Periodontal effects associated with the use of smokeless tobacco

Smokeless tobacco and periodontitis: A systematic review with meta-analysis

AIM

The present systematic review with meta-analysis aimed to investigate the global association between smokeless tobacco (SLT) use and periodontitis, considering significant effect size variation based on the income levels of countries.

METHODS

We searched seven databases to identify studies that assessed the prevalence of periodontitis in adult SLT users compared to non-users. The quality of studies was evaluated using the 10-item risk-of-bias tool, and publication bias was addressed through the trim-and-fill method. Sensitivity analysis utilized the leave-one-out approach. Meta-analysis and meta-regression, stratified by country income, SLT type, and smoking status, employed robust variance estimation.

RESULTS

From an initial pool of 484 studies, 29 studies met the selection criteria and were subjected to qualitative synthesis. Subsequently, data from 19 studies were included in the meta-analysis. SLT users exhibited a nearly threefold greater likelihood of periodontitis compared to non-users (OR = 2.99; 95% CI: 2.10, 4.27; p < .01). The pooled estimate did not vary significantly based on the type of SLT used or concurrent smoking. However, the odds of periodontitis varied according to the economic level of the country; the pooled estimate was higher in high-income countries (OR = 1.69; 95% CI: 1.20, 2.37; p < .01) and even higher in lower-middle-income and lower-income countries (OR = 3.91; 95% CI: 2.66, 5.77; p < .01).

CONCLUSIONS

Smokeless tobacco users have a higher likelihood of developing periodontitis. This study underscores global disparities in the SLT-periodontitis relationship, highlighting the need for targeted interventions, particularly in economically challenged areas where SLT use is largely unregulated.

Effects of Smokeless Tobacco on Oral Health: A Cross-Sectional Study

BACKGROUND

Smokeless tobacco (SLT) consumption poses a significant global public health challenge because of its adverse effects on oral health. Although the detrimental impact of SLT on oral tissues is well-documented, understanding its multifaceted effects is essential for effective prevention and intervention strategies.

OBJECTIVE

This study aimed to comprehensively assess the impact of SLT on oral health, focusing on various clinical parameters and their differences between placement and non-placement sites of SLT.

METHODS

A cross-sectional study involving 528 habitual users of SLT was conducted. Clinical parameters included the plaque index (PI), gingival index (GI), gingival bleeding index (GBI), gingival recession (GR), and probing depth (PD). Oral mucosal changes at SLT placement sites have also been reported. Statistical analysis was performed to compare parameters between the placement and non-placement sites.

RESULTS

 The study involved 528 subjects, mostly male (82%) and aged 21-40 years (mean±SD=31.14±9.10), habitual users of SLT. Prevalent SLT types included tobacco with betel nuts/masala/gutkha (59.9%) and tobacco with lime (54.5%). Significant differences were observed between SLT placement and non-placement sites: higher gingival inflammation (GI) at placement sites (1.54±0.61 vs. 1.45±0.54, p=0.01), lower GBI at placement sites (40.0% vs. 84.3%, p=0.001), and more prevalent GR (65.7% vs. 34.3%, p=0.03) at placement sites. Probing depths ≥ 3 mm were also less frequent at placement sites (2.67±0.72) than non-placement sites (3.37±1.03, p=0.001). These results highlight the detrimental impact of SLT on periodontal health, emphasizing the need for targeted interventions among SLT users.

CONCLUSION

SLT use is associated with adverse effects on oral health, including GI, plaque accumulation, gingival bleeding, GR, and changes in the oral mucosa. Targeted interventions and public health policies are needed to address these issues effectively.

The Prevalence of Smokeless Tobacco Consumption and Its Effects on Gingival and Periodontal Health Among the Adults in the Emirates of Sharjah, UAE - A Cross-Sectional Study

Introduction

Smokeless tobacco (SLT) has been linked with various oral signs and symptoms, such as oral mucosal lesions and gingival and periodontal effects. However, there is limited research on the prevalence of SLT use and its impact on gingival and periodontal health in the adult population of the Emirates of Sharjah.

Aim

To assess the prevalence of SLT consumption and its effects on gingival and periodontal health in the adult population of the Emirates of Sharjah.

Methods

The study evaluated 171 dentate patients aged 18-77 years who use SLT or are nonsmokers. Data were collected through a questionnaire on SLT use and periodontal health assessed using plaque index, gingival index (GI), attachment score, and gingival recession (GR). Statistical analysis was done using SPSS 27.0 version.

Results

Among 390 screened participants, 28 subjects (21 males and 7 females) were SLT users with prevalence of 7.18%. No significant differences were found in plaque index, GI, or periodontal pocket depth. However, SLT users had significantly higher clinical attachment loss scores (mean 4.01 mm, SD 0.35) compared to non-users (mean 1.49 mm, SD 1.12). Significant differences were also observed in GR.

Conclusions

This study provides insights into the prevalence and impact of SLT use on periodontal and gingival health in UAE adults. SLT usage is associated with a higher risk of periodontitis and gingivitis, indicating the need for awareness and intervention. Further research is required to validate results and consider confounding factors.

Comparative Analysis of Dentition and Periodontal Status in Patients With Unilateral Smokeless Tobacco Pouch Keratosis

INTRODUCTION

The consumption of smokeless tobacco (SLT) and related products has become an epidemic worldwide, especially among young people, as they come into direct contact with the tissues of the oral cavity. Therefore, the present cross-sectional study was conducted to compare the status of dentition and periodontal health of teeth associated with the unilateral SLT pouch keratosis with the unaffected contralateral side.

MATERIALS AND METHODS

In this study, 96 SLT users from north Maharashtra, India, with unilateral SLT pouch keratosis were studied. Demographic data, past and present SLT use history, features of SLT pouch keratosis, modified community periodontal index, dentition status index, and loss of tooth attachment were recorded. Data were collected and subjected to statistical analysis using the unpaired t-test and chi-square test.

RESULTS

The results of the present study showed a significant difference (p≤0.05) in gingival bleeding, pocket depth, and attachment loss in teeth associated with smokeless tobacco keratosis (STK) compared to teeth at the contralateral sides of the arch. The duration of tobacco use had a significant effect on the severity of loss of attachment at SLT pouch keratosis sides. There was a significant difference (p≤0.05) in the mean scores of the sound crown, carious crown, and coronal caries status between the SLT pouch keratosis side and the contralateral side.

CONCLUSION

The results of the study revealed that significant gingival bleeding, gingival recession, and attachment loss in the teeth are associated with SLT pouch keratosis compared with the teeth on the contralateral side without the lesion.

