Does smoking increase risk for caries? a cross-sectional study in an Italian military academy

Oral processing behavior and dental caries; an insight into a new relationship

INTRODUCTION

Previous evidence suggests an individual variation in the preferred oral processing behavior. Individuals can be classified as firm processing(FPL) or soft processing likers(SPL). FPL(crunchers and chewers) prefer using their teeth while SPL(smooshers and suckers) prefer using the tongue and the palate when processing different food items. Variation in the preferred oral processing behavior has been associated with differences in food texture preference and eating time. Time is one of the factors directly related to the development of dental caries(tooth decay). Oral retention and eating times are associated with greater caries experience. This study aims to explore if a relationship exists between the preferred oral processing behavior and the individual's caries experience.

MATERIALS AND METHODS

This was a cross-sectional, dental center-based study conducted at Jordan University of Science and Technology. Five hundred participants consented to fill out the preferred oral processing behavior(POPB) questionnaire. Anthropometric measurements (including weight, height, and waist circumference) were recorded. A single trained and calibrated dentist registered each participant's caries experience and plaque levels using the DMFS index and plaque index of Silness and Loe.

RESULTS

A total of 351(70.2%) and 149(29.8%) participants were typed as FPL and SPL, respectively. SPL demonstrated higher levels of dental caries experience compared to FPL. The mean DMFS score for SPL was 28.8(±25.43) while for FPL was 18.71(± 18.34). This difference remained significant after adjustment for confounders(P<0.001). SPL exhibited a significantly higher mean score for the "M" component(P <0.001) while no significant difference in the mean score of the "D"(P = 0.076) and "F"(P = 0.272) components was observed when compared to FPL.

CONCLUSION

The current findings provide new insight into a possible relationship between the preferred oral processing behavior and an individual's caries experience. A relationship in which the preferred oral processing behavior can potentially affect and/or be affected by the dental caries experience.

Effects of tobacco product use on oral health and the role of oral healthcare providers in cessation: A narrative review

Tobacco use has detrimental effects on health, including oral health. The emergence and increasing popularity of newer tobacco and nicotine products make tobacco use one of the major public health problems in the world. Tobacco use increases the risk of oral diseases such as oral cancer, oral mucosal lesions, periodontal disease, and dental caries, among many other oral diseases and conditions. The dental office is an excellent venue for providing cessation intervention. However, there is a lack of knowledge and training in tobacco use prevention among dental professionals. More efforts are needed for smoking cessation interventions in the dental office. Smoking cessation interventions provided by oral healthcare providers include brief educational, behavioral, and pharmacological interventions. This review provides an overview of the ill effects of tobacco use on oral health and the role of oral healthcare providers in managing and preventing tobacco dependence.

Inequalities in caries among pre-school Italian children with different background

Background

The study was aimed to describe caries prevalence and severity and health inequalities among Italian preschool children with European and non-European background and to explore the potential presence of a social gradient.

Methods

The ICDAS (International Caries Detection and Assessment System) was recorded at school on 6,825 children (52.8% females). Caries frequency and severity was expressed as a proportion, recording the most severe ICDAS score observed. Socioeconomic status (SES) was estimated by mean a standardized self-submitted questionnaire filled-in by parents. The Slope Index of Inequality (SII) based on regression of the mid-point value of caries experiences score for each SES group was calculated and a social gradient was generated, children were stratified into four social gradient levels based on the number of worst options. Multivariate regression models (Zero-Inflated Negative Binomial logistic and logistic regression) were used to elucidate the associations between all explanatory variables and caries prevalence.

Results

Overall, 54.4% (95%CI 46.7–58.3%) of the children were caries-free; caries prevalence was statistically significant higher in children with non-European background compared to European children (72.6% vs 41.6% p < 0.01) and to the area of living (p = 0.03). A statistically significant trend was observed for ICDAS 5/6 score and the worst social/behavioral level (Z = 5.24, p < 0.01). Children in the highest household income group had lower levels of caries. In multivariate analysis, Immigrant status, the highest parents’ occupational and educational level, only one kid in the family, living in the North-Western Italian area and a high household income, were statistically significant associated (p = 0.01) to caries prevalence. The social gradient was statistically significant associated (p < 0.01) to the different caries levels and experience in children with European background.

