Periodontal disease and oral cleanliness in tobacco smokers

Oral and periodontal implications of tobacco and nicotine products

Tobacco use contributes to more mortality and morbidity globally than any other behavioral risk factor. Adverse effects do not spare the oral cavity, with many oral diseases more common, and treatments less successful, in the tobacco-using patient. Many of the oral health effects of cigarette smoking are well established, but other forms of tobacco, including cigars and smokeless tobacco, merit dental professionals' attention. Recently, an expanding variety of new or emerging tobacco and/or nicotine products has been brought to market, most prominently electronic cigarettes, but also including heated tobacco and other noncombustible nicotine products. The use of cannabis (marijuana) is increasing and also has risks for oral health and dental treatment. For the practicing periodontist, and all dental professionals, providing sound patient recommendations requires knowledge of the general and oral health implications associated with this wide range of tobacco and nicotine products and cannabis. This review provides an overview of selected tobacco and nicotine products with an emphasis on their implications for periodontal disease risk and clinical management. Also presented are strategies for tobacco use counselling and cessation support that dental professionals can implement in practice.

The tobacco-using periodontal patient: role of the dental practitioner in tobacco cessation and periodontal disease management

Although the prevalence of tobacco use has declined in some parts of the world, tobacco use remains a persistent and, in some cases, growing problem that will continue to be a fundamental challenge facing dental practitioners in the decades ahead. Dental practitioners have a unique opportunity and professional obligation to be a positive influence in reducing the economic and social burden inflicted by tobacco use on dental and general health. In this article, the current noninvasive, evidence-based approaches are presented for dental practitioners to help patients avoid initiating tobacco use, to encourage and assist patients in ceasing tobacco use and to address tobacco-induced damage to periodontal supporting tissues.

A comparative study of the oral hygiene status of smokers and non-smokers in Ibadan, Oyo state

AIMS

The aim of this study was to assess the effect of tobacco smoking on gingival health and the oral hygiene status of respondents.

MATERIALS AND METHODS

A cross-sectional survey of 213 adults from three communities in the Ibadan North local government was carried out. Respondents were divided into two groups comprising of 117 smokers (cases) and 96 non-smokers (control). Intra oral examination was done using the Simplified Oral Hygiene Index (OHI-S) and Gingival index (GI).

RESULTS

The mean age of the smokers was 31.2 ± 12.6 years and that of the non-smokers 32.8 ± 9.5 years. The mean Simplified Oral Hygiene Index (OHI-S) was 1.15 ± 0.51 for the non-smokers and 2.19 ± 0.62 for the smokers (P < 0.05). The mean GI was 1.06 ± 0.55 for the non-smokers and 1.62 ± 0.58 for the smokers (P < 0.05).

CONCLUSION

The study shows that smoking is associated with increased severity of gingival disease. It is, therefore, recommended that smokers should be encouraged to visit a dentist for preventive procedure more regularly than the non-smokers and better still, smokers should be encouraged to quit smoking as gingival disease is not without consequences if allowed to persist.

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

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

Toothbrushing and smoking among adolescents--aggregation of health damaging behaviours

AIM

The aim of this study was to determine whether an association exists between daily smoking and infrequent toothbrushing habits among adolescents.

MATERIALS AND METHODS

Nationally representative samples of 14-, 16- and 18-year-old Finns (N=5643) took part in the survey. A 12-page structured questionnaire was posted to the adolescents, asking them to complete it and return it in an enclosed pre-paid envelope. The χ(2)-test and a logistic regression model were used for analyses.

RESULTS

At the age of 14 years, 8.5% reported smoking daily, at 16 years 25.0% and at 18 years 33.2%. Only 28.3-54.7% of the adolescents reported brushing their teeth more than once a day. Among 14-year-olds, 6.5% of the adolescents reported both smoking daily and brushing less than twice a day. The respective figures were 17.7% for the 16-year-olds and 21.6% for the 18-year-olds. Among the 14-year-olds, the strongest association with smoking daily and brushing less than twice a day was found with low school performance (OR=8.2), and among 16- and 18-year-olds school career (studying at a vocational school, OR=3.4).

CONCLUSION

Daily smoking and infrequent toothbrushing are strongly associated in adolescence.

Evaluation of clinical periodontal conditions in smokers and non-smokers

Given that tobacco smoking habit is a risk factor for periodontal diseases, the aim of this study was to compare clinical periodontal aspects between smokers and non-smokers. The clinical status were assessed in 55 patients, 29 smokers and 26 non-smokers, aged 30 to 50 years, with mean age of 40. The clinical parameters used were: probing depth (PD), plaque index (PI), gingival index (GI), clinical attachment level (CAL), gingival recession (GR) and gingival bleeding index (GBI) for arches (upper and lower) and teeth (anterior and posterior). Tooth loss was also evaluated in both groups. Multiple regression analysis showed: tendency of greater probing depth and clinical attachment level means for smokers; greater amount of plaque in smokers in all regions; greater gingival index means for non-smokers with clinical significance (p<0.05) in all regions. Although, without statistical significance, the analysis showed greater gingival bleeding index means almost always for non-smokers; similar gingival recession means in both groups and tendency of upper tooth loss in smokers and lower tooth loss in non-smokers. The findings of this study showed that clinical periodontal parameters may be different in smokers when compared to non-smokers and that masking of some periodontal signs can be a result of nicotine's vasoconstrictor effect.

Smoking and caries experience in subjects with various form of periodontal diseases from a teaching hospital clinic

OBJECTIVE

The aim of this study was to assess the relationships between aggressive periodontitis (AgP), caries and smoking.

METHOD AND MATERIALS

A cross-sectional study was conducted among patients who were specifically referred to the Dental Teaching Clinic in Irbid, Jordan for periodontal treatment. Self-administered questionnaire related to socio-demographic data and smoking habits was completed. The oral hygiene, gingival status, periodontal health and dental status of the participants was determined by using the plaque index of Silness and Loe [Acta Odontol Scand, 22 (1964), 121], the gingival index of Loe and Silness [Acta Odontol Scand, 21 (1963), 233], clinical attachment level (CAL) and decayed, missing and filled teeth (DMFT) index respectively.