Patterns and predictors of periodontal disease and tooth loss among users of smokeless tobacco

BACKGROUND

Smokeless tobacco (SLT) products of several different types are widely used in several South Asian countries including Pakistan. These products are consumed in different forms and with different names. The study aims to determine adverse effects of the SLT consumption on periodontal tissues.

METHODS

This cross sectional study was conducted in Karachi, Pakistan. It recruited 377 users of (SLT) with 231 males (61.3%) and 146 females (38.7%) of age 15 to 45 years. After obtaining informed consent, quantitative data were collected via a questionnaire followed by intra oral clinical examination to determine presence of periodontal diseases using community periodontal index (CPI). To determine the association between periodontal diseases and smokeless tobacco consumption habits, Chi Square test was conducted.

RESULTS

Gingival recession (Class II-IV) (65.8%) was the most prevalent periodontal disease among SLT users. CPI score was high (CPI score 3 and 4) in 31.3% participants, whereas tooth loss was found in 21%. Among types of SLT products, gutka (28.6%) and betel quid (23.3%) were most commonly used. Using SLT for five or more years was found to be associated with a high CPI score, gingival recession (Class II-IV), moderate to severe tooth mobility, and presence of tooth loss.

CONCLUSIONS

The study found statistically significant association between duration in years of using SLT and periodontal disease including gingival recession, tooth mobility and tooth loss. However, no significant results were found between retention during single use and frequency of SLT use per day. However, the link of these factors with the periodontal disease cannot be eliminated.

Emerging Oral Nicotine Products and Periodontal Diseases

Oral nicotine pouches are emerging as a new "modern oral" nicotine product. These prefilled pouches contain nicotine, flavorings, and filling agents that dissolve in the mouth. Nicotine can be derived from tobacco leaf or chemical synthesis. Traces of TSNAs and toxic chromium were detected in the pouch products. This raises the concern about general and periodontal health. This review aims to update the current oral nicotine products research relating to periodontal disease and its relevance in periodontal inflammation. Nicotine interacts with host cells and affects inflammatory responses to microbial challenges. It may directly or indirectly deteriorate periodontal tissues by activating nicotinic acetylcholine receptors, repressing PDL fibroblasts cells, increasing cellular ROS and cytokines/chemokines, growth factors, breaking microbiota balance, and dysregulating miRNAs expression. Studies show that appealing flavorings contained in nicotine pouches pose harm to periodontal innate immune responses and increase penetration of nitrosamines. In addition, flavored ONPs increase the risk of dual or poly-tobacco products among young adults, stacking up detrimental effects on the periodontium. Given the recent growth of users, further studies are needed to elucidate the impact of ONPs, even poly-tobacco use, on systemic and periodontal health. Moreover, policymakers should ensure to avoid generating a new wave of nicotine addiction among youths in the U.S.

Comparative evaluation of serum cotinine levels in chronic periodontitis and chronic obstructive pulmonary disease

Context:

Periodontitis and chronic obstructive pulmonary disease (COPD) are chronic progressive inflammatory conditions. Smoking has been associated with both chronic periodontitis and COPD. Hence, the present study was designed to correlate serum levels of cotinine with the severity of periodontal disease with or without COPD.

Settings and Design:

A total of eighty patients, twenty healthy individuals, twenty patients with chronic generalized periodontitis without smoking and without COPD, twenty patients who are smokers with chronic periodontitis without COPD and twenty patients who are smokers with chronic periodontitis and COPD in the age range of 43–65 years were selected for the study.

Subjects and Methods:

Serum cotinine level assessment, smoking history, and periodontal examination were done in all the patients and the data obtained were statistically analyzed.

Results:

The mean serum cotinine level was highest in smokers with chronic periodontitis and COPD (93.642 ± 14.727) and it differed significantly between the four groups (P < 0.001). There is a significant positive correlation between the number of cigarettes and serum cotinine levels in both groups involving smoking. There was no significant correlation between serum cotinine level and clinical attachment loss in chronic periodontitis smokers with or without COPD.

Conclusions:

The result of this study indicates that increased smoking with COPD causes a higher chance of progression of periodontal destruction but it is not statistically significant. Furthermore, this study indicates that the assessment of serum cotinine levels is a reliable method to evaluate smoking exposure.

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.

Utilization of oral check-up data of autopsy cases

The maintenance of oral health contributes to the overall health of an individual. Similar to the Adult Dental Health Survey in the UK, the Survey of Dental Diseases (SDD) is being conducted in Japan. However, our routine oral examination of autopsy cases showed that the oral cavities of the autopsied bodies were unhealthy as compared to the SDD data. Therefore, this study sought to understand the actual condition of the oral cavity and to clarify the factors related to the degradation of the oral status. This was achieved by comparing the data of the SDD subjects and autopsy cases in terms of the average number of teeth lost, the average total number of caries (number of decayed, missing, or filled teeth), percentage of people with untreated teeth, and 80-20 achievement rate (percentage of people aged 80 years with 20 or more teeth). Furthermore, this study investigated the relationship between the average number of missing teeth and smoking, psychiatric disorders, and body mass index (BMI) in autopsy cases. The oral condition of all autopsy cases was worse than that of SDD subjects. The 80-20 achievement rate was observed in more than half of the SDD subjects and only in less than 20% of the autopsy cases. Moreover, the average number of missing teeth was not significantly different depending on smoking status, BMI, and presence of psychiatric disorders in the autopsy cases. Unlike the SDD volunteers, there was no bias related to the inclusion of autopsy cases. Therefore, by analysing the data of both autopsy cases and SDD subjects, it may be possible to evaluate the oral condition more realistically. This could contribute to the realisation of improved health and quality of life.

Periodontal status associated with dual habits of smoking and smokeless tobacco use: A cross-sectional study in young adults

Background. Tobacco smoke is an established risk factor for periodontitis. However, few studies have evaluated the periodontal status of smokeless tobacco (SLT) users, while that of individuals with dual habits has largely been unexplored. Therefore, the current study aimed to find if the periodontal status in individuals with dual habits of smoking and SLT use is different from those with any single habit.Methods. Four groups (A: exclusive smokers, B: exclusive tobacco chewers, C: individuals with dual habits, and D: non-users of tobacco), each comprising 75 males in the age group of 20 to 35 years, were selected. Along with the history of tobacco use, a modified oral hygiene index (OHI), gingival index (GI), probing depth (PD), and the number of teeth with gingival recession (GR) were recorded. The data were assessed using the Chi-squared test, one-way ANOVA, and logistic regression. Statistical significance was set at P<0.05.Results. Group C exhibited the highest mean OHI scores, with 94.66% of participants having poor oral hygiene (OHI>3.0). The prevalence of severe gingivitis (GI>2.0) was significantly lower among exclusive smokers (group A) and those with dual habits (group C) compared to the other two groups. As much as 60% of group C participants had average PD in the range of 4-6 mm, while deeper average PD (>6 mm) was most common among smokers. The highest risk of having a tooth with GR was also associated with the dual habit (OR = 4.33, 95% CI = 3.24 - 5.76) compared with the non-users.Conclusion. While both forms of tobacco were associated with poor periodontal status, the additive effect of smoking and SLT use was evident in almost all the parameters, more so with poor oral hygiene and the prevalence of gingival recession. These findings emphasize that individuals with dual habits have an additional risk for periodontal destruction.