Conclusions

Data show how caries in preschool children is an unsolved public health problem especially in those with a non-European background.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-022-03470-4.

Effects of cigarette smoking on the growth of Streptococcus mutans biofilms: An in vitro study

The increased incidence of dental caries by cigarette smoking (CS) has been widely reported in epidemiological studies, but the relationship between CS and cariogenic biofilm growth has been rarely studied. This study aims to investigate the effects of CS exposure on the growth and virulence of Streptococcus mutans biofilms (S. mutans). Briefly, S. mutans biofilms were formed on saliva-coated hydroxyapatite disks, which were exposed to CS 1, 3, and 6 times per day, respectively. In addition, S. mutans biofilms without CS exposure were considered as the control group. Acidogenicity, dry weight, colony-forming units (CFUs), water-soluble/insoluble extracellular polysaccharides (EPSs), and intracellular polysaccharides (IPSs) were analyzed and confocal laser scanning microscopy (CLSM) images of 74-h-old S. mutans biofilms were obtained. The lowest accumulation of biofilms and EPSs were detected in the 6 times/day CS exposure group compared with those of the control group and other CS exposure groups in 74-h-old S. mutans biofilms. CLSM also revealed the lowest bacterial count (live and dead cells) and EPSs biovolume in the six times/day CS exposure group in 74-h-old S. mutans biofilms. CS exposure inhibited the growth of S. mutans biofilm in vitro study, the anti-cariogenic biofilm formation was enhanced with a dose (frequency)-dependent at which frequency has more influence in the present findings.

Tobacco Users among the Patients who Visited Dental Outpatient Department of a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Smoked and smokeless forms of tobacco is a preventable cause of morbidity and mortality with inevitable effects on the oral cavity as well. The aim of the study was to find out the prevalence of tobacco users among the patients who visited dental outpatient departments of a tertiary care hospital. Methods: A descriptive cross-sectional study was carried out among 255 patients visiting the dental outpatient department of a tertiary care hospital over the duration of six months. Data collection was done through personal interviews and clinical examinations. History of tobacco use was taken and patients were divided into current users, never users and ever users. Clinical examination was done using Decayed Missing Filled Teeth index, community periodontal index modified and loss of attachment. Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. Results: Among 255 patients, 91 (35.69%) (95% Confidence Interval = 29.81-41.57) patients used tobacco. Among them, 72 (28.2%) were current users, who had taken tobacco at least once during the past 30 days and 19 (7.5%) were ever users who had taken tobacco but not during the past 30 days. Conclusions: The prevalence of tobacco use among our study participants is similar in comparison to that of the general population. Our study shows greater prevalence of the use of a smokeless form of tobacco than the smoked form of tobacco.

Caries severity and socioeconomic inequalities in a nationwide setting: data from the Italian National pathfinder in 12-years children

This study presents the result of the second National pathfinder conducted in Italy on children's oral health, reporting the prevalence and severity of caries in 12-year old children and describing the caries figure related to the socioeconomic inequalities, both at individual level and macroeconomic level. The two-digit codes related to ICDAS (International Caries Detection and Assessment System) for each tooth and the gingival bleeding score were recorded at school on 7,064 children (48.97% males and 51.03% females). The Gross National Product (GNP) per capita, the Gini Index and Unemployment rate in each Italian section, parents' educational levels, working status, smoking habit and their ethnic background were recorded. Zero-inflated-negative-binomial (ZINB) models were run, using caries-free teeth, teeth with enamel lesions, cavitated lesions and restorations as functions of socioeconomic explanatory variables, to evaluate the effects of justifiable economic factors of geographical distribution. The mean number of enamel lesions, cavitated lesions and filled per teeth were statistically significant (p < 0.01) dissimilar among the Italian section. GNP per capita, Gini Index and Unemployment rate were significantly correlated to ICDAS scores and filled teeth. Important differences in ICDAS score values remain among children from different socioeconomic backgrounds. Efforts should be made to improve awareness and knowledge regarding oral health practice and to implement preventive programs and access to dental services in Southern Italy where the disease is still unresolved.