RESULT

The prevalence of smoking was greater in chronic periodontitis (CP) group (44.2%) than in either chronic gingivitis (CG) (27.4%) or AgP (29.9%) group. Self-reported perio-diseases in the close family was more prevalent (77%) among subjects diagnosed with AgP. The mean plaque scores were significantly higher for smoker than non-smoker in AgP group only (P = 0.04), with significantly greater plaque and gingival scores in CG and CP groups than AgP group (P = 0.012, 0.004). A significantly greater mean gingival scores were noted among CG and CP groups than AgP group (P = 0.004). The mean CAL was higher in smokers than in non-smokers in the three groups, with statistically significant differences in CP and AgP groups (P = 0.04, 0.01 respectively).The mean number of DMFT was significantly higher in smoker than in non-smoker of all age groups (P = 0.016, 0.043 and 0.01). However, mean DMFT was significantly greater in CP and CG than AgP groups.

CONCLUSION

It was concluded that (i) higher plaque and gingival index among smokers in all groups; (ii) significant difference in the CAL between smoker and non-smoke in CP and AgP groups; (iii) significant increase in caries risk among smokers in all groups; (iv) smokers and non-smokers of AgP group had significantly lower mean DMFT scores than those of CG or CP groups.

Risk Assessment for Severe Clinical Attachment Loss in an Adult Population

BACKGROUND

This study was carried out to identify variables related to severe clinical attachment loss (CAL) in an adult French population.

METHODS

This cross-sectional survey employed 2,132 subjects of the First National Periodontal and Systemic Examination Survey (NPASES I) aged 35 to 64 years, each with at least six teeth. A nationally representative sample was obtained from September 2002 to June 2003 by a quota method stratified on age, gender, socioeconomic status, and geographic areas. The subjects had a complete full-mouth periodontal examination of four sites per tooth, assessment of missing teeth, and a number of laboratory tests and questionnaires. The periodontal status of each subject was assessed by criteria based on the severity and extent of CAL. The data were analyzed by univariable and multivariable models using logistic regression analyses.

RESULTS

Nineteen and seven-tenths percent (19.7%) of the subjects had CAL>5 mm. When dental variables were not included in the analysis (model 1), age (odds ratio [OR]=1.8), male gender (OR=1.7), body mass index (OR=1.2), and white blood cell count (OR=2.2) showed significant association with severe CAL. A significantly higher risk was also present in non-drinkers and regular drinkers compared to occasional drinkers (OR=1.6). Model 2, including dental variables in addition to model 1 variables, showed that a significantly higher risk for severe CAL was also present with age (OR=1.6) and in males (OR=1.7). The number of teeth (OR=1.1), and the mean gingival bleeding index (OR=1.7) were the dental variables significantly associated with severe CAL.

CONCLUSIONS

The results indicated that age and gender are powerful independent predictors of clinical attachment loss, as is the mean gingival bleeding index. To a lesser extent, the number of missing teeth was a good predictive variable. The patient profile for severe clinical attachment loss also included body mass index and white blood cell count. Occasional drinking may be associated with decreased severity of CAL.

Mechanisms of action of environmental factors--tobacco smoking

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.

Tobacco smoking and subgingival dental calculus

OBJECTIVE

A radiographic investigation into the relationship between tobacco smoking and subgingival dental calculus was conducted in an adult population, including 48 current smokers, 57 former smokers, and 125 non-smokers.

MATERIAL AND METHODS

Assessment of subgingival calculus was based on a full set of radiographs. Mesial and distal root surfaces were assessed as to presence or absence of radiopaque deposits apical to the cemento-enamel junction. The severity of subgingival calculus deposition, labeled subgingival calculus load, was estimated from both the total number and the proportion of proximal sites affected.

RESULTS

The overall prevalence of individuals exhibiting at least one subgingival calculus positive site was 43%, ranging from 15% in age stratum 20-34 years to 72% in age stratum 50-69 years. The prevalence among current smokers, former smokers, and non-smokers was 71%, 53%, and 28%, respectively. The differences between smoking groups were statistically significant (p<0.001). The mean subgingival calculus load of current smokers, former smokers, and non-smokers was 3.4, 1.2, and 0.6 affected sites per person, respectively, or expressed as mean proportions, 6.2%, 2.4%, and 1.1%, respectively. The association between smoking and subgingival calculus load was statistically significant (p<0.001). The subgingival calculus load increased with increasing smoking exposure, suggesting a dose-response relationship.

CONCLUSION

The present observations in dentally aware adults indicate a strong and independent impact of tobacco smoking on subgingival calculus deposition.

Salivary calcium reflects skeletal bone density of heavy smokers

OBJECTIVE

Our recent studies suggest, that elevated calcium concentration of saliva is characteristic of periodontitis. In this study we analyzed the effect of smoking on salivary calcium and bone density by comparing the level of salivary calcium and the ultrasound scale of bone density of heavy smokers to those of non-smokers.

DESIGN

Salivary samples were collected from 603 women (50-62 years) participating in a pre-screen referral program for osteoporosis. Out of this group a total of 577 were accepted for the present study. General health, medications and tobacco smoking were recorded. The group included 487 non-smokers, 37 moderate smokers (1-10 cigarettes per day) and 53 heavy smokers (>10 cigarettes per day). Bone density was measured at the right heel by the quantitative ultrasound technique. Calcium and phosphate concentrations of saliva were measured and expressed as microg/ml of saliva.

RESULTS

The ultrasonographic variables of the heel, broadband ultrasound attenuation (BUA), speed of sound (SOS) and T-score (a standard deviation unit from mean values of healthy young adults) of heavy smokers were significantly lower than those of women who did not smoke (P = 0.007, 0.014 and 0.011, respectively). Salivary calcium concentration of heavy smokers 70.5 (14.6) microg/ml was higher than that of non-smokers 64.0 (14.1) microg/ml (P = 0.001). There were no significant differences in salivary phosphate level or in the salivary flow rate between heavy smokers and non-smokers.

CONCLUSIONS

Heavy smokers seem to have lower bone mineral density and higher salivary calcium than their non-smoking counterparts. We suggest that the high salivary calcium concentration of smokers is in connection with skeletal calcium disturbances.

