Cigarette smoking and periodontal bone loss

Microfibers from cigarette butts can induce exoskeletal alteration in whiteleg shrimp (Penaeus vannamei)

Cigarette butts (CB) are a source of microfibers (MFs) in aquatic environments, posing a risk to the health of aquatic organisms. Research has been focused on examining the toxicity of CBs on ecological receptors, including invertebrates. More focus has been on death, growth, or movement inhibition of but less on exoskeletal effects in malacostracans. We evaluated the alteration in the carapace structure of whiteleg shrimp (Penaeus vannamei Boone, 1931) caused by MFs derived from CBs (CB-MF). Exposure to CB-MF damaged the gills, the main organs adsorbing calcium in shrimps to generate a hard carapace, disturbing calcium uptake via respiration. Rapid ecdysis caused on CB-MF exposure reduced the environmental adaptation capacity of crustaceans in the absence of normal pigments in the chromatophore of the carapace. These findings indicate that MFs released from CBs released into the aquatic environment can adversely affect exoskeletal alteration within the overall ecosystem.

Benefits of Antimicrobial Photodynamic Therapy as an Adjunct to Non-Surgical Periodontal Treatment in Smokers with Periodontitis: A Systematic Review and Meta-Analysis

The objective of this study was to analyze evidence of the clinical and microbiological benefits of antimicrobial photodynamic therapy (aPDT) adjunctive to scaling and root planing (SRP) in smokers with periodontitis. Randomized clinical trials (RCTs) were included, through an electronic search in PubMed/MEDLINE, LILACS, Web of Science, and the Cochrane Library for articles published in English until December 2022. The quality of the studies was assessed using the JADAD scale and the risk of bias was estimated using the Cochrane Collaboration assessment tool. Of the 175 relevant articles, eight RCTs were included. Of these, seven reported clinical results and five microbiological results, with a follow-up time of 3–6 months. A meta-analysis was performed for the probing depth (PD) reduction and clinical attachment level (CAL) gain at 3 and 6 months. The weighted mean differences (WMDs) and 95% confidence intervals (CIs) were counted for the PD and CAL. The overall effect for the PD reduction at 3 and 6 months (WMD = −0.80, 95% CI = −1.44 to −0.17, p = 0.01; WMD = −1.35, 95% CI = −2.23 to −0.46, p = 0.003) was in favor of aPDT. The CAL gain (WMD = 0.79, 95% CI = −1.24 to −0.35, p = 0.0005) was statistically significant at 6 months, in favor of aPDT. In these RCTs, aPDT was unable to demonstrate efficacy in reducing the microbial species associated with periodontitis. aPDT as an adjuvant to SRP improves the PD reduction and CAL gain more effectively than only SRP. RCTs are needed to establish standardized protocols with longer follow-up times in order to provide more results on aPDT adjunctive to SRP in smokers with periodontitis.

Embryonic Exposure to Cigarette Smoke Extract Impedes Skeletal Development and Evokes Craniofacial Defects in Zebrafish

Exposure to cigarette smoke represents the largest source of preventable death and disease in the United States. This may be in part due to the nature of the delayed harmful effects as well as the lack of awareness of the scope of harm presented by these products. The presence of "light" versions further clouds the harmful effects of tobacco products. While active smoking in expectant mothers may be reduced by educational and outreach campaigns, exposure to secondhand smoke is often involuntary yet may harm the developing embryo. In this study, we show that the main component of secondhand smoke, sidestream cigarette smoke, from several brands, including harm-reduction versions, triggered unsuccessful hatching at 3 dpf and reduced overall survival at 6 dpf in developing zebrafish. At non-lethal concentrations, craniofacial defects with different severity based on the cigarette smoke extract were noted by 6 dpf. All tested products, including harm-reduction products, significantly impacted cartilage formation and/or bone mineralization in zebrafish embryos, independent of whether the bones/cartilage formed from the mesoderm or neural crest. Together, these results in a model system often used to detect embryonic malformations imply that exposure of a woman to secondhand smoke while pregnant may lead to mineralization issues in the skeleton of her newborn, ultimately adding a direct in utero association to the increased fracture risk observed in children of mothers exposed to cigarette smoke.