Oral Health Effects of Combusted and Smokeless Tobacco Products

The oral cavity is usually the first part of a consumer's body exposed to the constituents of tobacco products or their emissions. Consequently, the oral cavity is a frequent site for carcinogenic, microbial, immunologic, and clinical effects of tobacco use. This article summarizes 5 presentations on various aspects of oral health affected by combusted or noncombusted tobacco products from a recent conference, "Oral Health Effects of Tobacco Products: Science and Regulatory Policy," sponsored by the American Association for Dental Research and the Food and Drug Administration.

Effect of nicotine on biofilm formation of Streptococcus mutans isolates from smoking and non-smoking subjects

Objectives: To investigate effects of nicotine on biofilm formation of Streptococcus mutans isolates from oral washes of smoker and non-smoker human subjects. Materials and methods: This study was conducted using 60 S. mutans isolates with three S. mutans isolates collected from oral washes of ten smoking subjects and ten from non-smoking subjects. Biofilm was formed by culturing each S. mutans strain (10 μl) in 190 μl of TSB supplemented with 1% sucrose (TSBS) containing 0, 0.25, 0.5, 1.0, 2.0, 4.0, 8.0, 16.0, and 32.0 mg/ml of nicotine for 24 h in 5% CO2 at 37°C in 96 well microtiter plates. The absorbance values of biofilm were measured at 490 nm in a microplate spectrophotometer. Results: There was a significant effect (p-value < 0.05) of nicotine concentrations and smoking on the growth of biofilm, planktonic cells, and total absorbance, for all strains of S. mutans. Isolates from smokers had significantly more biofilm at 0-16 mg/ml of nicotine compared to those from non-smokers (p-value < 0.0001). Conclusion: S. mutans smoker isolates are more affected by high nicotine concentrations than non-smoker isolates. Clinical Relevance: The use of nicotine products increases the growth of S. mutans and may place tobacco users at risk for dental decay.

Correlation between tobacco smoking and dental caries: A systematic review and meta-analysis

INTRODUCTION

Tobacco is responsible for infaust oral conditions and many oral diseases. Dental caries is one of the most prevalent oral diseases. The association between tobacco smoking and dental caries has become an important recent topic of research. A systematic review and meta-analysis was conducted to evaluate the association between tobacco smoking and dental caries.

METHODS

A literature search was conducted in the databases PubMed, EMBASE, Medline and Cochrane, up to December 2018. Original observational articles that estimated relevance between tobacco smoking and dental caries in adults were included. Caries were determined by measurements of decayed, missing or filled teeth (DMFT), or decayed, missing or filled surface (DMFS), or caries-related microflora levels. Trials did not include a non-smoking group, exposure to smokeless tobacco products, or participants under 16 years old. Also, literature reviews, comments, case reports and letters to the editor were not considered. Both methods of systematic review and meta-analysis were adopted. Newcastle-Ottawa Scale (NOS) was used to assess the methodological quality of all the included studies.

RESULTS

Ten out of eleven of the included studies indicated a positive association between tobacco smoking and dental caries. Two meta-analyses were performed: one included five studies using DMFT as an outcome; the other included two studies of DMFS. A random effects model was used. Both were highly heterogeneous (I²=93%, chi-squared p<0.00001; I²=70%, chi-squared p=0.07, respectively) and statistically significant (mean difference, MD=1.20, 95% confidence interval, CI: 0.40-2.00, z-test p=0.003; MD=1.88, 95% CI: 0.99-2.77, z-test p<0.0001, respectively). The quality scores of all varied from 7 to 9.