Effect of a combination of amine/stannous fluoride dentifrice and mouthrinse in periodontal maintenance patients

AIM

The purpose of the present study was to evaluate the beneficial effect of using a dentifrice and mouthrinse containing amine fluoride (AmF) and stannous fluoride (SnF(2)) in a group of periodontal maintenance patients. Efficacy parameters were plaque, gingival inflammation, pocket depth and attachment loss. An additional parameter was development of stain.

MATERIAL AND METHODS

In total, 80 patients who had been treated for moderate-to-severe periodontitis agreed to participate in this study. Subjects received supportive periodontal therapy at regular intervals of 3-4 months for at least a period of 1 year. The patients were randomly divided into two groups: (1). the test group used an AmF/SnF(2) dentifrice and mouthrinse and (2). the control group used a sodium fluoride (NaF)-containing dentifrice and mouthrinse. Clinical assessments were performed at baseline, 3, 6, 12, 18 and 24 months.

RESULTS

The mean plaque index score after 3 months in the test group (0.24) was significantly lower than that in control group (0.34) (p<or=0.05), a difference that was maintained throughout the remainder of the study. In terms of bleeding on probing, at no point in time were significant differences between test and control group found. No significant differences were noted between the two groups, nor were there any significant changes in comparison with baseline values with respect to pocket depth and attachment level. At baseline, the mean percentage of sites with no staining was 98% for both the test and control groups. At all further assessments, the staining in both groups was elevated as compared with baseline. Smoking did not affect the outcome of the study.

CONCLUSION

The combined use of an AmF/SnF(2) dentifrice and mouthrinse did not affect the parameters of inflammation (bleeding upon marginal probing and probing pocket depth), but it has shown to be more effective in terms of plaque reduction when compared with the use of an NaF dentifrice and mouthrinse in a group of periodontal patients placed under regular maintenance care.

Effect of smoking and periodontal treatment on the subgingival microflora

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

The effects of cigarette smoking on the periodontal condition of young Jordanian adults

BACKGROUND

Several studies have reported an association between smoking and periodontal destruction in young adults.

AIMS

To investigate the effects of cigarette smoking on the periodontal condition of young Jordanian adults.

METHODS

A case-control study of young adults between the ages of 20 and 35 years who were attending a dental hospital in Jordan for routine dental treatment. A group of 100 subjects who had smoked for at least 2 years were compared with 100 age- and sex-matched never smokers. Clinical measurements of plaque, bleeding on probing and probing depth were recorded and interproximal bone levels related to molar teeth were assessed from bitewing radiographs.

RESULTS

The smokers had higher levels of plaque, more sites which bled in response to probing and a greater mean probing depth than never smokers. The unadjusted odds ratio for smoking to be associated with the presence of more than 10 pockets which were > or =4 mm was 3.08 (95% confidence interval 1.58-6.03). The proportion of measurable surfaces in smokers (22.7%) which had bone levels > or =3 mm below the cementoenamel junction was significantly higher (P<0.0001) than in never smokers (7.4%). Independent predictors of reduced bone levels in multivariate analysis were infrequent interdental cleaning (P=0.03), age of 30 or older (P=0.03) and smoking (P<0.0001). Within the multivariate analysis the adjusted odds ratio for smoking to be associated with reduced molar bone levels was 4.95 (confidence interval 2.48-9.88).

CONCLUSIONS

It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in the young adult Jordanians investigated.

Mechanisms of cytotoxicity of nicotine in human periodontal ligament fibroblast cultures in vitro

The use of tobacco products significantly contributes to the progression of periodontal disease and poor response to healing following periodontal therapy. The purpose of this study was to determine the effects of nicotine, a major component of cigarette smoking, on human periodontal ligament fibroblast (PDLF) growth, proliferation, and protein synthesis to elucidate its role in periodontal destruction associated with its use. Human PDLFs were derived from three healthy individuals undergoing extraction for orthodontic reasons. At a concentration higher than 2.5 mM, nicotine was found to be cytotoxic to human PDLFs (P < 0.05). Nicotine also significantly inhibited cell proliferation and decreased protein synthesis in a dose-dependent manner. At concentrations of 50 and 200 microM, nicotine suppressed the growth of PDLFs by 48% and 86% (P < 0.05), respectively. A 10-mM concentration level of nicotine significantly inhibited the protein synthesis to only 44% of these in the untreated control (P < 0.05). Furthermore, the effects of antioxidants (superoxide dismutase (SOD); catalase and 2-oxothiazolidine-4-carboxylic acid (OTZ) and buthionine sulfoximine (BSO) were added to search for the possible mechanism of action, as well as a method for the prevention, of cigarette smoking-associated periodontal diseases. The addition of OTZ, a precursor of cysteine that metabolically promotes GSH synthesis, acted as a protective effect on the nicotine-induced cytotoxicity. However, SOD and catalase did not decrease the nicotine-induced cytotoxicity. In contrast, the addition of BSO, a cellular GSH synthesis inhibitor, enhanced the nicotine-induced cytotoxicity. These results indicate that thiol depletion could be the mechanism for nicotine cytotoxicity. The levels of nicotine tested inhibited cell growth, proliferation, and protein synthesis on human PDLFs. This suggests that nicotine itself might augment the destruction of periodontium associated with cigarette smoking. In addition, these inhibitory effects were associated with intracellular thiol levels. Factors that induce glutathione synthesis of human PDLF may be used for further chemoprevention of cigarette smoking-related periodontal diseases.

Prevalence and severity of periodontal disease at mandibular molar teeth in smokers with regular oral hygiene habits

BACKGROUND

Smoking appears to be detrimental to health because it has been associated with several diseases including cancer and cardiovascular diseases. Smoking also appears to be a major environmental factor associated with periodontal disease progression. The objective of this study was to evaluate the prevalence and severity of periodontal destruction as influenced by smoking in a Thai population.

METHODS

Gingival health and periodontal conditions at mandibular molar furcation sites in 120 Thai dental patients (60 smokers and 60 never-smokers, age range 31 to 60 years) with generally high oral hygiene standards and regular dental care habits were evaluated.