The Impact of Nonsurgical Periodontal Therapy on Serum Levels of Dickkopf-Related Protein-1 in Smokers and Nonsmokers with Periodontitis: A Prospective Comparative Study

Purpose

Patients and Methods

Results

Conclusion

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

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

Effect of adjuvant bisphosphonates on treatment of periodontitis: Systematic review with meta-analyses

Background

Previous systematic reviews showed additional benefit of adjuvant bisphosphonates (BP) in the treatment of periodontitis. In contrast, it is unclear the effect of BP in patients with diabetes and smokers, its pooled effect when administered locally or systemically is also unknown.

Objectives

This study aimed to systematically review the literature about the use of BP as adjuvant to nonsurgical scaling and root planning (SRP).

Methodology

This study followed the PRISMA guideline. This study included randomized clinical trials that administered locally or systemically BPs as adjuvant for periodontal treatment. Five databases were used. Meta-analyses were performed, using the pooled mean differences (MD) for clinical attachment level (CAL) and probing pocket depth (PPD). Standard mean difference (SMD) was used for radiographic assessment (RADIO). Subgroup analyses were performed for locally delivered meta-analyses, considering diabetes and smoking exposure.

Results

Thirteen studies were included. It was showed MD of 1.52 ​mm (95%CI: 0.97-2.07) and 1.44 ​mm (95%CI: 1.08-1.79) for PPD reduction and CAL gain, respectively, for locally delivered BP. BP was not able to provide significant improvements in smokers (subgroup analysis) when considering CAL (MD: 1.37; 95%CI: -0.17-2.91) and PPD (MD: 1.35; 95%CI: -0.13-2.83). Locally delivered BP also improved significantly the RADIO assessments (SMD: 4.34; 95%CI: 2.94-5.74). MD for systemically administered BP was 0.40 ​mm (95%CI: 0.21-0.60), 0.51 ​mm (95%CI: 0.19-0.83) and 1.05 (95%CI: 0.80-1.31) for PPD, CAL and RADIO, respectively.

Conclusion

The administration of BP in adjunct to SRP may result in additional clinical effects.

An Update on the Links Between Periodontal Health and General Health

It should come as no surprise to the reader that the oral cavity, including the periodontal tissues, are not somehow disjointed from the rest of the body. In this paper, we will explore the links between the periodontal and general health of our patients in both directions. That is to say we will explore how someone's general or systemic health conditions/habits are likely to affect their periodontal health, and how someone's periodontal health is likely to affect their systemic health.<br/> Before exploring these links, we will discuss the distinction between an association and a causal relationship, which is a subtle but vital distinction to make. We will then discuss the role of systemic conditions/habits such as diabetes, smoking, diet and stress on the periodontal health of individuals. Following from this, we will discuss the potential influence of the periodontal health of our patients on their systemic health, focussing on the more established links with diabetes and cardiovascular diseases as well as exploring the mechanisms by which these links may exist.<br/> We will conclude with some tips on the holistic care of our patients, incorporating changes that will benefit their oral and systemic health.

Influence of smoking on periodontal healing one year after active treatment

OBJECTIVE

To investigate the impact of smoking on the reduction of pockets >4 mm deep and a composite variable of residual pockets >4 mm and bleeding on probing (BoP) after treatment.

METHODS

Eligible after exclusion due to missing records were 3,535 individuals, referred for periodontal treatment between 1980 and 2015. The number of teeth (NT), probing pocket depth (PPD), proportion of plaque (PLI) and BoP were registered before treatment and 1 year after treatment. To analyse the impact of smoking on PPD reduction, a mixed model adjusted for age, sex, type of therapy, baseline PPD, reduction of PLI, BoP and NT was used. Depending on residual PPD and BoP, two categories were created: good and poor responders.