Patterns of Periodontal Destruction among Smokeless Tobacco Users in a Central Indian Population

BACKGROUND

Findings of studies testing the association between smokeless tobacco (SLT) use and periodontal health have shown varying results in different populations. Considering the high prevalence of SLT use in India, the present study was conducted to understand the pattern of periodontal destruction within different areas of the dentition among SLT users.

METHODS

Age, gender, oral hygiene habits, the frequency and duration of SLT consumption, the type of SLT product used, and the site of retention of the SLT product in the oral cavity were recorded among 90 SLT users. Probing depth (PD), recession (REC), and clinical attachment loss (CAL) at SLT-associated and non SLT-associated teeth of the mandibular arch were compared based on the site of retention of the SLT product, the type of product used, and the duration of the habit.

RESULTS

REC and CAL were significantly higher at the SLT-associated zones compared to non SLT-associated zones and at both interproximal and mid-buccal sites of SLT-associated teeth. Among individuals who had the habit for more than 5 years and also among those who had the habit for 5-10 years, PD, REC, and CAL were significantly higher at SLT-associated teeth than at non SLT-associated teeth. Significantly greater periodontal destruction was observed at SLT-associated teeth among khaini users and gutkha users.

CONCLUSIONS

Smokeless tobacco consumption resulted in greater destruction of periodontal tissues. The severity of periodontal destruction at SLT-associated sites differed depending on the type of smokeless tobacco used, the site of retention of the SLT, and the duration of the habit.

Aqueous extract of tobacco induces mitochondrial potential dependent cell death and epithelial-mesenchymal transition in gingival epithelial cells

Smokeless tobacco habits are detrimental to oral health. A correlation between tobacco use and local epithelial tissue damage exists. Yet, the underlying cellular mechanism is not precisely characterized. This study assessed the dose-dependent action of Smokeless tobacco extract on gingival epithelial cells. Gingival tissue was taken from 5 healthy donors. Gingival epithelial cells were isolated by an enzymatic method and cultured up to passage 2. The cultured cells were treated with smokeless tobacco extract at 10%, 25%, 50%, and 75% volume concentration. After 48 h of incubation, MTT assay, Annexin V/PI assay, and DiIC1(5) assay were used to evaluate viability, apoptosis, and mitochondrial potential of the cells. RT-qPCR was used to determine the expression of BAX, BCL2, ECAD, NCAD, and TWIST. The Smokeless tobacco extract reduced cell viability by disrupting the mitochondrial potential and inducing apoptosis. Further, the Smokeless tobacco extract induced a dose-dependent epithelial-mesenchymal-transition in gingival epithelial cells. Apoptotic cellular death caused by tobacco extract on the gingival epithelial system was dependant on the mitochondrial potential of the cell. The results demonstrate that smokeless tobacco causes detrimental metabolic alterations of the periodontium.

Featured application

This study elucidates the mechanism by which Smokeless tobacco products cause cellular damage to the gingival epithelium. The use of Smokeless tobacco products can lead to major cellular and surface changes in the gingiva and its appearance. The consequences of these changes are not limited to oral cancer but also increases a person's risk for dental and periodontal disease.

Current status of periodontitis and its association with tobacco use amongst adult population of Sunsari district, in Nepal

BACKGROUND

Tobacco products are considered significant, but preventable factors related to initiation and progression of periodontal diseases. We assessed the prevalence of periodontitis and evaluated its association with tobacco use and other factors amongst the adult population of Sunsari district in eastern Nepal.

METHODS

A community-based, cross-sectional study was conducted in rural municipalities in the province one of eastern Nepal. A total of 440 adults were interviewed with a set of a pre-tested semi-structured questionnaire. Data on social demographics, adverse oral habits followed by periodontal clinical examination were recorded. Prevalence of periodontitis was assessed by a case definition provided by CDC-AAP. Univariate and multivariate logistic regression analysis was done to measure the association between tobacco use and other factors with periodontitis.

RESULTS

The overall prevalence of periodontitis was found to be 71.6%. Majority (85.4%) of tobacco users had periodontitis and they were significantly associated with the disease and its severity. The study identified age groups, 45-65 years (AOR = 7.58, 95% CI 3.93-14.61), plaque accumulation (AOR = 1.01, 95% CI 1.00-1.02), smoking (AOR = 3.14, 95% CI 1.36-7.27), khaini users (smokeless tobacco, AOR = 2.27, 95% CI 1.12-4.61) and teeth loss (AOR = 2.02, 95% CI 1.21-3.38) as the significant factors associated with periodontitis.

CONCLUSION

The prevalence of periodontitis is high in the surveyed rural adult population. Cigarette smoking along with the use of smokeless tobacco in the form of khaini were identified as significant factors associated with periodontitis.

Prevalence, patterns and sociocultural factors associated with use of tobacco-based dentifrices (Gul) in India

BACKGROUND

India poses a novel tobacco problem with majority of the tobacco users consuming smokeless form of tobacco (21.4%). Gul is one such Smokeless Tobacco (ST) product that is manufactured commercially as a dentifrice to be applied to the teeth and then to gums many times during the day, making it a cheap and easy tobacco source. Hence, the aim of the present study was to estimate the usage of Gul and its social determinants among adults in the capital city of India, Delhi.

METHODS

The cross-sectional study was conducted among 1300 adults across 27 Delhi government dispensaries across 3 districts of Delhi through multistage stratified random sampling. A structured, close-ended, validated questionnaire inquiring about the tobacco practices was used for all the participants and a specially constructed, structured, close-ended, validated proforma was used for Gul users to assess practice and pattern of use.

RESULTS

The overall prevalence of Gul users was found to be 4.9% with a mean usage duration of 6.28 ± 6.75 years. The usage was found to be more among males (67.7%) and unskilled workers (45.2%). 74.9% started using Gul to treat dental pain with 93.47% of them reporting pain relief.

