Microbiological and biochemical findings in relation to clinical periodontal status in active smokers, non-smokers and passive smokers

Evaluation of Salivary Biomarkers of Periodontal Disease Based on Smoking Status: A Systematic Review

Saliva is a useful biomarker for diagnosing oral health conditions, including periodontal disease (PD). Smoking is a risk factor for PD. The aim of this systematic review was to summarize the salivary biomarkers associated with PD based on smoking status. A comprehensive search of the MEDLINE (via PubMed), EMBASE, Cochrane, SCOPUS, and Web of Sciences databases was conducted up to 1 January 2021 using key terms relevant to the topic of our research and Cochrane methodology and improved with searching a gray literature resource. The methodological quality of all included studies was assessed with the revised Quality Assessment of Diagnostic Accuracy Studies-2. Seven studies were included. Smokers had increased levels of malondialdehyde, sialic acid, salivary cortisol, salivary interleukin 1β, albumin, tissue inhibitor of matrix metalloproteinase (TIMP), and the pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP), as well as decreased levels of superoxide dismutase, activity of lactate dehydrogenase, activity of enzyme activity of β-glucuronidase, uric acid, matrix metalloproteinase-8 (MMP-8)/TIMP-1 ratio, and combinations of MMP-8 and ICTP. However, mixed results were observed some studies in detecting glutathione peroxidase, MMP-8, and MMP-14. The results were interpreted with caution because of limitations in the number of included studies and the study design. Some salivary biomarkers are potentially useful in combination or alone for diagnosing PD. Methodological and systematic studies are needed to develop more effective biomarkers.

Associations between environmental tobacco smoke exposure and oral health symptoms in adolescents

Background

Oral health condition in adolescence impacts the oral well-being throughout life. This study aimed to determine the association between environmental tobacco smoke (ETS) exposure and oral health in adolescents, using nationally representative data.

Methods

Using data from the 2020 Korea Youth Risk Behavior Web-based Survey, we assessed self-reported data on ETS exposure and oral health symptoms in 37,591 non-smoking adolescents. The dependent variables were self-reported oral health symptoms of adolescents (tooth fracture, dental pain, and gum bleeding). ETS exposure was the primary independent variable. Chi-square tests and multivariable logistic regression analyses were performed to examine these relationships.

Results

ETS exposure was positively associated with oral symptoms compared to no-ETS exposure in adolescents [boys, odds ratio (OR) 1.56, 95% confidence interval (CI) 1.46–1.66; girls, OR 1.50, 95% CI 1.41–1.60]; individuals with good oral health habits such as frequent tooth brushing [boys, three times or more a day, OR 1.38, 95% CI 1.24–1.53] and less soda consumption [girls, less than once a day, OR 1.73, 95% CI 1.29–2.33] had a weaker association. ETS exposure was positively associated with dental pain [boys, OR 1.55, 95% CI 1.45–1.66; girls, OR 1.50, 95% CI 1.41–1.60] and gum bleeding [boys, OR 1.43, 95% CI 1.29–1.58; girls, OR 1.32, 95% CI 1.21–1.44]; however, tooth fracture was significantly associated only in girls [OR 1.28, 95% CI 1.13–1.45].

Conclusions

ETS in various environments is negatively associated with oral health in adolescents. This association could vary depending on health habits. Sophisticated policies to protect South Korean adolescents from ETS can be developed from these findings.

Association between Vitamin D Receptor Gene Polymorphisms and Periodontal Bacteria: A Clinical Pilot Study

Background: Periodontitis is an inflammatory disease caused by microorganisms involving the supporting tissues of the teeth. Gene variants may influence both the composition of the biofilm in the oral cavity and the host response. The objective of the study was to investigate the potential correlations between the disease susceptibility, the presence and the quantity of periodontopathogenic oral bacterial composition and the VDR gene polymorphisms. Methods: Fifty (50) unrelated periodontal patients and forty-one (41) healthy controls were selected for genomic DNA extraction. DNA concentration was measured and analyzed. The periodontopathogenic bacterial species were identified and quantified using a Real Time PCR performed with species-specific primers and probes. Results: Genotype distribution showed a different distribution between the groups for BsmI rs1544410 genotypes (p = 0.0001) with a prevalence of the G(b) allele in periodontal patients (p = 0.0003). Statistical significance was also found for VDR TaqI rs731236 (p ≤ 0.00001) with a prevalence of the T(T) allele in periodontal patients (p ≤ 0.00001). The average bacterial copy count for the periodontitis group was significantly higher than that of control group. Dividing patients into two groups based on high or low bacterial load, FokI rs2228570 T allele (f) was statistically more represented in patients with high bacterial load. Conclusions: The findings of the study suggest the involvement of the VDR gene BsmI and TaqI polymorphisms in periodontal disease, while FokI and BsmI may be involved in determining an increased presence of periodontopathogens.