RESULTS

PLI was reduced by 20% in non-smokers and by 18% in smokers, and BoP by 46% and 37%, respectively. In the adjusted mixed model, the mean reduction of PPD > 4 mm among smokers undergoing surgery was 14.4 versus 9.7 in non-smokers (p < .001). The odds ratio for being a poor responder was 2.40 (95% CI 1.99-2.91, p < .001) for smokers.

CONCLUSION

Although surgical treatment reduced PPD >4 mm in smokers more effectively than in non-smokers, significantly more non-smokers were good responders after periodontal therapy.

The comparative evaluation of 1% alendronate gel as local drug delivery system in chronic periodontitis in smokers and non smokers: Randomized clinical trial

INTRODUCTION

Periodontitis is a progressive disease of microbial origin involving the loss of supporting tissues of the teeth resulting from host inflammatory and immunologic reactions. The standard approach to the prevention and treatment of periodontal diseases for a number of years has been mechanical therapy and if required surgical intervention Researcher thought of creating a treatment modality where by altering the host response, the destructive host mechanisms could be interfered affecting the final outcome of the disease process.

AIM

The present study aims to explore the efficacy of local delivery of a 1% Alendronate (ALN) gel as an adjunct to scaling and root planing (SRP) for the treatment of infrabony periodontal pockets in smokers and non-smoker with Chronic Periodontitis.

MATERIALS AND METHOD

60 infrabony periodontal pockets in patients with chronic periodontitis between the age group of 30-50 years were selected. The study consisted of 2 groups smoker and nonsmoker. A gel based drug delivery system of Alendronate was formulated. 0.1 ml alendronate gel and 0.1 ml placebo gel was placed at the experimental and control sites respectively following root planing. Clinical and radiographic parameters were recorded at baseline, three months and six months.

RESULTS

Alendronate was effective in improving clinical and radiographic parameters compared to placebo. Alendronate showed better result in non smoker group when compared with smoker group.

CONCLUSION

This Study showed improvements in clinical parameters both at the control and experimental sites. However, the experimental sites (Alendronate) showed greater improvement as compared to the control sites (Placebo). A significant gain in alveolar crest height and defect fill was measured radiographically at non smoker Alendronate group.

Effect of orthodontic force associated with cigarette smoke inhalation in healthy and diseased periodontium. A histometric and immunohistochemistry analysis in rats

BACKGROUND

The aim of the present study is to evaluate the effect of orthodontic forces in healthy or diseased periodontium of rats submitted/not submitted to cigarette smoke inhalation.

MATERIAL AND METHODS

Fifty-six male Wistar rats were allocated into two groups of conditions: smoking and non-smoking. Each group was divided into the following subgroups: control (C), orthodontic tooth movement (OTM), ligature-induced periodontitis (P) and P+OTM (POTM), with n = 14 each. Periodontitis was induced in the lower first molar by cotton ligature, and a 4 mm closed stainless steel spring was used for orthodontic movement. Animals were exposed to the smoke of 10 cigarettes for 8 minutes, 3 times a day for 60 days before P induction and OTM. Evaluation parameters were macroscopic analysis of dental movement, bone loss and bone density. In addition, the receptor activator of nuclear factor-kappaB (RANK) immunostaining and RANK ligand/osteoprotegerin ratio in the furcation region were assessed.

RESULTS

There was no statistically significant difference between groups, ie, smoking and non-smoking conditions (P = .338). Bone loss intragroup analysis between the P and POTM groups was not significant in smoking (P = 1) and non-smoking (P = .5) conditions; both were different from OTM and C in each condition. Regarding bone density, POTM and P were significant to C (P < .05). The POTM group was significant to the P and C (P = .001) regarding dental movement. The RANK ligand/osteoprotegerin ratio in the non-smoking condition was higher in P and POTM compared to C and OTM and to P and POTM in the smoking condition. RANK immunostaining was significant in the smoking condition for the P and POTM groups (P < .05).