RESULTS

Smokers exhibited more frequent and severe mandibular molar periodontal destruction than never-smokers. The prevalence and severity of gingival recession, periodontal pocket formation, clinical attachment loss, furcation involvement, and tooth mobility were significantly increased in smokers compared to never-smokers. Seventy-three percent of the smokers exhibited furcation involvement in contrast to only 20% of the never-smokers.

CONCLUSIONS

The results of this study suggest that smoking appears to be a major environmental factor associated with accelerated periodontal destruction in adult smokers with generally high oral hygiene standards and regular dental care habits in a Thai population.

Tobacco use and oral hygiene as risk indicators for periodontitis

OBJECTIVE

To detect the periodontal status of male smokers and betel chewers in a rural community in Sri Lanka and compare it with that of male non-tobacco users of the same community.

METHODS

A cross-sectional community based study was carried out in a sample of 2277 rural adult males aged 20-60 years, adopting multistage cluster sampling technique. The present analysis was confined to 2178 subjects who were mutually exclusive smokers, betel chewers or non-tobacco users. The periodontal status was assessed by clinical measurement of levels of bacterial plaque (PLI), gingival inflammation (GI) and loss of epithelial attachment (LA). All measurements were carried out on four sites of all teeth present except third molars and the mean values for periodontal parameters were calculated.

RESULTS

Bivariate analysis revealed that the overall periodontitis levels were significantly higher in betel chewers and smokers than in non-tobacco users. Multiple linear regression analysis showed that there were no significant effects of smoking and betel chewing per se on LA, independent of age, socioeconomic status (SES) and whether or not controlled for PLI. The effect of the quantified tobacco use on LA was statistically significant regardless of age, PLI or SES. However, the effect of the quantified tobacco use was considered limited when compared to that of oral hygiene.

CONCLUSIONS

The findings highlighted the importance of oral hygiene in the aetiology of periodontitis while confirming the statistical significance of the quantified tobacco use on LA. Oral hygiene and the quantified tobacco use may be considered as risk indicators for periodontitis.

Longitudinal association between plaque and gingival bleeding in smokers and non-smokers

BACKGROUND/AIMS

Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site-specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non-smoking young adults.

METHODS

65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non-smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site-specific analyses considering the correlated structure of data were performed.

RESULTS

At the outset and after 6 months, smokers had significantly more supragingival plaque than non-smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site-by-site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non-smokers (median Mantel-Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non-bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking.

CONCLUSIONS

In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non-bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.

Gingival recession in smokers and non-smokers with minimal periodontal disease

BACKGROUND/AIMS

Smoking is a major risk factor for destructive periodontal disease. There is limited information with regard to effects of smoking in subjects with minimal periodontal destruction. The aim of the present investigation was to assess the development of gingival recession in young adult smokers and non-smokers.

METHODS

61 systemically healthy young adults, 19 to 30 years of age completed the final examination. 30 volunteers smoked at least 20 cigarettes per day, whereas 31 subjects were non-smokers. Clinical periodontal conditions were assessed 4x within a time period of 6 months. Site-specific analyses considering the correlated structure of data were performed.

RESULTS

At the outset, 50% of subjects presented with gingival recession at 1 or more sites. There was no significant difference in the prevalence of gingival recession between non-smokers and smokers. Severe recession in excess of 2 mm affected about 23% non-smokers but only 7% smokers. Some further gingival recession developed during the 6-month observation period. In a multivariate logistic regression analysis, the risk for recession development appeared not to be influenced by smoking status after adjusting for periodontal probing depth, recession at baseline, tooth brushing frequency, gender, jaw, tooth type and site.

CONCLUSIONS

Present data did not support the hypothesis that smokers are at an increased risk for the development of gingival recession.

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets

AIM

The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers.

METHODS

The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated.

RESULTS

No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth.

CONCLUSIONS

The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.

The natural history of periodontal disease in man. Risk factors for progression of attachment loss in individuals receiving no oral health care

BACKGROUND

Few investigations have reported on risk factors for periodontal attachment loss over time in subjects with no home or professional dental care. The purpose of this report was to identify potential risk factors for progression of periodontal attachment loss among male Sri Lankan tea laborers who participated in a 20-year investigation of the natural history of periodontal disease.

METHODS

Data for this report were obtained from the 154 subjects who participated in the 1970 baseline and the final 1990 examinations and included data from their interim examinations performed in 1971, 1973, 1977, 1982, and 1985. Oral health assessments included: 1) attachment levels in millimeters on mesial and mesio-buccal surfaces of all but third molar teeth; 2) plaque index (PI); 3) gingival index (GI); 4) calculus index (CI); 5) caries index (DMFS); and 6) presence or absence of teeth. Other variables included age, history of smoking, and/or use of betel nut. Statistical analyses used multivariate repeated measures analysis of variance (ANOVA).

RESULTS

The final adjusted model indicated that attachment loss increased significantly with age (X2 = 74.0; df = 1), GI (X2 = 45.5; df = 1), CI (X2 = 52.7; df = 1) and follow-up time (X2 = 219.8; df = 6, P<0.0001 for all variables).

CONCLUSIONS

Age, GI, CI, and time were significantly associated with mean attachment loss over 20 years. Neither PI, history of smoking, or history of betel nut use were significantly associated with attachment loss over time.

Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status. A 10-year longitudinal study

BACKGROUND, AIMS

The primary purpose of this study was to determine the association of salivary and gingival crevicular fluid (GCF) cotinine levels with periodontal disease status in smokers and non-smokers.

METHODS

147 male smokers and 30 male non-smokers were included in the current longitudinal study. The 177 individuals were part of a group of 200 subjects (89%) seen 10 years previously for a baseline survey. Oral hygiene indices, probing depth and attachment loss were recorded. Salivary and GCF cotinine levels of 58 smokers were determined by means of ELISA.