CONCLUSION

Gul usage is an emerging menace in Delhi. Awareness programs and initiatives are the need of the hour to bring this tobacco product under the tobacco control policy radar and at the same time educate people about the actual contents and ill effects of Gul usage.

The influence of tobacco consumption on periodontal health: A stratified analysis based on type of tobacco use

Introduction

Though the negative influence of tobacco consumption on the periodontal status of an individual is established, the magnitude of this association based on the type of tobacco used is seldom investigated.

Aim

The aim of this study is to check the differences in the periodontal status of individuals based on their current tobacco consumption status and type of tobacco consumption.

Materials and Methods

This study was conducted among subjects attending a teaching dental institution in Andhra Pradesh. Subjects were divided into three groups based on their current tobacco consumption status. The following parameters were recorded after examination by two calibrated investigators: number of sites with bleeding on probing; number of teeth with periodontal pockets; number of teeth with clinical attachment loss of ≥5 mm; number of teeth lost. SPSS version 20 software was used to analyze the data.

Results

While current users demonstrated poor periodontal status than the former and nonusers, there was a significant difference in periodontal health between former users and nonusers in all the study parameters except the mean number of teeth lost. Among current users, the mean percentage of sites with bleeding and attachment loss >5 mm were found to be least among smokers compared to tobacco chewers and those who consume both smoke and smokeless forms of tobacco.

Conclusion

The study confirms the negative influence of tobacco consumption on periodontal health and also establishes the increased destruction of clinical attachment levels among tobacco chewers compared to smokers.

Tobacco-product usage as a risk factor for dental implants

The oral cavities of tobacco smokers and users of smokeless tobacco products are exposed to high concentrations of nicotine. A limited number of animal studies have assessed the effect of nicotine on osseointegration. Results from experimental studies have reported a statistically significant decrease, at 4 weeks of follow-up, in bone-to-implant contact among rats exposed to nicotine compared with unexposed rats. Nicotine increases the production of inflammatory cytokines (such as interleukin-6 and tumor necrosis factor-alpha) by osteoblasts. Waterpipe, pipe, and cigarette smokers are at increased risk of developing oral cancer, periodontal disease, and alveolar bone loss. One explanation for this is that smokers (regardless of the type of tobacco product) are exposed to similar chemicals, such as nicotine, tar, oxidants, polyaromatic hydrocarbons, and carbon monoxide. Moreover, raised levels of proinflammatory cytokines have been identified in the gingival crevicular fluid of cigarette smokers with peri-implant diseases. Therefore, it is hypothesized that nicotine and chemicals in tobacco smoke induce a state of oxidative stress in peri-implant tissues (gingiva and alveolar bone), thereby increasing the likelihood of peri-implant disease development via an inflammatory response, which if left uncontrolled, will result in implant failure/loss. In this regard, tobacco smoking (including cigarettes, waterpipe, and pipe) is a significant risk factor for peri-implant diseases. The impact of vaping electronic cigarettes using nicotine-containing e-juices remains unknown. Habitual use of smokeless tobacco products is associated with oral inflammatory conditions, such as oral precancer, cancer, and periodontal disease. However, the effect of habitual use of smokeless tobacco products on the success and survival of dental implants remains undocumented.

Tobacco-use patterns and self-reported oral health outcomes: A cross-sectional assessment of the Population Assessment of Tobacco and Health study, 2013-2014

BACKGROUND

Few studies consider simultaneously the oral health implications of nontraditional tobacco products and tobacco-use patterns. The authors aimed to evaluate self-reported gingival disease among cigarette smokers and users of other types of tobacco products.

METHODS

The authors used survey-weighted multivariable logistic regression to assess associations between different tobacco products, use patterns (for example, dual or multiple tobacco product use or product switching); and lifetime history of gingival disease diagnosis and treatment. They used the nationally representative (US) Population Assessment of Tobacco and Health study's Wave 1 (2013-2014) adult data (N = 32,320).

RESULTS

Overall, 12.1% of participants self-reported gingival disease diagnosis, and 19.1% reported receiving treatment. Groups with the highest adjusted relative odds for diagnosis (reference, lifetime tobacco never users) were pipe users (2.7; 95% confidence interval [CI], 1.3 to 5.3), e-cigarette users (2.9; 95% CI, 1.9 to 4.5), multiple tobacco product users (2.8; 95% CI, 2.4 to 3.4), and recent (< 12 months) quitters (2.8; 95% CI, 2.0 to 3.8). Similarly, odds of treatment report were highest among pipe users (2.3; 95% CI, 1.3 to 4.1), e-cigarette users (2.3; 95% CI, 1.3 to 4.1), multiple tobacco product users (1.6; 95% CI, 1.4 to 1.9), and recent quitters (1.7; 95% CI, 1.3 to 2.2).

CONCLUSIONS

Numerous tobacco-use patterns were associated with worse periodontal health compared with tobacco never users. These findings are consistent with previous biological and epidemiologic evidence linking tobacco use to poor periodontal health.

PRACTICAL IMPLICATIONS

Dental clinicians should anticipate various tobacco-use patterns among their patients, all of which may impact oral health. Oral health care professionals should remain informed of, screen for, and address the use of all tobacco products in practice.

Personalized periodontal treatment for the tobacco- and alcohol-using patient

The use of various forms of tobacco is one of the most important preventable risk factors for the incidence and progression of periodontal disease. Tobacco use negatively affects treatment outcomes for both periodontal diseases and conditions, and for dental implants. Tobacco-cessation programs can mitigate these adverse dental treatment outcomes and may be the most effective component of a personalized periodontal treatment approach. In addition, heavy alcohol consumption may exacerbate the adverse effects of tobacco use. In this review, the microbiology, host/inflammatory responses and genetic characteristics of the tobacco-using patient are presented as a framework to aid the practitioner in developing personalized treatment strategies for these patients. These personalized approaches can be used for patients who use a variety of tobacco products, including cigarettes, cigars, pipes, smokeless tobacco products, e-cigarettes and other tobacco forms, as well as patients who consume large amounts of alcohol. In addition, principles for developing personalized tobacco-cessation programs, using both traditional and newer motivational and pharmacological approaches, are presented.

Is Khat (Catha edulis) chewing a risk factor for periodontal diseases? A systematic review

Background

Khat (Catha edulis) chewing is a highly prevalent habit in the Arabian Peninsula and East Africa, and has recently spread to Western countries. The association between khat chewing and oral mucosal lesions is well documented in the literature. However, there is no concrete evidence on the association between khat chewing and periodontal disease. The purpose of this systematic review was to analyze the influence of khat chewing on periodontal health.