Periodontal treatment outcomes in smokers: A narrative review

Smoking is considered as the major environmental risk factor for periodontal diseases. Smokers have a higher risk for severe periodontitis with more periodontal tissue destruction, more gingival recession, and more susceptibility for tooth loss. The aim of this narrative review is to provide up-to-date evidence on the clinical outcomes of periodontal treatment in smokers. Electronic databases were searched for studies that compare the clinical outcomes in smokers and non-smokers following non-surgical and surgical periodontal treatment modalities and also during the supportive periodontal treatment. Clinical studies published before May 2021 were included in the review. Smokers have a higher risk for recurrence of periodontal disease and the response to non-surgical as well as surgical periodontal treatment is not as good as that of non-smokers. Moreover, there is a dose-response effect in the adverse effects of smoking on periodontal health. Compared to non-smokers, smoker patients with periodontitis tend to respond less favorably to non-surgical and surgical periodontal treatment, and exhibit recurrence more frequently during supportive periodontal treatment. Along with the periodontal treatment, smokers may be encouraged to quit. Long follow-up and the communication between the dentist and the patient give a great opportunity for such counseling.

The Impact of Smoking on Subgingival Plaque and the Development of Periodontitis: A Literature Review

Smoking seriously affects oral health and causes a variety of oral diseases. Numerous clinical data show that smoking significantly increases the risk of periodontitis, and the duration and amount of smoking are positively correlated with the severity of periodontitis. In fact, smoking creates an environment conducive to the colonization of periodontopathogens, which affects the process of periodontitis. Since subgingival plaque which harbors periodontopathogens is the initiation factor of periodontitis, it is critical to study the impact of smoking on subgingival microbiota for understanding the relationship between smoking and periodontitis. Continuous advances have been made on the understanding of effects of smoking on subgingival plaque and the development of periodontitis. Smoking is observed to enhance the pathogenicity of periodontopathogens, especially the red complex microorganisms, via promoting their colonization and infection, and regulating the expression and function of multiple virulence factors. Furthermore, smoking has a negative impact on periodontal microecological homeostasis, which is reflected in the decrease of commensal bacteria and the increase of periodontopathogens, as well as the changes in the interaction between periodontopathogens and their commensal microbes in subgingival biofilm, thus influencing the pathogenicity of the subgingival plaque. In summary, the mechanism of smoking on subgingival plaque microorganisms represented by the red complex and its effect on the periodontal microecology still need to be further explored. The relevant research results are of great significance for guiding the periodontal clinical treatment of smoking population. This review summarizes the effects and relevant mechanisms of smoking on subgingival plaque and the development of periodontitis.

The impact of smoking different tobacco types on the subgingival microbiome and periodontal health: a pilot study

Smoking is a risk factor for periodontal disease, and a cause of oral microbiome dysbiosis. While this has been evaluated for traditional cigarette smoking, there is limited research on the effect of other tobacco types on the oral microbiome. This study investigates subgingival microbiome composition in smokers of different tobacco types and their effect on periodontal health. Subgingival plaques were collected from 40 individuals, including smokers of either cigarettes, medwakh, or shisha, and non-smokers seeking dental treatment at the University Dental Hospital in Sharjah, United Arab Emirates. The entire (~ 1500 bp) 16S rRNA bacterial gene was fully amplified and sequenced using Oxford Nanopore technology. Subjects were compared for the relative abundance and diversity of subgingival microbiota, considering smoking and periodontal condition. The relative abundances of several pathogens were significantly higher among smokers, such as Prevotella denticola and Treponema sp. OMZ 838 in medwakh smokers, Streptococcus mutans and Veillonella dispar in cigarette smokers, Streptococcus sanguinis and Tannerella forsythia in shisha smokers. Subgingival microbiome of smokers was altered even in subjects with no or mild periodontitis, probably making them more prone to severe periodontal diseases. Microbiome profiling can be a useful tool for periodontal risk assessment. Further studies are recommended to investigate the impact of tobacco cessation on periodontal disease progression and oral microbiome.