RESULTS

Results indicated that no significant difference was found in subjects who smoked, when compared to subjects who did not smoke with respect to plaque accumulation and calculus deposits. Smokers, however, had fewer gingival bleeding sites. Cigarette smoking was associated with a greater increase in probing depth and attachment loss, as well as greater tooth loss at an earlier age. There was greater tooth loss in smokers than non-smokers (p < 0.001). 11 smokers became edentulous, while only 1 non-smoker lost all his teeth within 10 years. The degree of periodontal tissue breakdown was different in each age group with greater periodontal deterioration as age increased. All smokers had detectable salivary and GCF cotinine. Mean GCF cotinine was about 4x higher than mean salivary cotinine levels. Individuals who smoked > or = 20 pack years when compared to <20 pack years, had significantly higher saliva and GCF cotinine levels (p < or = 0.05).

CONCLUSION

Neither salivary cotinine nor GCF cotinine was significantly correlated with probing depth, attachment loss and tooth loss (p > 0.05).

The influence of nicotine on the bone loss rate in ligature-induced periodontitis. A histometric study in rats

BACKGROUND

The present study investigated the possible influence of nicotine on the bone loss rate in the furcation region due to ligature-induced periodontitis in rats.

METHODS

Twenty adult male Wistar rats were included. After anesthesia, the tooth was randomly assigned to receive the cotton ligature in the sulcular area, while the contralateral tooth was left unligated. The animals were randomly assigned to one of the following treatments, including daily intraperitoneal injections: group A, 2 microl/g body weight of saline solution; group B, 2 microl/g body weight of a nicotine solution with 0.13 microl of nicotine/ml of saline solution; group C, 2 microl/g body weight of a nicotine solution with 0.19 microl of nicotine/ml of saline solution; and group D, 2 microl/g body weight of a nicotine solution with 0.26 microl of nicotine/ml of saline solution. Thirty days later, the animals were sacrificed and the specimens routinely processed for serial decalcified sections.

RESULTS

Intergroup analysis revealed greater bone loss in the ligated teeth of group B (1.01 +/- 0.61 mm2), group C (1.14 +/- 0.72 mm2), and group D (1.36 +/- 0.60 mm2) when compared with group A (0.64 +/- 0.62 mm2) (P <0.01). However, no statistically significant differences in bone loss were found among groups B, C, and D. In addition, no bone loss was observed for unligated teeth (P>0.01).

CONCLUSIONS

Within the limits of the present study, nicotine enhanced the effects of the local components of periodontal disease in a non-dose-dependent way; nevertheless, the administration of nicotine did not produce periodontal bone loss by itself.

The prevalence of pathogenic periodontal microflora in healthy young adult smokers

BACKGROUND

Smoking is a major risk factor in periodontitis, although the mechanisms of its effects are not well understood. The overall goal of this clinical study was to determine if smoking enhances the colonization of the oral cavity by pathogenic bacteria in a periodontitis-free population. The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens, Bacteroides forsythus, and Treponema denticola was investigated in 25 smokers and 25 non-smokers by using DNA probes.

METHODS

The subjects were 21 to 35 years of age with a healthy periodontium or slight gingivitis and were systemically healthy. The test group included subjects who had a minimum of a 1.5 pack-year history of smoking, while the control subjects never smoked. Subgingival plaque samples were taken by paper point following the assessment of multiple clinical parameters.

RESULTS

This investigation showed: 1) no statistically significant differences were noted in any clinical parameter measured between the groups; 2) of the 8 subjects who were infected by at least 1 tested pathogen, seven were smokers (P= 0.02); 3) infected smokers had a 15.7+/-3.5 pack-year history and smoked a mean of 27+/-5 cigarettes/day versus 4.4+/-0.8 pack years and 15+/-1 cigarettes/day for the non-infected smokers (P = 0.0001 and P = 0.004); and 4) smokers were 18 times more likely to exhibit the presence of pathogens than non-smokers.

CONCLUSIONS

These data indicate that the prevalence of colonization of the sulcus by pathogenic bacterial species in periodontitis-free individuals is related to the quantity and duration of cigarette smoking.

The effect of smoking and periodontal treatment on salivary composition in patients with established periodontitis

BACKGROUND

The purpose of this study was to evaluate the effect of smoking on the periodontal status and the salivary composition in subjects with established periodontitis before and after periodontal therapy.

METHODS

Our study group included 26 healthy subjects, 12 smokers and 14 non-smokers with established periodontitis. Clinical measurements and non-stimulated whole saliva were obtained and analyzed at baseline and after scaling and root planing. Smokers presented at baseline with significantly greater probing depth (4.16+/-0.26) compared to non-smokers (3.52+/-0.32) which was statistically significant (P = 0.0268); likewise, baseline clinical attachment level was greater in smokers (4.49+/-0.31 compared to non-smokers 3.87+/-0.13; P = 0.0620). Mean plaque index was also greater in smokers compared to non-smokers (0.86 and 0.65, respectively; P = 0.0834). Baseline pretreatment sodium values were significantly greater in non-smokers (14.36 mEq/l compared to 9.31 mEq/l in smokers; P = 0.0662); likewise non-smokers exhibited 50% greater salivary calcium levels (6.04 mg/100 ml compared to 4.32 mg/100 ml in smokers; P = 0.0133).

RESULTS

Post-treatment probing depth and clinical attachment level were not different between smokers and non-smokers; this in spite of significant difference in plaque index in smokers (0.35 compared to 0.13 in non-smokers; P = 0.0135). Post-treatment, smokers had reduced calcium concentration (3.58 mg/100 ml compared to 5.11 mg/100 ml in non-smokers; P = 0.0438). Treatment affected albumin level in smokers only, consequently non-smokers had significantly greater salivary albumin concentration (1.1 mg/100 ml compared to 0.38 mg/100 ml in smokers; P = 0.0274).

CONCLUSIONS

Subjects with established periodontitis exhibited elevated concentrations of salivary electrolytes and proteins. Within this study group, smokers exhibited greater disease level but reduced sodium, calcium, and magnesium concentrations. Smokers responded favorably to treatment. The clinical improvement eliminated the differences in salivary composition.