CONCLUSIONS

There is a correlation between tobacco smoking and an increased risk of dental caries. However, the overall representativeness of the studies is not good. More prospective and extensive research on this topic is needed to get validation. Even so, it is imperative that people quit tobacco smoking.

The effect of smoking on caries-related microorganisms

INTRODUCTION

Epidemiological studies have shown a close relationship between smoking and dental caries. Bacteria are one of the essential factors of caries formation. The imbalance of cariogenic bacteria and commensal bacteria in dental plaque results in higher production of acid that can corrode dental hard tissue. The aim of our review is to summarize the effect of smoking on caries-related bacteria.

METHODS

English articles available in Pubmed and ScienceDirect databases and published before December 2018 were searched. A variety of evidence was collected including not only the influence of cigarette products on bacteria strains in vitro but also their effect on bacterial composition in saliva and dental plaque in vivo. We particularly emphasize the mechanisms by which nicotine acts on oral bacteria.

RESULTS

The components of cigarettes promote the growth of cariogenic microorganisms. The mechanisms of how nicotine enhances Streptococcus mutans, Lactobacilli, Streptococcus gordonii, Actinomyces and Candida albicans are described separately in detail. The commensal bacteria, Streptococcus sanguinis, show less competitive capability in the presence of nicotine. Smoking influences saliva by lowering the buffer capability, altering its chemical agent and bacterial components, and therefore promotes the formation of a caries-susceptible environment.

CONCLUSIONS

Cigarette smoking and nicotine exposure promote the cariogenic activity of oral microorganisms and the formation of a caries-susceptible environment. This suggests that smokers should quit smoking, amongst other health reasons, also for their oral health.

Inhibition of nicotine-induced Streptococcus mutans biofilm formation by salts solutions intended for mouthrinses

OBJECTIVES

Biofilm formation is critical to dental caries initiation and development. The aim of this study was to investigate the effects of nicotine exposure on Streptococcus mutans (S. mutans) biofilm formation concomitantly with the inhibitory effects of sodium chloride (NaCl), potassium chloride (KCl) and potassium iodide (KI) salts. This study examined bacterial growth with varying concentrations of NaCl, KCl, and KI salts and nicotine levels consistent with primary levels of nicotine exposure.

MATERIALS AND METHODS

A preliminary screening experiment was performed to investigate the appropriate concentrations of NaCl, KCl, and KI to use with nicotine. With the data, a S. mutans biofilm growth assay was conducted using nicotine (0-32 mg/mL) in Tryptic Soy broth supplemented with 1% sucrose with and without 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI. The biofilm was stained with crystal violet dye and the absorbance measured to determine biofilm formation.

RESULTS

The presence of 0.45 M of NaCl, 0.23 M of KCl, and 0.113 M of KI significantly inhibited (p < 0.05) nicotine-induced S. mutans biofilm formation by 52%, 79.7%, and 64.1%, respectively.

CONCLUSIONS

The results provide additional evidence regarding the biofilm-enhancing effects of nicotine and demonstrate the inhibitory influence of these salts in reducing the nicotine-induced biofilm formation. A short-term exposure to these salts may inhibit S. mutans biofilm formation.