Material and Methods

A literature search of PubMed, Scopus and Web of Sciences databases was carried out to identify relevant articles published from 1990 to May 2017. The inclusion criteria were all clinical studies that assessed the relationship between khat chewing and periodontal disease.

Results

The search yielded 122 articles, of which 10 were included in this systematic review. Most of the studies exhibited a positive correlation between khat chewing and periodontal disease.

Conclusions

Altogether, the analysis of the current evidence reveals that khat chewing is destructive to the periodontium and enhances the risk of periodontal disease progression. However, due to variability of studies, more longitudinal case-controlled studies are highly warranted to establish a causal relation between khat chewing and periodontal disease.

Key words:Khat chewing, periodontal health, periodontal disease, risk factor.

Gamma Glutamyl Transpeptidase, Smokeless Tobacco, Chronic Periodontitis: Exploring the Link

INTRODUCTION

Oxidative Stress (OS) is implicated in the pathogenesis of many systemic and oral diseases such as periodontal disease. Smokeless tobacco extract produces apoptosis and causes an imbalance between reactive oxygen species and antioxidants, such as Gamma Glutamyl Transpeptidase (GGT). Epidemiological research implied serum GGT within its normal range to be an early sensitive enzyme related to OS.

AIM

To assess how GGT fares as a biomarker in periodontitis subjects with or without the usage of smokeless tobacco and correlate it with clinical parameters.

MATERIALS AND METHODS

Ninety subjects were divided into three groups of healthy, chronic periodontitis, and smokeless tobacco users with chronic periodontitis from the dental outpatient department of P.M. Nadagouda Memorial Dental College and Hospital. Serum samples of patients were collected after obtaining consent and analyzed for GGT. Statistical Analysis was performed using ANOVA, and Pearson's correlation coefficient.

RESULTS

GGT levels were found to be significantly higher in chronic periodontitis patients compared to smokeless tobacco users with chronic periodontitis and healthy subjects. Conclusion: GGT may be used as a quick, easy and precise marker for measuring OS in patients with chronic periodontitis and smokeless tobacco users.

Chromium Exposure in the Adult Population, Consuming Different Types of Smokeless Tobacco Products in Pakistan

The pervasive smokeless tobacco (SLT) consumption and diseases related to its use is a hot topic for the public discussion. In this study, concentrations of chromium (Cr) were measured in different SLT products [snuff (dry and moist), mainpuri, and gutkha] offered and used in Pakistan. The current study was also designed to assess the Cr levels in the biological (scalp hair and blood) samples of male and female subjects, age ranged from 25 to 60 years, chewing different SLT products. For comparative purpose, the healthy persons of the same age group, who did not consume any SLT products, were selected as referents. The concentrations of Cr in SLT products and biological samples were measured by electrothermal atomic absorption spectrophotometer after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The resulted data indicated that the adult persons, who consumed different SLT products, have 2-3 fold higher levels of Cr in biological samples as compared to referent subjects (p < 0.01). The persons, who chew/sniff different SLT products, have 50-80 and 42-82 % higher levels of Cr in their scalp hair and blood samples as related to referents. The daily intake of Cr is lower as compared to the recommended value of 50-200 μg/day. It was expected that 10 g consumption of various kinds of SLT products (snuff, mainpuri, and gutkha) may subsidize 21.2-220, 17.7-122, and 18.4-273 % of the recommended daily intake of Cr, respectively.

Smokeless Tobacco and Severe Active Periodontal Disease, NHANES III

Whereas smoking is a major risk factor for periodontal disease, the role of smokeless tobacco is unclear. The purpose of this US population-based study of 12,932 adults participating in the Third National Health and Nutrition Examination Survey was to evaluate the association between smokeless tobacco use and severe active periodontal disease. Univariable and multivariable logistic regression modeling quantified the associations between tobacco use and severe active periodontal disease. All adults and never-smokers who currently used smokeless tobacco were twice as likely to have severe active periodontal disease at any site [respective odds ratios (ORAdj) and 95% confidence intervals: ORAdj = 2.1; 1.2–3.7 and ORAdj = 2.1; 1.0–4.4] or restricted to any interproximal site [respective ORAdj = 2.1; 1.0–4.2 and ORAdj = 2.3; 0.9–6.3], simultaneously adjusted for smoking, age, race, gender, diabetes, and having a dental visit in the past year. These results indicate that smokeless tobacco may also be an important risk factor for severe active periodontal disease.

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

INTRODUCTION

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

AIM

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSION

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

The impact of lifestyles on the periodontal health of adults in Udupi district: A cross sectional study

OBJECTIVES

(1) To assess the impact of different lifestyle factors on periodontal health of adults. (2) To assess the impact of overall/combined lifestyle variable (calculated by health practice index [HPI]) on periodontal health of adults.

MATERIALS AND METHODS

A cross-sectional study consisting of a structured questionnaire on HPI, oral health-related behavior, and personal habits as well as sociodemographic variables was conducted on 800 subjects aged 20-50 years attending dental outreach set-ups of Manipal College of Dental Sciences, Manipal. Clinical examination for periodontal status was done by recording loss of attachment scores using community periodontal index (FDI/WHO-1982). Statistical analysis was done by bivariate analysis using Chi-square followed by multivariate analysis to obtain adjusted odds ratio with 95% confidence interval.

RESULTS

After adjusting for all the confounding variables in multivariate logistic regression analysis, the variables that showed an independent association with periodontitis were age, location, marital status, smoking, hours of sleep per night, physical activity, and overall poor lifestyles.

CONCLUSION

Our results support studying a combined approach using various lifestyle behaviors for controlling chronic periodontitis. Necessary public health action on conditions which determine unhealthy lifestyle behaviors across population is needed which is possible by patient's involvement in self-care by promoting healthy lifestyles.

Metabolomics evaluation of the impact of smokeless tobacco exposure on the oral bacterium Capnocytophaga sputigena

The association between exposure to smokeless tobacco products (STP) and oral diseases is partially due to the physiological and pathological changes in the composition of the oral microbiome and its metabolic profile. However, it is not clear how STPs affect the physiology and ecology of oral microbiota. A UPLC/QTof-MS-based metabolomics study was employed to analyze metabolic alterations in oral bacterium, Capnocytophaga sputigena as a result of smokeless tobacco exposure and to assess the capability of the bacterium to metabolize nicotine. Pathway analysis of the metabolome profiles indicated that smokeless tobacco extracts caused oxidative stress in the bacterium. The metabolomics data also showed that the arginine-nitric oxide pathway was perturbed by the smokeless tobacco treatment. Results also showed that LC/MS was useful in identifying STP constituents and additives, including caffeine and many flavoring compounds. No significant changes in levels of nicotine and its major metabolites were found when C. sputigena was cultured in a nutrient rich medium, although hydroxylnicotine and cotinine N-oxide were detected in the bacterial metabolites suggesting that nicotine metabolism might be present as a minor degradation pathway in the bacterium. Study results provide new insights regarding the physiological and toxicological effects of smokeless tobacco on oral bacterium C. sputigena and associated oral health as well as measuring the ability of the oral bacterium to metabolize nicotine.