Cigarette smoking and periodontitis: methodology to assess the strength of evidence in support of a causal association

Identification of the cause of the development and progression of periodontitis has received extensive attention, with notable advances over the past decade in clinical, microbiological, immunological, biochemical, and behavioral knowledge. However, it is still largely unknown which factors lead to the conversion of non-destructive forms of periodontal disease into destructive forms and disease progression. Chronic adult periodontitis is believed to be influenced by an interaction of host defense and environmental factors. Although these variables have been studied extensively, no study has employed randomized controlled prospective human or randomized controlled community intervention designs, methodologies necessary to prove a variable to be a cause of periodontitis. Owing to the absence of literature employing rigorous experimental design, this article assesses systematically observational, cross-sectional and longitudinal studies to examine the potential causal association between cigarette smoking and periodontitis. The methodology of Sir Bradford Hill's criteria for causation was used as the framework. Results suggest that cigarette smoking is causally associated with periodontitis. That is, cigarette smoking is consistently associated with an increased prevalence/severity of periodontitis and is suspected on theoretical grounds of playing a causal role. Hill's criteria provide a useful methodology to better understand the pathogenesis of periodontal diseases and may be applied to study the pathogenesis of other dental diseases as well.

Psychosocial factors, dental plaque levels and smoking in periodontitis patients

Psychological disturbances may lead patients to neglect oral hygiene. This study investigated whether a number of psychosocial factors (depression, state and trait anxiety, total and average perceived stress, and loneliness) could predict dental plaque levels in patients with adult onset rapidly progressive periodontitis (RPP) and routine chronic adult periodontitis (RCAP), before periodontal treatment. It was also examined whether RPP and RCAP patients differed on plaque and smoking. Plaque was scored in a sample of 6 teeth in each of 80 subjects, 40 with RPP, 40 with RCAP, before psychosocial questionnaire completion. Multiple regression was performed between plaque as the dependent and psychosocial factors, gender, education, form of periodontitis and smoking as independent variables. Only gender contributed significantly to prediction of plaque, t=-2.70, p=0.01, partial regression coefficient -0.37, 95% CI: -0.64 to -0.10, indicating that plaque was on average 0.37 lower for females than males, after adjusting for the other predictor variables. It was confirmed that RPP and RCAP patients did not differ significantly on plaque, univariate t-test(69.99)= 0.65, p=0.13. However, RPP patients smoked significantly more than RCAP patients t(69.72)=2.36, p=0.02. There was also a marginally significant correlation between depression and smoking, r=0.16, p=0.07. One possible reason advanced for the lack of an association between psychosocial factors and plaque, and the absence of a difference in plaque between RPP and RCAP patients is the fact that the patients involved in the present study were seen as secondary referrals. The gender difference in plaque levels and the greater incidence of smoking in RPP patients may be of significance in planning interventions with patients with periodontitis.

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

The aim of the present study was to examine the dental status and smoking habits in randomized samples of 35-, 50-, 65-, and 75-year-old subjects (n = 1093), recruited for a cross-sectional epidemiological study in the County of Värmland, Sweden. The following clinical variables were recorded by 4 well-calibrated dentists: number of edentuolous subjects, number of missing teeth, probing attachment level, furcation involvement, CPITN scores, DMF surfaces, plaque and stimulated salivary secretion rate (SSSR). In addition, the subjects reported in a questionnaire their tobacco habits, oral hygiene habits, dietary habits etc. The percentage of smokers in 35-, 50-, 65-, and 75-year-olds was 35%, 35%, 24% and 12%, respectively. In 75-year-olds, 41% of the smokers were edentulous compared to 35% of non-smokers. The difference in number of missing teeth between smokers and non-smokers was 0.6 (p=0.15), 1.5 (p=0.013), 3.5 (p=0.0007) and 5.8 (p=0.005) in the 4 age groups. Smokers had the largest mean probing attachment loss in all age groups. The differences between smokers and non-smokers in mean attachment level were 0.37 (p=0.001), 0.88 (p=0.001), 0.85 (p=0.001) and 1.33 mm (p=0.002) in the 35-, 50-, 65-, and 75-year-olds, respectively. Treatment need assessed by CPITN was in all age groups greatest among smokers. The number of intact tooth surfaces was fewer in 35-, 50-, and 75-year-old smokers than in non-smokers. The number of missing surfaces (MS) was higher in 50-, 65-, and 75-year-old smokers than in non-smokers. In addition, 35-year-old smokers exhibited a significantly larger number of decayed and filled tooth surfaces (DFS) than non-smokers. Male smokers had significantly higher SSSR than non-smoking males (p=0.012). Plaque index and oral hygiene were similar in smokers and non-smokers. Smokers reported a more frequent intake of sugar containing soft drinks (p=0.000) and snacks (p=0.003) than non-smokers. The opposite was reported for consumption of fruit (p=0.003). It was concluded that smoking is a significant risk indicator for tooth loss, probing attachment loss and dental caries.

Results of limited initial periodontal therapy in smokers and non-smokers

Eighty-seven adult patients (54 non-smokers and 33 smokers) with moderate to advanced periodontitis were treated with 1-hour full-mouth subgingival scaling and root planing, with no maintenance recalls, during this 9-month study. Clinical parameters assessed at target sites included probing depth, clinical attachment level, bleeding on probing, gingival index, and plaque index. Data were collected at baseline, and 3, 6, and 9 months. Baseline probing depth for non-smokers was 5.46 +/- .46 mm and for smokers 5.70 +/- 0.66 mm. Data analysis (t test) revealed that both non-smokers and smokers had a statistically significant decrease (P < 0.05) in probing depth at 3 months which was maintained throughout the study. At 9 months non-smokers maintained a mean decrease in probing depth of 0.60 mm and smokers a mean decrease of 0.65 mm. Both smokers and non-smokers displayed a significant gain (P < 0.05) in clinical attachment level after initial therapy when compared to baseline readings. At 9 months the mean gain in clinical attachment level for non-smokers was 0.47 mm and 0.59 mm for smokers. Plaque index scores remained consistent for smokers and non-smokers for the duration of the study. The gingival index at baseline was significantly (P < 0.05) lower in smokers (1.32 +/- 0.45) than non-smokers (1.45 +/- 0.40). By 9 months only the gingival index of non-smokers decreased significantly compared to baseline (1.26 +/- 0.37). Bleeding on probing was a prerequisite for target sites at baseline. At 9 months both smokers (0.67 +/- 0.39) and non-smokers (0.78 +/- 0.30) had a significant decrease in bleeding on probing compared to baseline. At 9 months there were no significant differences between smokers and non-smokers comparing probing depth, clinical attachment level, plaque index, bleeding on probing, and gingival index. The data have shown that smokers and non-smokers responded similarly after 9 months to the limited amount of initial therapy provided.