SOCIOECONOMIC INFLUENCE OF TOBACCO USE AND DENTAL CARIES EXPERIENCE IN DIFFERENT MALE CROATIAN POPULATIONS

SUMMARY – The purpose was to evaluate dental caries experience in different male subpopulations of Croatian Army recruits and dental students, and subsequently, smoking habits related to the level of education and place of residence. Croatian army recruits (n=248; mean age 20.2) and male dental students (n=56; mean age 21.5) were evaluated according to DMFT and FST indices, divided according to age and place of residence, and interviewed about their dietary habits and smoking of tobacco. In the subpopulation of recruits, the median value of DMFT was 6 and of FST index 25. A statistically significant difference was recorded between DT and FST index (p<0.05) according to dietary role of carbohydrates reflected in caries development. The number of recruits with finished elementary school coming from a rural area who smoked (in total 57.66% of smokers) was significantly larger (p=0.0041). In dental students, the median value of DMFT was 5, with statistical significance in comparison with recruits (p=0.03). There was a difference in FST index (median 28) (p<0.0001). Students were mostly nonsmokers (71.43%) and had urban residence (p<0.0001). FST index was a more specific indicator in the socioeconomically heterogeneous sample of recruits (more subjects coming from rural areas and with a lower level of education) than in the sample of dental students (more subjects coming from urban areas).

Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study

Objective

To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study.

Methods

Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance).

Results

Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ²₍₉₎ = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ²₍₉₎ = 25.68 p < 0.01, Z = −4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking (p < 0.01).

Conclusions

The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.

Permanent tooth loss and sugar-sweetened beverage intake in U.S. young adults

OBJECTIVE

In young adults, sugar-sweetened beverage (SSB) intake is associated with dental caries, which in turn is a major contributor to tooth loss. The independent role of SSB intake on tooth loss, however, has not been well-described. This cross-sectional study examined associations between tooth loss and SSB intake among U.S. young adults.

METHODS

The outcome was number of permanent teeth lost because of dental caries or periodontal disease (0, 1-5, ≥6 teeth). Data from the 2012 Behavioral Risk Factor Surveillance System were used. The 22,526 adults aged 18-39 years completed the Sugar Drink Module. The exposure variable was daily frequency of SSB intake. We used multinomial logistic regression to examine the adjusted associations between tooth loss and daily SSB consumption (0, >0 to <1, 1-2, >2 times/day).

RESULTS

Approximately, 26% of young adults reported losing at least one permanent tooth. Tooth loss was positively associated with SSB intake frequency; the odds of losing 1-5 teeth were higher among adults drinking SSBs >0-<1 times/day (OR = 1.44, 95%CI = 1.16-1.79), 1-2 times/day (OR = 1.58, 95%CI = 1.25-1.99), and >2 times/day (OR = 1.97, 95%CI = 1.51-2.58) than non-SSB consumers. The odds of losing ≥6 teeth were higher among adults drinking SSBs 1-2 times/day (OR = 2.20, 95%CI = 1.15-4.22) and >2 times/day (OR = 2.81, 95%CI = 1.37-5.76) than non-SSB consumers.

CONCLUSIONS

Frequency of SSB consumption was positively associated with tooth loss among young adults even when the average SSB intake was less than one time per day. This study suggests that efforts to reduce SSB intake among young adults may help to decrease the risk of tooth loss.

Nicotine Enhances Interspecies Relationship between Streptococcus mutans and Candida albicans

Streptococcus mutans and Candida albicans are common microorganisms in the human oral cavity. The synergistic relationship between these two species has been deeply explored in many studies. In the present study, the effect of alkaloid nicotine on the interspecies between S. mutans and C. albicans is explored. We developed a dual-species biofilm model and studied biofilm biomass, biofilm structure, synthesis of extracellular polysaccharides (EPS), and expression of glucosyltransferases (Gtfs). Biofilm formation and bacterial and fungal cell numbers in dual-species biofilms increased in the presence of nicotine. More C. albicans cells were present in the dual-species biofilms in the nicotine-treated groups as determined by scanning electron microscopy. The synthesis of EPS was increased by 1 mg/ml of nicotine as detected by confocal laser scanning microscopy. The result of qRT-PCR showed gtfs expression was upregulated when 1 mg/ml of nicotine was used. We speculate that nicotine promoted the growth of S. mutans, and more S. mutans cells attracted more C. albicans cells due to the interaction between two species. Since S. mutans and C. albicans are putative pathogens for dental caries, the enhancement of the synergistic relationship by nicotine may contribute to caries development in smokers.