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.

Effect of the use of snuff on the levels of interleukin-1 β and interleukin-8 in the gingival crevicular fluid of periodontitis patients

Background:

Use of smokeless tobacco in the form of moist snuff placed in the oral cavity is popular in rural India. The aim of the present cross-sectional study was to determine the effect of snuff on periodontitis by assessing interleukin (IL)-1 β and IL-8 levels in gingival crevicular fluid.

Materials and Methods:

A total of 60 subjects were selected for this study. 40 subjects presented with periodontitis, which included 20 snuff users (SP) and 20 nonsnuff users (NS). 20 periodontally healthy patients formed the controls (healthy control: HC). The clinical parameters recorded were gingival index (GI), plaque index, calculus index, bleeding on probing (BOP), probing depth (PD), recession (RC), and clinical attachment level (CAL). The IL-1 β and IL-8 levels were assessed through enzyme-linked immunosorbent assay (Quantikine^®). Analysis of variance (ANOVA), post-hoc Tukey's, Kruskal-Walli's ANOVA and Mann-Whitney test was used for comparison among groups and P > 0.05 was considered statistically significant.

Results:

No significant difference was seen in levels of IL-1 β and IL-8 between SP and NS groups (P = 0.16, 0.97). However, both the periodontitis groups (SP and NS) had increased IL-β levels when compared to HC group (P = 0.01, 0.001). The snuff users showed significant increase in GI, BOP, RC, and CAL when compared with NS (P = 0.002, 0.001, 0.012, 0.002) whereas NS group had significant increase in PD (P = 0.003).

Conclusion:

Within the limitations of this study, use of snuff does not affect the host inflammatory response associated with periodontitis and leads to RC and increased CAL due to local irritant effect.

Comparison of clinical periodontal status among habitual smokeless-tobacco users and cigarette smokers

AIM

Investigating the comparative effect of cigarette smoking and smokeless-tobacco use on periodontal health.

BACKGROUND

There is a dearth of studies comparing the effects of smoking and smokeless tobacco on periodontal health. Smokeless tobacco is emerging as a major public health hazard, but is often neglected as a risk factor by many clinicians.

MATERIALS AND METHODS

A cross-sectional study of 286 subjects was conducted. The participants were divided into mutually exclusive groups (i.e. any subject who had the habit of both smoking as well as smokeless tobacco usage was excluded from the study), as follows: a smoking group (SG; n=121); a smokeless-tobacco group (ST; n=81); and a non-tobacco-consuming group (NT; n=84). Data were obtained using a questionnaire and by clinical examination. The Periodontal Disease Index (PDI) and Oral Hygiene Index-Simplified (OHI-S) were used to clinically evaluate the periodontal and dental health status of the subjects. Multivariate analysis was performed to identify statistical correlations.

RESULTS

The Plaque Index was higher in the ST group than in the SG group and was statistically significantly higher in the ST group than in the NT group. Probing depth and gingival inflammation (components of the PDI) were also higher in the ST group than in the SG and NT groups, but this was not statistically significant.

CONCLUSIONS

Within the limits of the study, and for this study population, the impact on the periodontium as a result of smokeless tobacco use appeared to be comparable with that of smoking tobacco. The results of this study affirm the need to consider smokeless tobacco as a possible contributory factor to periodontal disease, in addition to smoking, and to counsel patients accordingly. Further randomised clinical trials are necessary to validate the long-term impact of smokeless tobacco on periodontal disease.

Smoking and inflammation: evidence for a synergistic role in chronic disease

Tobacco smoking is the most important preventable risk factor for periodontitis; however, the underlying biological mechanisms responsible for the detrimental effects of smoking on periodontal health remain largely unclear. It is also well established that smoking has a negative impact on several inflammatory diseases, including rheumatoid arthritis, multiple sclerosis and inflammatory bowel disease. The aim of this paper was to review smoking-related changes in local and systemic host responses with a focus on cellular and molecular effects that could explain a hyperinflammatory response leading to periodontal destruction. Biological mechanisms that may be common to periodontal disease and other chronic inflammatory diseases were also explored, together with gene-smoking interactions. An epidemiologic perspective on the burden of smoking on periodontal health and the potential for smoking cessation is also presented. Tobacco smoking seems to induce changes ranging from decreased leukocyte chemotaxis to decreased production of immunoglobulins. Smoking also seems to cause a stronger inflammatory reaction with an increased release of potentially tissue-destructive substances (e.g. reactive oxygen species, collagenase, serine proteases and proinflammatory cytokines). These findings support a hypothesis that periodontitis is a hyperinflammatory condition rather than a hypo-inflammatory condition.

Does Gingival Recession Require Surgical Treatment?

Gingival recession represents a clinical condition in adults frequently encountered in the general dental practice. Clinicians often face dilemmas of whether or not to treat such a condition surgically. An initial condensed literature search was performed using a combination of gingival recession and surgery controlled terms and keywords. An analysis of the search results highlights the limited understanding of the factors that guide the treatment of gingival recession. Understanding the cause, prognosis, and treatment of gingival recession continues to offer many unanswered questions and challenges in periodontics as we strive to provide the best care possible for our patients.

Evaluated the levels of lead and cadmium in scalp hair of adolescent boys consuming different smokeless tobacco products with related to controls

The present study was aimed to evaluate the cadmium (Cd) and lead (Pb) levels in the scalp hair samples of adolescent boys age ranged 12-15 years, chewing different smokeless tobacco (SLT) products. For comparative purpose, boys of the same age group who did not consume any SLT products were selected as referents. The concentrations of Cd and Pb in SLT products and the scalp hair samples were measured by electrothermal atomic absorption spectrophotometer (ETAAS) after microwave-assisted acid digestion. The validity and accuracy of the methodology were checked by certified reference materials (CRMs). The difference between experimental and certified values of both elements was not significant (p > 0.05). The resulted data indicated that the adolescent boys who consumed different SLT products have two- to threefold higher levels of Cd and Pb in the scalp hair samples as compared to the referent boys (p < 0.01). The adolescent chewing different SLT products have 82.2-110 and 60.6-94.5% higher levels of Cd and Pb, respectively, in their scalp hair as related to the referents.