Relation between smoking and periodontal disease by oral hygiene status in Japanese factory workers

The relation between smoking and periodontal disease as classified by the Community Periodontal Index of Treatment Needs (CPITN) code was investigated in 1,611 Japanese male factory workers in Osaka, 20-59 years of age. The Simplified Debris Index (DI-S) according to the Simplified Oral Hygiene Index was employed as an index for the quantity of dental plaque. For the items related to smoking, a self-reporting form on smoking, the number of years of smoking, and the number of cigarettes smoked was distributed prior to the oral examination. Our results indicated the following: in the group with a poor state of oral hygiene, the negative effects of smoking were evident, resulting in unhealthy periodontal tissue. We believe that this result further confirms the contention that the removal of dental plaque is most important as a prophylaxis for periodontal diseases, and public education about this negative consequence of smoking will further strengthen prophylactic measures.

The relationship of smoking on peri-implant tissue: a retrospective study

The term "peri-implantitis" is used to describe the formation of deep mucosal pockets around dental implants, inflammation of the peri-implant mucosa, and increased resorption of peri-implant bone. It has been speculated that when left untreated, peri-implantitis can result in implant failure. This retrospective study examines a possible correlation between smoking and the appearance of peri-implantitis. The clinical and radiographic observations of 366 implants in 107 patients who smoke were compared with those of a group of 1000 implants in 314 nonsmoking patients. Despite the retrospective nature of this study, a comparison between the two groups was possible. The mean follow-up period, mean patient age, implant locations, and percentages of fixed partial dentures and overdentures were consistent in both groups. There was no significant difference in the mean maxillary and mandibular hygienic indices between the group of smokers and that of nonsmokers. However, the group of smokers showed a higher score in the bleeding index, the mean peri-implant pocket depth, the degree of peri-implant mucosal inflammation, and radiographically discernible bone resorption mesial and distal to the implant. In the maxilla of the smoking group, these observations were significantly higher than both the mandibular observations for smokers and the maxillary observations of the group of nonsmokers (p < 0.01). No differences between the two groups were observed in the mandible. Aside from the systemic effects of tobacco smoking on the human organism, local cofactors seem to be responsible for the higher incidence of peri-implantitis in smokers and have a particularly negative effect on the maxilla. These findings confirm that smokers treated with dental implants have a greater risk of development of peri-implantitis.

Serum cotinine levels, smoking, and periodontal attachment loss

Cigarette smoking and tobacco use have been the subjects of numerous studies for many years. Smoking has also been associated with periodontal disease. However, no relationship between a reliable biochemical marker and increased severity of the periodontal condition has yet been described. It was thus the aim of this study to apply the measurement of cotinine, the major metabolite of nicotine, as a quantitative method to assess levels of smoking, and to correlate serum levels of cotinine with severity of periodontal disease. The degree of association between smoking and periodontal attachment loss was investigated in a study including 79 patients 25 to 64 years old suffering from periodontitis. Patients were examined and the following parameters recorded: Gingival Assessment (GA), Probing Pocket Depth (PPD), Clinical Attachment Level (CAL), and Bone Crest Height (BCH). In addition, self-reported histories of tobacco use as well as blood samples for quantitative analysis of serum levels of cotinine were taken. The serum samples were analyzed for cotinine content by means of a competitive-inhibition ELISA technique. The differences in mean cotinine levels were statistically significant (p = 0.0001) between smokers and non-smokers, showing no overlap between the groups. Severity of periodontal attachment loss was positively correlated with serum levels of cotinine for both measures of periodontal disease (CAL p = 0.005; BCH p = 0.008). Results from the present study indicate that serum cotinine levels used as a biochemical marker of smoking status are correlated with severity of periodontal attachment loss.

Initial study of periodontal status in non-insulin-dependent diabetics in Mauritius

OBJECTIVES

Investigation of Mauritian non-insulin diabetic periodontal health.

METHODS

In Port Louis, the capital of Mauritius, 24 patients with non-insulin-dependent diabetes mellitus were matched by age with 24 controls. Because matching was incomplete for gender and race, the groups were treated as independent for data analysis. Operator-blind scores were recorded for the presence of plaque, bleeding on probing, probing depth, recession and probing attachment level.

RESULTS

When variations in plaque and age were taken into account, there was a significant difference in probing attachment level between the groups (diabetic mean = 4.16 mm, control mean = 3.09 mm), and an effect of gender on gingival bleeding which may relate to tobacco smoking.

CONCLUSION

In an isolated community with a 13% prevalence of NIDDM, this study confirms previous periodontal findings regarding the effect of the disease.

Inhibition of neutrophil and monocyte defensive functions by nicotine

To learn more about the effects of smokeless tobacco on the defensive functions of neutrophils, we studied the influence of nicotine on these cells in vitro, looking at their bactericidal activity against oral pathogens, and at their ability to produce microbicidal reactive oxygen species (oxygen radicals). Exposure of human blood neutrophils to nicotine (0.01% to 0.1%) inhibited their ability to kill Actinomyces naeslundii, Actinobacillus actinomycetemcomitans, and Fusobacterium nucleatum. Although these concentrations of nicotine are high, such concentrations are relevant to phagocytes in the gingival sulcus, because smokeless tobacco contains 0.5% to 3.5% nicotine by dry weight. Nicotine had no such inhibitory effect when the killing assay was performed in an anaerobic environment, implying that nicotine preferentially affected oxygen-dependent killing mechanisms. To further investigate the effects of nicotine on production of oxygen radicals, neutrophils were primed with lipopolysaccharide and triggered with f-met-leu-phe or phorbol ester in the presence of nicotine. Nicotine inhibited production of superoxide anion (measured by reduction of cytochrome c) and hydrogen peroxide (measured by oxidation of phenol red). Nicotine inhibition of superoxide production was reversible by washing away the nicotine. By observing that nicotine inhibited the reduction of cytochrome c by reagent potassium superoxide, we determined that nicotine directly absorbed superoxide. In addition, by examining nicotine inhibition of the uptake of oxygen by neutrophils, we determined that nicotine also interfered with the production of oxygen radicals by these cells. Nicotine also inhibited production of superoxide and interleukin-1 beta by monocytes. Nicotine did not affect the viability of neutrophils and monocytes, as determined by their ability to exclude trypan blue dye. Inhibition of the aerobic antimicrobial functions of neutrophils and monocytes by nicotine may alter the microbial ecology of the oral cavity, and this might be one mechanism by which nicotine compromises the oral health of users of tobacco products.