CONCLUSION

Within the limitations of the present study, it was concluded that cigarette smoke inhalation had no influence on the evaluated groups, even with the presence of low levels of nicotine, carbon monoxide and tar. The POTM groups did not present greater bone loss compared to P groups, thus periodontal disease is essential for bone loss.

Risk indicators for prevalence, extent and severity of periodontitis among rural Indian population aged 35-54 years

AIMS

This study aimed to identify risk indicators associated with periodontitis and the contribution of each of the indicators towards the prevalence, extent and severity of periodontitis in a rural Indian population.

METHODS

A cross-sectional study design was used to collect data according to National Survey of Adult Oral Health Australia guidelines. A multistage stratified random sampling was followed to select 1401 participants, who were in the age group of 35-54 years. The participants were selected from 50 villages belonging to the 5 sub-provinces of 2 Indian districts. Data were collected through face-to-face interviews and oral examination. Statistical analysis was performed using SAS version 9.3. The univariate, bivariate and multivariate analyses were performed to determine the risk indicators of prevalence, extent and severity of periodontitis. Population attributable fraction was estimated for each of the significant risk indicators of prevalence and extent.

RESULTS

In this study, factors such as age, education, tobacco chewing and plaque accumulation were significantly associated with the prevalence of periodontitis. Age, socioeconomic status, method of tooth cleaning, alcohol consumption and plaque accumulation were significant risk indicators for generalized periodontitis. Age, tobacco chewing and plaque were associated with severity of periodontitis in the population.

CONCLUSION

The rural population had a high prevalence of periodontitis. Sociodemographic factors, poor oral hygiene, tobacco and alcohol were the main risk indicators attributable to periodontitis.

Predictors of long-term outcomes in patients undergoing periodontal maintenance

AIM

This retrospective study aimed to characterize the baseline status of patients following periodontal maintenance, analysing the association between the long-term outcome of these patients, smoking, bruxism, and the main clinical and radiographic variables.

MATERIAL AND METHODS

A sample of 174 patients with moderate to severe periodontitis was refined into homogeneous subsamples according to smoking and bruxism and the rate of tooth loss due to periodontal disease (TLPD): 0, 1-2, and >2 teeth. The association and the distribution (χ² test) of the variables within the subsamples were analysed.

RESULTS

Smoking and bruxism were significantly associated with higher TLPD rates. Vertical and circumferential bone defects (p < .0001), and abfractions (p < .0001) were associated with bruxism and particularly with bruxism and TLPD >2. Furcation defects (p = .0002), fewer radio-opaque subgingival calculus (χ² p < .0001), a lower mean Gingival index (χ² p = .027), and increased mean recessions >1.5 mm (χ² p = .0026) were associated with smoking and higher TLPD rates. The mean baseline mobility, abfractions, and recessions characterized two basic types of TLPD.

CONCLUSIONS

Smoking, bruxism, and routine clinical and radiological parameters can be used to characterize the baseline status of patients with worse outcomes.

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.

Complications when augmenting the posterior maxilla

The maxillary posterior edentulous region presents a challenge when planning for restoring missing teeth with a dental implant. The available bone in such cases is often not dense and not adequate for the placement of a properly sized implant because of maxillary sinus pneumatization and alveolar bone loss. Maxillary sinus lift is a predictable procedure to provide adequate bone height for the purpose of implant placement. However, complications are encountered during or after the execution of the sinus lift procedure. In this article, the prevention and management of maxillary sinus complications are discussed.