Modeling Caries Experience: Advantages of the Use of the Hurdle Model

In dental epidemiology, the decayed (D), missing (M), and filled (F) teeth or surfaces index (DFM index) is a frequently used measure. The DMF index is characterized by a strongly positive skewed distribution with a large stack of zero counts for those individuals without caries experience. Therefore, standard generalized linear models often lead to a poor fit. The hurdle regression model is a highly suitable class to model a DMF index, but its use is subordinated. We aim to overcome the gap between the suitability of the hurdle model to fit DMF indices and the frequency of its use in caries research. A theoretical introduction to the hurdle model is provided, and an extensive comparison with the zero-inflated model is given. Using an illustrative data example, both types of models are compared, with a special focus on interpretation of their parameters. Accompanying R code and example data are provided as online supplementary material.

Nicotine promotes Streptococcus mutans extracellular polysaccharide synthesis, cell aggregation and overall lactate dehydrogenase activity

Several epidemiology studies have reported a positive relationship between smoking and dental caries. Nicotine, an alkaloid component of tobacco, has been demonstrated to stimulate biofilm formation and metabolic activity of Streptococcus mutans, one of the most important pathogens of dental caries. The first aim of the present study was to explore the possible mechanisms leading to increased biofilm by nicotine treatment from three aspects, extracellular polysaccharides (EPS) synthesis, glucosyltransferase (Gtf) synthesis and glucan-binding protein (Gbp) synthesis at the mRNA and protein levels. The second aim was to investigate how nicotine affects S. mutans virulence, particular in lactate dehydrogenase (LDH) activity. Confocal laser scanning microscopy results demonstrated that both biofilm bacterial cell numbers and EPS were increased by nicotine. Gtf and GbpA protein expression of S. mutans planktonic cells were upregulated while GbpB protein expression of biofilm cells were downregulated by nicotine. The mRNA expression trends of those genes were mostly consistent with results on protein level but not statistically significant, and gtfD and gbpD of biofilm cells were inhibited. Nicotine was not directly involved in S. mutans LDH activity. However, since it increases the total number of bacterial cells in biofilm, the overall LDH activity of S. mutans biofilm is increased. In conclusion, nicotine stimulates S. mutans planktonic cell Gtf and Gbp expression. This leads to more planktonic cells attaching to the dental biofilm. Increased cell numbers within biofilm results in higher overall LDH activity. This contributes to caries development in smokers.

Dental patient's knowledge and perceptions about the effects of smoking and role of dentists in smoking cessation activities

OBJECTIVES

The objective of the following study is to assess the knowledge of patients about the consequences of smoking on the general and oral health, to analyze the patient's perceptions about the role of dentists in smoking prevention, counseling and cessation and to analyze the willingness of smokers to quit smoking following dentist's advice.

MATERIALS AND METHODS

A descriptive study was conducted in a sample of 486 dental patients visiting Vokkaligara Sangha Dental College and Hospital, Bengaluruin the month of August 2011 using a self-administered questionnaire. Descriptive statistics and Chi-square test was performed to analyze data.

RESULTS

The patients had good knowledge about the effects of smoking on general and oral health. Statistically significant difference was observed in the knowledge of smokers and non-smokers about the effects of smoking on ageing (P = 0.008) and oral cancer (P = 0.0012). Patients had a positive perception about the role of dentists in smoking cessation activities. Smokers exhibited a willingness to quit if suggested by the dentist.

CONCLUSION

Patients perceive that dentists can play an important part in smoking cessation activities. Hence, dentists should not hesitate to give smoking cessation advice to their patients and grasp this opportunity to improve the general and oral health of the community.