Smoke signals: an alert for oral disease

Since the early 1600s, questions have been raised about the ill effects of smoking. Tobacco has long been linked to oral cancer and leukoplakia, but research in the last 20 years suggests an association with other oral diseases as well. Studies concerning the effects of smoking on the periodontal diseases--and the mechanisms involved--are reviewed.

Periodontal status in an urban adult population in Sweden

The purpose was to describe the current periodontal status in a Swedish urban population aged 31-40 yr. 1681 individuals, 840 men and 841 women, participated in the study. 68.5% of the subjects had low amount of plaque, 82.8% low level of calculus and 28.9% healthy gingiva or mild gingivitis. 82.8% of the subjects had no pockets with probing depth (PD) > or = 5 mm. 4.9% of the subjects had one tooth with PD > or = 5 mm, 6.7% 2-5 teeth, 2.4% 6-9 teeth and 3.2% > or = 10 teeth with pockets. 55.8% of the subjects had no missing teeth, third molars excluded. 16.5% had one tooth missing, 23.8% 2-5 teeth, 2.7% 6-9 teeth and 1.2% > or = 10 teeth. 8.6% of the subjects had at least one front tooth missing, 28.7% one premolar and 24.1% one molar missing. Men had significantly higher scores than women for plaque (DI-S), calculus (CI-S), gingivitis (GI-M), and number and percent of remaining teeth with PD > or = 5 mm. Smokers had significantly higher scores than non-smokers for DI-S, CI-S, GI-M, number and percent of remaining teeth with PD > or = 5 mm, and number of missing teeth. The individuals who visited the dentist every year had better oral hygiene and gingival status than those who attended for > 3 yr. The multiple regression analysis showed that calculus (P = 0.0001) smoking (P = 0.001), and dental visits (P = 0.0284) were significantly correlated to the number of teeth with PD > or = 5 mm.

Tobacco use: a modifiable risk factor for dental disease among the elderly

OBJECTIVES

Because the public health literature contains few analytic studies of modifiable behavioral risk factors for dental disease among older community-dwelling populations, the New England Elders Dental Study was undertaken as an epidemiologic study of the oral health status of a representative sample of older adults living within the six New England states.

METHODS

Five dentists conducted comprehensive in-home oral health examinations on 1156 community-dwelling adults aged 70 and older to determine whether lifetime use of tobacco products was a significant risk factor for tooth loss, caries, and periodontal disease.

RESULTS

Among New England elders, tobacco use was more common among men (18.1%) than women (7.9%), with a combined rate of 12.3%. Further, 64.7% of men and 36.6% of women were previous tobacco users. Years of exposure to tobacco products was a statistically significant risk factor for tooth loss, coronal and root caries, and periodontal disease, regardless of other social and behavioral factors.

CONCLUSIONS

Lifelong tobacco use is a modifiable risk factor for poor dental health among older adults. Dental practitioners need to intervene with all their adult patients to discourage use of tobacco products for oral as well as general preventive health care.

Binding, uptake, and release of nicotine by human gingival fibroblasts

Previous studies of the effects of nicotine on fibroblasts have reported an altered morphology and attachment of fibroblasts to substrates and disturbances in protein synthesis and secretion. This altered functional and attachment response may be associated with changes in the cell membrane resulting from binding of the nicotine, or to disturbances in cell metabolism as a result of high intracellular levels of nicotine. The purpose of the present study, therefore, was to 1) determine whether gingival fibroblasts bound nicotine and if any binding observed was specific or non-specific in nature; 2) determine whether gingival fibroblasts internalized nicotine, and if so, at what rate; 3) determine whether gingival fibroblasts also released nicotine back into the extracellular environment; and 4) if gingival fibroblasts release nicotine intact or as a metabolite. Cultures of gingival fibroblasts were prepared from gingival connective tissue biopsies. Binding was evaluated at 4 degrees C using a mixture of 3H-nicotine and unlabeled nicotine. Specific binding was calculated as the difference between 3H-nicotine bound in the presence and absence of unlabeled nicotine. The cells bound 1.44 (+/- 0.42) pmols/10(6) cells in the presence of unlabeled nicotine and 1.66 (+/- 0.55) pmols/10(6) cells in the absence of unlabeled nicotine. The difference was not significant. Uptake of nicotine was measured at 37 degrees C after treating cells with 3H-nicotine for time periods up to 4 hours. Uptake in pmols/10(6) cells was 4.90 (+/- 0.34) at 15 minutes, 8.30 (+/- 0.75) at 30 minutes, 12.28 (+/- 2.62) at 1 hour and 26.31 (+/- 1.15) at 4 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of cigarette smoking on periodontal healing following surgical therapy

The influence of cigarette smoking on the outcome of surgical therapy was investigated in 54 patients, 24 of whom were smokers. The patients had moderate to severe periodontitis with persisting diseased pockets after non-surgical therapy. The surgical modality used was the modified Widman flap operation and the pockets under scrutiny were those with an initial probing depth of 4-6 mm. Re-examination was made 12 months following the completion of surgery. The probing depth reduction at the 12-month follow-up was 0.76 +/- 0.36 mm (mean +/- SD) in smokers as compared to 1.27 +/- 0.43 mm in non-smokers. The difference was statistically significant (P less than 0.001) and persisted after accounting for plaque. The results suggest that smoking may impair the outcome of surgical therapy.