Subgingival microbiome in smokers and non-smokers in Korean chronic periodontitis patients

Smoking is a major environmental factor associated with periodontal diseases. However, we still have a very limited understanding of the relationship between smoking and subgingival microflora in the global population. Here, we investigated the composition of subgingival bacterial communities from the pooled plaque samples of smokers and non-smokers, 134 samples in each group, in Korean patients with moderate chronic periodontitis using 16S rRNA gene-based pyrosequencing. A total of 17,927 reads were analyzed and classified into 12 phyla, 126 genera, and 394 species. Differences in bacterial communities between smokers and non-smokers were examined at all phylogenetic levels. The genera Fusobacterium, Fretibacterium, Streptococcus, Veillonella, Corynebacterium, TM7, and Filifactor were abundant in smokers. On the other hand, Prevotella, Campylobacter, Aggregatibacter, Veillonellaceae GQ422718, Haemophilus, and Prevotellaceae were less abundant in smokers. Among species-level taxa occupying > 1% of whole subgingival microbiome of smokers, higher abundance (≥ 2.0-fold compared to non-smokers) of seven species or operational taxonomic units (OTUs) was found: Fusobacterium nucleatum, Neisseria sicca, Neisseria oralis, Corynebacterium matruchotii, Veillonella dispar, Filifactor alocis, and Fretibacterium AY349371. On the other hand, lower abundance of 11 species or OTUs was found in smokers: Neisseria elongata, six Prevotella species or OTUs, Fusobacterium canifelinum, Aggregatibacter AM420165, Selenomonas OTU, and Veillonellaceae GU470897. Species richness and evenness were similar between the groups whereas diversity was greater in smokers than non-smokers. Collectively, the results of the present study indicate that differences exist in the subgingival bacterial community between smoker and non-smoker patients with chronic moderate periodontitis in Korea, suggesting that cigarette smoking considerably affects subgingival bacterial ecology.

Comparison of red blood cell parameters in smokers and nonsmokers with chronic periodontitis

OBJECTIVE

Recent studies suggest that chronic periodontitis can lead to a decrease in levels of red blood cell (RBC) and hemoglobin concentration. Smoking is an established risk factor for periodontitis. The present study was carried out to evaluate the effect of cigarette smoking on the various parameters of RBC in the subjects with chronic periodontitis.

METHODS

A total of 77 males with chronic periodontitis were divided into 38 nonsmokers (group I) and 39 current smokers (group II). Clinical parameters recorded were probing pocket depth and clinical attachment level. Laboratory blood investigations included hemoglobin concentration, RBC count, packed cell volume, mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration and erythrocyte sedimentation rate.

RESULTS

In group II probing pocket depth and clinical attachment level and erythrocyte sedimentation rate were significantly higher than in group I. The RBC count, hemoglobin concentration, and packed cell volume were significantly lower in group II compared to group I. While the mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration were comparable in both the groups.

CONCLUSION

Smoking may have an effect on levels of various RBC parameters in patients with chronic periodontitis.

Chairside quantitative immunochromatographic evaluation of salivary cotinine and its correlation with chronic periodontitis

BACKGROUND

Cigarette smoking is an established and modifiable risk factor for periodontitis. Periodontitis appears to be dose-dependent on smoking. The purpose of this study was to assess a reliable marker of tobacco smoke exposure (salivary cotinine) chairside and to confirm the quantitative association between smoking and chronic periodontitis.

MATERIALS AND METHODS

Saliva samples from 80 males, aged 30-60 years, with chronic periodontitis, were evaluated chairside using NicAlert™ cotinine test strips (NCTS). Patients were divided into two groups: A (cotinine negative) and B (cotinine positive). Plaque index (PI), Gingival index (GI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were compared between the two groups and among the subjects of group B.

RESULTS

Comparison showed that the severity of PPD (P<0.001), CAL (P<0.001), and GR (P<0.001) was more in group B than in group A. Severity of all periodontal parameters increased with increased salivary cotinine among the subjects in group B.