Flavorless vs. Flavored Electronic Cigarette-Generated Aerosol and E-Liquid on the Growth of Common Oral Commensal Streptococci

Introduction

Electronic cigarette (ECIG) use or vaping has become popular globally. While the question “Is vaping safer than smoking?” continues, it is becoming clearer that one of the most dangerous components of E-liquids are the flavorings. Since the oral cavity is the first anatomical site to be assaulted by ECIG aerosol, the aim of this study is to test the hypothesis that flavored ECIG aerosols or E-liquids pose a more detrimental effect on the growth of commensal oral streptococcal bacteria compared to flavorless aerosols or E-liquids.

Methods

Kirby Bauer assays and 24-h planktonic growth curves were used to compare the effects of flavorless vs. flavored (tobacco, menthol, cinnamon, strawberry and blueberry) ECIG-generated aerosols and E-liquids on the growth of four common strains of oral commensal bacteria (Streptococcus gordonii, Streptococcus intermedius, Streptococcus mitis and Streptococcus oralis).

Results

Kirby Bauer assays revealed inhibition of growth for all bacteria tested when exposed to 100% menthol, cinnamon or strawberry flavors. In contrast, 5% flavor in E-liquid had no effect. When exposed to 100 puffs of ECIG-generated aerosol ± flavors (≈ 0.05% flavor in brain heart infusion media) or an equivalent amount of E-liquid ± flavors, twenty-four hour planktonic growth curves indicated no effect on growth for all streptococci tested. Subsequent twenty-four hour planktonic growth curves testing the effects of E-liquid ± flavors (0.0625, 0.125, 0.25, 0.3125, 0.625, and 1.25% flavor in brain heart infusion media) revealed dose-dependent inhibition of growth, particularly for menthol, cinnamon and strawberry), for all bacteria tested.

Conclusion

These results support the hypothesis that flavored E-liquids are more detrimental to the growth of oral commensal bacteria than unflavored E-liquids. The streptococci tested in this study are early colonizers and part of the foundation of oral biofilms and dental plaque. Disturbances in the composition and growth of these primary colonizers is crucial to the development of a healthy dental plaque and host-bacteria interactions. E-liquids and their aerosols containing flavoring agents alter the growth of these bacteria. Such perturbations of pioneering oral communities pose a potential risk to the health of the oral cavity and, ultimately, health in general.

Environmental factors and periodontal microbiome

Periodontal diseases are chronic inflammatory, multifactorial diseases where the major triggering factors for disease onset are bacteria and their toxins, but the major part of tissue destruction occurs as a result of host response towards the periodontal microbiome. Periodontal microbiome consists of a wide range of microorganisms including obligate and facultative anaerobes. In health, there is a dynamic balance between the host, environment, and the microbiome. Environmental factors, mainly tobacco smoking and psychological stress, disrupt the symbiotic relationship. Tobacco smoke and its components alter the bacterial surface and functions such as growth. Psychological stressors and stress hormones may affect the outcome of an infection by changing the virulence factors and/or host response. This review aims to provide currently available data on the effects of the major environmental factors on the periodontal microbiome.

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

Periodontitis combined with smoking increases risk of the ulcerative colitis: A national cohort study

BACKGROUND

Periodontitis is a chronic inflammation of periodontal tissues. The effect of periodontitis on the development of inflammatory bowel disease (IBD) remains unclear.

AIM

To assessed the risk of IBD among patients with periodontitis, and the risk factors for IBD related to periodontitis.

METHODS

A nationwide population-based cohort study was performed using claims data from the Korean National Healthcare Insurance Service. In total, 9950548 individuals aged ≥ 20 years who underwent national health screening in 2009 were included. Newly diagnosed IBD [Crohn’s disease (CD), ulcerative colitis (UC)] using the International Classification of Disease 10^th revision and rare intractable disease codes, was compared between the periodontitis and non-periodontitis groups until 2017.