Spontaneous improvement of gingival recession after correction of tooth positioning

A 30-year-old woman sought treatment for malpositioned mandibular incisors; the roots were positioned outside the alveolar bone, related to severe localized gingival recession. She had been previously treated orthodontically and subsequently underwent 2 gingival grafts. The new treatment included torquing the roots back within the alveolar bone and referral to a periodontist for a gingival graft. In this clinical report, the possible spontaneous improvement of gingival recession is discussed. A hypothesis described in the literature is called the "creeping attachment" phenomenon. The literature includes conflicting reports about the cause-and-effect relationship between orthodontics and gingival recession. This clinical example reports spontaneous improvement of gingival recession after correction of tooth positioning in the alveolar bone. A gingival graft can be performed after adequate root positioning in the alveolar bone housing, thus increasing the chance of achieving more favorable results.

Evaluation of interleukin-1β and 8 in gutka chewers with periodontitis among a rural Indian population

PURPOSE

Smokeless tobacco-based oral-use products like gutka are popular in India. Gutka usage leads to increased periodontal destruction and inflammation; however, the relevant mechanism remains unknown. This study aimed to elucidate the role of gutka in periodontitis by examining its effect on the levels of interleukin (IL) 1β and IL-8 from the gingival crevicular fluid (GCF).

METHODS

A total of 45 patients were enrolled in this study. Thirty patients with periodontitis (15 gutka chewers [GCP] and 15 nongutka chewers [NGC]) and 15 periodontally healthy controls (HC) were selected. The full-mouth plaque index (PI), gingival index (GI), probing depth (PD), clinical attachment level (CAL), and recession (RC) were recorded. The IL-1β and IL-8 levels in the GCF of all subjects were assessed through an enzyme-linked immunosorbent assay (Quantikine).

RESULTS

The IL-1β and IL-8 levels were not significantly higher in the GCP group (IL-1β, 369.01±273.44 µL; IL-8, 205.97±196.78 µL) as compared to those in the NGC group (IL-1β, 195.57±96.85 µL; IL-8, 178.61±149.35 µL). More gingival RC and loss of attachment was seen among the GCP group (RC: 2.02±0.31, P=0.013; CAL: 4.60±0.56, P<0.001) than among the NGC group (RC, 1.21±1.15; CAL, 3.70±0.32); however, PD was deeper among the NGC subjects (P=0.002). PI and GI were significantly higher for the periodontitis group (P<0.001) when compared to the HC, but there was no difference among gutka chewers and non-chewers (P=0.22 and P=0.89). A positive correlation was found between the IL-8 levels and the duration of gutka chewing (r=-0.64, P<0.01).

CONCLUSIONS

Gutka chewing leads to increased gingival RC and clinical loss of attachment. There was no effect seen in the proinflammatory cytokine levels in the GCF of gutka users.

Estimation and correlation of salivary thiocyanate levels in healthy and different forms of tobacco users having chronic periodontitis: A cross-sectional biochemical study

BACKGROUND

Periodontitis is a common inflammatory disease with complex and multi-factorial origin. Tobacco usage has shown its adverse effect on periodontal health. Various components within saliva not only protect the integrity of oral tissues, but also provide clues to local and systemic diseases and conditions. Salivary thiocyanate (SCN) has been shown to be a chemical indicator in smokers and smokeless tobacco users. Noninvasive nature of salivary testing has made it an attractive and effective alternative to blood and urine testing. Limited studies are there comparing and correlating the salivary SCN levels in smokers with chronic periodontitis (CP). However, no studies show correlation of salivary SCN among gutka chewers with CP.

AIMS AND OBJECTIVES

The objective of the following study is to estimate, compare, and correlate the SCN levels in periodontally healthy, CP, smokers with CP and gutka chewers with CP subjects.

MATERIALS AND METHODS

Study includes 120 subjects with age 18-55 years, categorized as periodonally healthy (n = 30), CP (n = 30), smokers (n = 30), and gutka chewers (n = 30) with CP. Required clinical parameters such as gingival index, probing depth and clinical attachment loss were recorded and salivary SCN levels were estimated through ultraviolet-spectrophotometer.

RESULTS

Mean salivary SCN level were shown to be higher among smokers and gutka chewers with CP as compared to healthy and CP alone.

CONCLUSION

The present study exhibited the significant increase in salivary SCN levels among smokers and gutka chewers when compared to others, concluding that the analysis of salivary SCN levels could be used as an adjunctive means of diagnosis.

Minimally-invasive non-surgical periodontal therapy

Periodontitis is a complex disease that has both oral and systemic consequences. The treatment of periodontitis may be both surgical and non-surgical but, in recent years, there has been a shift towards managing disease non-surgically in preference to surgery. Fundamental to all types of therapy is the patient's role in disease control, in the form of self-performed plaque control, and it is important that the patient understands this. Non-surgical periodontal therapy has a long history and has traditionally been carried out using a variety of hand and powered instruments, the objective being root surface disinfection by the removal of plaque, calculus and contaminated root cementum. However, over the last 30 years or so, it has become apparent that calculus does not cause disease, cementum does not become significantly infected and bacteria and their toxins are only loosely adherent to the diseased root surface. This has led to the development of less invasive instrumentation principles which may be better for patients, more cost-effective and more easily applied in different clinical settings.

CLINICAL RELEVANCE

This paper aims to describe and justify a minimally-invasive approach to the management of the diseased root surface in periodontitis, to clarify the terminology used and to suggest how these principles may be applied in general practice.

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.

Influence of smokeless tobacco on periodontal health status in local population of north India: A cross-sectional study

Background:

Limited studies have been published so far, which revealed the association of different types of smokeless tobacco on various periodontal health indicators, including mobility and furcation, on North Indian population. The present study has been undertaken to evaluate the effects of commonly used smokeless tobacco forms on periodontal health in Lucknow, North India.

Methods:

This cross-sectional study investigated the effect of commonly used smokeless tobacco on periodontal health in local population of Lucknow, for which 2045 individuals were evaluated. Amongst them, 1069 individuals were found to be using some kind of tobacco; amongst the tobacco users, n=122 were smokers, n=657 were only using only smokeless tobacco and n=290 were using both smokeless tobacco as well as tobacco in smoking form. After completing the questionnaire, all the participants underwent clinical examination for the various clinical parameters.

Results:

The impact of smokeless form of tobacco use was significantly higher on all the periodontal health indicators, viz., plaque index, gingival index, calculus, clinical attachment loss, gingival recession, mobility, furcation, lesion, and probing pocket depth. Both duration and frequency of smokeless tobacco use significantly affected the periodontal health.