Effect of nicotine on dual-species biofilms of Streptococcus mutans and Streptococcus sanguinis

Both Streptococcus mutans and Streptococcus sanguinis are normal bacterial inhabitants of dental plaque. Streptococcus mutans is the major agent causing dental caries. It has been well documented that nicotine affects the growth of S. mutans. This study investigated the effect of nicotine on mono- and dual-species growth of S. mutans and S. sanguinis. The results indicate that nicotine has no significant effect on S. sanguinis grown in either mono- or dual-species biofilms. However, nicotine significantly increased (P < 0.05) the growth of S. mutans in dual-species biofilm formation. In addition, the CFU level of S. sanguinis was higher than S. mutans without nicotine in the culture. With the addition of nicotine, the level of S. mutans biofilm was significantly enhanced as the nicotine concentration increased over the level of S. sanguinis in dual-species biofilm, and we also got the same result from the fluorescence in situ hybridization detecting the two bacteria grown in biofilm formation. The exopolysaccharide (EPS) of S. mutans has also been increased by the increasing nicotine concentration, while the EPS of S. sanguinis was decreased or inhibited by the affected nicotine. The data further confirm that nicotine is able to enhance the growth of S. mutans.

Tobacco use and caries risk among adolescents--a longitudinal study in Sweden

BACKGROUND

Smoking and the use of smokeless tobacco have a detrimental impact on general and oral health. The relationship to dental caries is however still unclear. As caries is a multi-factorial disease with clear life-style, socio-economic and socio-demographic gradients, the tobacco use may be a co-variable in this complex rather than a direct etiological factor. Our aim was to analyze the impact of tobacco use on caries incidence among adolescents, with consideration to socio-economic variables by residency, using epidemiological data from a longitudinal study in the region of Halland, Sweden.

METHODS

The study population consisted of 10,068 adolescents between 16-19 years of age from whom yearly data on caries and tobacco use (cigarette smoking and use of smokeless tobacco) were obtained during the period 2006-2012. Reported DMFS increment between 16 and 19 years of age (∆DMFS) for an individual was considered as the primary caries outcome. The outcome data were compared for self-reported never vs. ever users of tobacco, with consideration to neighborhood-level socio-economy (4 strata), baseline (i.e., 16 years of age) DMFS and sex. The region consists of 65 parishes with various socio-economic conditions and each study individual was geo-coded with respect to his/her residence parish. Neighborhood (parish-level) socio-economy was assessed by proportion of residing families with low household purchasing power.

RESULTS

∆DMFS differed evidently between ever and never users of tobacco (mean values: 1.8 vs. 1.2; proportion with ∆DMFS > 0: 54.2% vs. 40.5%; p < 0.0001). Significant differences were observed in each neighborhood-level socio-economic stratum. Even after controlling for baseline DMFS and sex, ∆DMFS differed highly significantly between the ever and never users of tobacco (overall p < 0.0001).

CONCLUSION

Tobacco use was clearly associated with increased caries increment during adolescence. Hence, this factor is relevant to consider in the clinical caries risk assessment of the individual patient as well as for community health plans dealing with oral health.

The role of tobacco use on dental care and oral disease severity within community dental clinics in Japan

Background

To examine facilitators of dental smoking intervention practices in Japan, where smokeless tobacco is rarely used, we evaluated the characteristics of dental care for smokers.

Methods

Community dentists volunteered to record the treated disease or encounter with patients that was principally responsible for their dental care on the survey day. Patients were classified into groups receiving gingival/periodontal treatment (GPT), caries/endodontic treatment (CET), prosthetic treatment (PRT), periodical check-up/orthodontic treatment (POT), or other encounters/treatments. Potential effect of dentist clustering was adjusted by incorporating the complex survey design into the analysis.

Results

Data of 2835 current smokers (CS) and 6850 non-smokers (NS) from 753 clinics were analysed. Distribution of treatments significantly differed between CS and NS (P = 0.001). In ad hoc multiple comparisons for each treatment, CS were significantly higher than NS for CET (47.1% vs. 43.6%, P = 0.002), and lower for POT (1.6% vs. 2.7%, P = 0.001), whereas GPT and PRT proportions were equivalent by smoking. When stage of disease progression was compared in the GPT subpopulation, CS were more likely received treatment for advanced stage disease than NS in the age groups of 40–59 years (24.9% vs. 15.3%, P = 0.001) and more than 60 years (40.8% vs. 22.1%, P < 0.001). However, the difference was less apparent in the entire population (9.7% vs. 6.0%), and CS were not predominant among patients receiving GPT for advanced stage disease (37.6%).