RESULTS

A total of 1092825 individuals (11.0%) had periodontitis. Periodontitis was significantly associated with older age, male gender, higher body mass index, quitting smoking, not drinking alcohol, and regular exercise. The mean age was 51.4 ± 12.9 years in the periodontitis group and 46.6 ± 14.2 years in the non-periodontitis group (P < 0.01), respectively. The mean body mass index was 23.9 ± 3.1 and 23.7 ± 3.2 in the periodontitis and non-periodontitis groups, respectively (P < 0.01). Men were 604307 (55.3%) and 4844383 (54.7%) in the periodontitis and non-periodontitis groups, respectively. The mean follow-up duration was 7.26 years. Individuals with periodontitis had a significantly higher risk of UC than those without periodontitis [adjusted hazard ratio: 1.091; 95% confidence interval (CI): 1.008-1.182], but not CD (adjusted hazard ratio: 0.879; 95% confidence interval: 0.731-1.057). The risks for UC were significant in the subgroups of age ≥ 65 years, male gender, alcohol drinker, current smoker, and reduced physical activity. Current smokers aged ≥ 65 years with periodontitis were at a 1.9-fold increased risk of UC than non-smokers aged ≥ 65 years without periodontitis.

CONCLUSION

Periodontitis was significantly associated with the risk of developing UC, but not CD, particularly in current smokers aged ≥ 65 years.

Evaluation of cardiac biomarkers in smokers and non-smokers with chronic periodontitis

OBJECTIVES

The present study aimed to assess the levels of the cardiac biomarkers in smokers versus non-smokers chronic periodontitis (CP) patients and periodontally healthy subjects, also to correlate cardiac biomarkers level with the severity of CP.

METHODS

Eighty selected individuals were divided into three groups: Smokers CP (28), non-smokers CP (32), and healthy control subjects (20). The CP evaluated clinically by plaque index (PI), bleeding index (BI), clinical attachment loss (CAL), and pocket depth (PD). Serum levels of cardiac biomarkers were assayed for the following: Aspartate transaminase (AST), alanine transaminase (ALT), troponin-I (Tr-I), creatinine kinase (CK), and lactate dehydrogenase (LDH).

RESULTS

The statistical analysis of the investigated biomarkers showed that ALT and AST significantly increased in smokers versus non-smokers CP patients (P ≤ 0.05). In addition, the other biomarkers (Tr-I, CK, and LDH) showed a non-significant increase in smokers compared with non-smokers periodontitis patients (P ≥ 0.05). Furthermore, the mean values of all biomarkers, Tr-I, ALT, AST, LDH, and CK, expressed highly significant comparisons (P ≤ 0.01) in smokers and non-smokers CP patients against healthy subjects.

CONCLUSION

The present study suggested that the cardiac biomarkers affected by CP and worse aggravated by the presence of smoking that could play a bidirectional effect on periodontitis and cardiovascular (CV) conditions. Further researches are needed to elucidate the efficacy of periodontal treatment and serum cardiac biomarkers in systemically healthy and diseased CV patients.

A Comparison of Flavorless Electronic Cigarette-Generated Aerosol and Conventional Cigarette Smoke on the Planktonic Growth of Common Oral Commensal Streptococci

Background: Smoking is the number one predictor for the development of periodontal disease. Consequently, electronic cigarette (ECIG) use has prompted investigations into the health-related risks induced by ECIG-generated aerosol on oral commensal bacteria as compared to cigarette smoke. Since E-liquid contains fewer constituents than smoke, we hypothesize that growth media containing E-liquid or aerosol has less impact on oral commensal streptococci than cigarette smoke. Methods: Eight-hour growth curves were generated for three strains of streptococci following exposure of growth media to nicotine alone (0.05, 0.1, 0.2 mg/mL), E-liquid ± nicotine (2.3, 4.7, 7.0 µL/mL), ECIG-generated aerosol ± nicotine (25, 50, 75 puffs), or cigarette smoke (2, 5, 10, 25, 50, 75 puffs). Nicotine and E-liquid were added to the media at concentrations equivalent to vaporized amounts of 25, 50, or 75 puffs. Absorbance readings were taken at 0, 2, 4, 6, and 8 h of bacterial growth. Results: Both E-liquid and aerosol (±nicotine) had little to no effect on eight-hour streptococcal growth. In contrast, five puffs of smoke inhibited streptococcal growth. Conclusions: Smoke-treated growth media, but not E-liquid or ECIG-generated aerosol, inhibits the growth of oral commensal streptococci. A possible implication is that aerosol may induce less periodontitis than smoke.