Conclusion:

The periodontal health of the general population in the region required immediate attention as majority of subjects irrespective of their habit status had onset of clinical attachment loss and gingival recession, more so amongst the smokeless tobacco users than smoking form of tobacco as well as than from non-tobacco users.

The use of a disclosing agent during resective periodontal surgery for improved removal of biofilm

A total removal of the bacterial deposits is one of the main challenges of periodontal therapy. A surgical approach is sometimes required in order to allow a correct access to the areas not thoroughly reached during the initial therapy. The present study focuses on the surgical scaling effectiveness in root deposits removal; the potential support of a disclosing agent during this procedure is also evaluated. Forty surgical periodontal patients were randomly divided between surgeries where the operator was informed about a final examination of the residual root deposits and surgeries where the operator was not informed. Straight after scaling procedures a supervisor recorded the O'Leary Plaque Index of the exposed roots by mean of a disclosing agent and the percentage of teeth with residual biofilm. After the stained deposits removal, a second chromatic examination was performed and new data were collected. Mann-Whitney U-test and Wilcoxon test for paired samples were used for comparisons respectively between the two surgery groups and the first and the second chromatic examination; one-sided p-value was set at 0.05. At first examination no significant differences between the two groups were observed regarding Plaque Index (p=0.24) and percentages of teeth with residual biofilm (p=0.07). The 100% removal of roots deposits was never achieved during the study but a significant reduction of 80% of root deposits was observed between first and second examination (p=0.0001). Since root deposits removal during periodontal surgery resulted always suboptimal, the use of a disclosing agent during this procedure could be a useful and practical aid.

[Smokeless tobacco]

Use of smokeless tobacco (ST) (chewing tobacco and snuff) can lead to a number of consequences detrimental to health. ST rapidly delivers high doses of nicotine, which can lead to dependence and is also a source of carcinogenic nitrosamines. Changes usually develop in the mouth area where the ST is most often placed. Non-malignant oral lesions include leuko-oedema, hyperkeratotic lesions of the oral mucosa and localised periodontal disease. Oral premalignant lesions are leukoplakia, erythroplakia, submucosal fibrosis and lichen planus. Betel chewing, with or without tobacco, may increase the incidence of oral cancer. There is conflicting evidence with regard to snuff users about the risk of oral and gastro-oesophageal cancer. ST use is a risk factor for pancreatic cancer and may increase the risk of fatal myocardial infarction and ischemic stroke. During pregnancy, ST is associated with an increase in pre-eclampsia, preterm delivery and stillbirth. Nicotine replacement therapy and bupropion reduce withdrawal symptoms and tobacco craving during ST cessation. However, they have not been shown to help long-term abstinence. Information concerning the potential hazards of ST products should be incorporated into educational programmes to discourage its use and to help users to quit. Smokeless tobacco is not recommended to help smoking cessation.

Periodontal disease in relation to smoking and the use of Swedish snus: epidemiological studies covering 20 years (1983-2003)

AIM

The aim of the present study was to examine how deleterious current smoking and the use of Swedish moist snuff (snus) is for periodontal health compared with non-tobacco users.

MATERIALS AND METHODS

The studies comprised three epidemiological cross-sectional studies, in 1983, 1993 and 2003, of stratified random samples aged 20, 30, 40, 50, 60 and 70 years. The numbers of dentate participants were 550, 552 and 523, respectively. The participants were examined clinically and radiographically. Diagnostic criteria were the number of teeth, plaque, gingival status, probing pocket depth (PPD) ≥ 4 mm, height of the alveolar bone level and classification by periodontal disease experience. In addition, participants were asked about their tobacco habits.

RESULTS

Multiple logistic regression shows, after adjusting for age, gender and sociodemographic variables, that relative to non-tobacco users, cigarette smokers had statistically significant less gingivitis, a higher frequency of PPD ≥ 4 mm and a higher incidence of severe periodontitis. There was no significant association between gingivitis, frequency of PPD ≥ 4 mm and periodontal disease experience and snus use.

CONCLUSIONS

Cigarette smokers were found to have a statistically significant higher risk of severe periodontitis than non-tobacco users and users of snus. Using snus did not seem to be a risk factor for periodontitis.

Smokeless tobacco use and periodontal health in a rural male population

BACKGROUND

Despite the reported effects of smokeless tobacco (ST) on the periodontium and high prevalence of ST use in rural populations and in men, studies on this specific topic are limited. The purpose of this cross-sectional investigation is to evaluate the periodontal health status of male ST users from a rural population.

METHODS

Adult male residents of two rural Appalachian Ohio counties and daily ST users, with a unilateral mandibular oral ST keratosis lesion, were recruited. Subjects completed a questionnaire and received oral examination. Teeth present, ST keratosis lesion, plaque and gingival index, probing depth (PD), recession depth (RD), and attachment level were recorded. Statistical analysis compared ST-site mandibular teeth (teeth adjacent to the subject's unilateral ST keratosis lesion) to NST-site teeth (contralateral corresponding teeth).

RESULTS

This study includes 73 ST users. Recession prevalence is much greater in ST-site quadrants (36%) compared to NST-site quadrants (18%; P <0.001). Twice as many teeth had recession on ST-site (approximately 20%) than NST-site (approximately 10%; P = 0.0001). Average buccal RD on ST-site teeth did not differ from that on the NST-site teeth (P = 0.0875). Although average buccal attachment loss is greater on ST-site teeth (P = 0.016), the mean difference is <0.5 mm. When stratified by years of ST use, subjects using ST for 10 to 18 years exhibit the most differences between ST and NST sites, whereas subjects using ST for <10 years show no differences.

CONCLUSION

The results indicate that greater gingival recession prevalence and extent are associated with ST placement site in rural male ST users.

[Effects of smoking on periodontal disease]

INTRODUCTION

Smoking is an independent risk factor for periodontal disease and tooth loss.

STATE OF THE ART

Smoking impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Periodontal disease is increased both in prevalence and severity in smokers. Smoking is a predisposing factor to acute necrotizing ulcerative gingivitis and is associated with an increased rate of periodontal disease in terms of pocket formation and attachment loss, as well as alveolar bone loss. Cigar, pipe, water-pipe and cannabis smoking have similar adverse effects on periodontal health as cigarette smoking. Passive smoking is also an independent periodontal disease risk factor. Smokeless tobacco is associated with localized periodontal disease. Smokers respond less favourably to both non-surgical and surgical treatments and have higher failure rates and complications following dental implantation. Smoking cessation may halt the disease progression and improve the outcome of periodontal treatment.

CONCLUSION

Smoking cessation counselling should be an integral part of periodontal therapy and prevention.