Conclusions

The association of smoking with type of dental care of CET and GPT severity would warrant the need for dental professionals to engage their patients smoking within clinical practice. The detrimental effects of smoking in dental care for smokers, as evidenced by the distribution of treatment and encounter and stage of treated disease, may not be clearly realized by dental professionals, unless the smoking status of all patients is identified.

Tobacco and dental caries: a systematic review

OBJECTIVE

Despite the abundance of evidence linking tobacco consumption to many oral conditions, no systematic review of the relationship with dental caries is available. The main aim of this systematic review was, therefore, to evaluate the effect of tobacco smoking on dental caries in adult smokers.

MATERIALS AND METHODS

According to the PRISMA checklist, observational studies published from January 1991 to June 2011 were reviewed. The quality of evidence for each finding was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology.

RESULTS

Five studies, four related to dental caries and one on oral bacteria activity, were finally included in a qualitative analysis; they were all cross-sectional studies. As a result, the overall quality of evidence was poor, with two articles given a score of very low and three a score of low according to GRADE.

CONCLUSIONS

Tobacco smoking was found to be associated with an increased risk of dental caries. However, the overall poor quality of studies produced no validation for such an association. Further, more extensive research on this topic and prospective studies are needed.

Effect of nicotine on growth and metabolism of Streptococcus mutans

Streptococcus mutans is a key contributor to dental caries. Smokers have a higher number of caries-affected teeth than do nonsmokers, but the association among tobacco, nicotine, caries, and S. mutans growth has not been investigated in detail. Seven S. mutans strains--UA159, UA130, 10449, A32-2, NG8, LM7, and OMZ175--were used in the present study. The minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), minimum biofilm inhibitory concentration (MBIC), planktonic cell growth, biofilm formation, metabolism, and structure (determined using scanning electron microscopy) of the seven strains treated with different concentrations of nicotine (0-32 mg ml(-1)) were investigated. The MIC, MBC, and MBIC were 16 mg ml(-1) (0.1 M), 32 mg ml(-1) (0.2 M), and 16 mg ml(-1) (0.1 M), respectively, for most of the S. mutans strains. Growth of planktonic S. mutans cells was significantly repressed by 2.0-8.0 mg ml(-1) of nicotine. Biofilm formation and metabolic activity of S. mutans was increased in a nicotine-dependent manner up to 16.0 mg ml(-1) of nicotine. Scanning electron microscopy revealed that S. mutans treated with a high concentration of nicotine a had thicker biofilm and more spherical bacterial cells. In summary, nicotine enhances S. mutans biofilm formation and biofilm metabolic activity. These results suggest that smoking can increase the development of caries by fostering increased formation of S. mutans biofilm on tooth surfaces.

Review and recommendations for zero-inflated count regression modeling of dental caries indices in epidemiological studies

Over the past 5-10 years, zero-inflated (ZI) count regression models have been increasingly applied to the analysis of dental caries indices (e.g. DMFT, dfms). The main reason for that is linked to the broad decline in children's caries experience, such that dmf and DMF indices more frequently generate low or even zero counts. This article specifically reviews the application of ZI Poisson and ZI negative binomial regression models to dental caries, with emphasis on the description of the models and the interpretation of fitted model results given the study goals. The review finds that interpretations provided in the published caries research are often imprecise or inadvertently misleading, particularly with respect to failing to discriminate between inference for the class of susceptible persons defined by such models and inference for the sampled population in terms of overall exposure effects. Recommendations are provided to enhance the use as well as the interpretation and reporting of results of count regression models when applied to epidemiological studies of dental caries.