P, Lindhe J. Some risk factors for periodontal bone loss in 50-year-old individuals. A 10-year cohort study. J Clin Periodontol 2004; 31:489-96. [PMID: 15191581 DOI: 10.1111/j.1600-051x.2004.00514.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Jörgen Paulander
- Department of Periodontology, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, Sweden.
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Abstract
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.
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Affiliation(s)
- Brian H Mullally
- Division of Restorative Dentistry (Periodontics), School of Clinical Dentistry, Queen's University of Belfast, Northern Ireland.
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48
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Abstract
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.
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Affiliation(s)
- Georgia K Johnson
- Department of Periodontics and Dows Institute for Dental Research, University of Iowa College of Dentistry, Iowa City, IA 52242, USA.
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Sönmez S, Canda T, Ozkara E, Ak D. Quantitative evaluation of the vasculature and fibronectin localization in gingival connective tissue of smokers and non-smokers. J Periodontol 2003; 74:822-30. [PMID: 12886992 DOI: 10.1902/jop.2003.74.6.822] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND It has been shown that tobacco is a significant risk factor for periodontal disease. The reason for decreased gingival bleeding in smokers is not known. The aim of the present study was to demonstrate the localization of fibronectin in the extracellular matrix of the inflamed gingiva of smokers and non-smokers and to evaluate the chronic effect of smoking on the gingival microvessel number (NVES) and vascular surface density (VSD). METHODS Seventy-four (74) adult patients with periodontitis were included in this investigation. Of these patients, 38 were smokers and 36 were non-smokers. Probing depths (PD), papillary bleeding index (PBI) of both groups, and the smoking habits of the smokers were recorded. Biopsy specimens obtained during periodontal surgery were prepared to evaluate fibronectin distribution and to quantitate the vasculature. RESULTS The mean VSD values of smokers and non-smokers were 6.721 +/- 1.845 and 5.721 +/- 3.118 (mean +/- SD), and the mean NVES of smokers and non-smokers was 31.582 +/- 11.810 and 30.145 +/- 15.442, respectively. The difference between the mean PD and PBI values of the 2 groups was not statistically significant. The location of the biopsy specimen, whether in the anterior or posterior area of the mouth, did not lead to any statistically significant differences between the groups. In addition, the number of years smoked and the tobacco brand used did not result in statistically significant differences. The most intense staining of fibronectin was observed beneath the epithelium around the blood vessels of the uppermost region of the connective tissue, showing a fibrillar and diffuse distribution; however, there was no significant difference between smokers and non-smokers. CONCLUSION The results of the present study indicate that smoking does not affect the vascular surface density, number of vessels per mm2 stroma, or fibronectin distribution in subepithelial gingival connective tissue.
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Affiliation(s)
- Sule Sönmez
- Ege University, School of Dentistry, Department of Periodontology, Bornova, Izmir, Turkey.
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50
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Nair P, Sutherland G, Palmer RM, Wilson RF, Scott DA. Gingival bleeding on probing increases after quitting smoking. J Clin Periodontol 2003; 30:435-7. [PMID: 12716336 DOI: 10.1034/j.1600-051x.2003.20039.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gingival inflammation associated with plaque accumulation is delayed or impaired in smokers. Anecdotal evidence suggests that smokers who quit experience an increase in gingival bleeding. METHOD A group of 27 subjects on a Quit-smoking programme were examined for changes in gingival health over a 4-6-week period. RESULTS The bleeding on probing with a constant force probe increased from 16% of sites to 32% of sites, despite improvements in the subjects oral hygiene. CONCLUSION This provides further evidence that tobacco smoking affects the inflammatory response and that these changes are reversible on quitting.
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Affiliation(s)
- P Nair
- Department of Periodontology and Preventive Dentistry, Guy's, King's and St Thomas' School of Dentistry, Kings College, Guy's Campus, London SE1 9RT, UK
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