CONCLUSION

Quantitative direct association can be established between salivary cotinine and the severity of periodontitis. Immunochromatography-based cotinine test strips are a relatively easy method for quantification of salivary cotinine chairside. Immediate and personalized feedback from a chairside test can improve compliance, quit rates, and ease reinforcing smoking cessation.

Retrospective investigation of gingival invaginations: Part II: microbiological findings and genetic risk profile

BACKGROUND AND OBJECTIVE

Gingival invaginations are a frequent finding during tooth extraction and following orthodontic space closure. Based on the interdental localization and sometimes pronounced depth, it has been suggested that a gingival invagination may impede oral hygiene. In Part I of this series, the time until active tooth movement and the localization of extraction were identified as potential risk factors for the development of gingival invagination. The aims of the present study were the analysis of the microbial spectrum of a gingival invagination in comparison with pool samples of the sulcus of Ramfjord teeth, on the one hand, and the importance of genetic variations of the pro-inflammatory mediator interleukin-1 (IL-1) and its receptor antagonist (IL-1-RN), on the other hand. In addition, a possible role of smoking as a risk factor was evaluated.

SUBJECTS AND METHODS

A total of 30 patients with (n=16) and without (n=14) gingival invagination were examined for the presence of eleven periodontal pathogen bacterial species with a commercially available test (micro-IDent®Plus, Hain Lifescience, Nehren, Germany). The genetic evaluation was performed with the GenoType® IL-1 test (Hain Lifescience).

RESULTS

The results of the microbiological analysis of gingival invaginations showed that the bacterial flora might differ or even be higher than the pool sample from sulcus regions. The genetic evaluation demonstrated that in the group without gingival invagination only 14% showed an IL-1 polymorphism, whereas this value was twice as high (35%) in the group with gingival invagination. In addition, a combination of both polymorphisms IL-1 and IL-1-RN was only found in patients with gingival invagination (25%). Interestingly, smoking patients showed a significant increase of the severity of the gingival invagination.

CONCLUSION

This retrospective study demonstrated that gingival invagination might be accompanied with an altered microbiological bacterial spectrum and a genetic IL-1 polymorphism. In addition, smoking was identified as another potential risk factor for the severity of gingival invaginations.

Effect of cigarette smoking on the periodontal health status: A comparative, cross sectional study

CONTEXT

Survey.

AIMS

The objective of the study was to evaluate the periodontal health status among cigarette smokers and non cigarette smokers, and oral hygiene measures.

SETTINGS AND DESIGN

Cross sectional study.

MATERIALS AND METHODS

The study included 400 male (200 cigarette smokers and 200 non smokers) aged 18-65 years. The subjects were randomly selected from the patients attending dental out-patient department of civil hospital and Himachal Dental College, Sundernagar. Community Periodontal Index (CPI) score was recorded for each patient and a questionnaire was completed by each patient.

STATISTICAL ANALYSIS USED

Chi square and t-test.

RESULTS

Periodontal condition as assessed by CPI score showed that there was statistically significant difference in the findings between cigarette smokers and non-smokers.

CONCLUSIONS

Within the limits of this study, positive association was observed between periodontal disease and cigarette smoking. It was found that cigarette smoking was associated with lesser gingival bleeding and deeper pockets as compared to non-smokers.

Secondhand smoke and periodontal disease: atherosclerosis risk in communities study

OBJECTIVES

We investigated the relationship between secondhand smoke and periodontal disease in nonsmokers.

METHODS

We undertook a cross-sectional analysis of the Atherosclerosis Risk in Communities study with 2739 lifetime nonsmokers aged 53-74 years, unexposed to other sources of tobacco, who received a complete periodontal examination at visit 4. Exposure was reported as average hours per week in close contact with a smoker in the preceding year. We defined severe periodontitis as 5 or more periodontal sites with probing pocket depth of 5 millimeters or more and clinical attachment levels of 3 millimeters or more in those sites. Other outcomes were extent of periodontal probing depths of 4 millimeters or more and extent of clinical attachment levels of 3 millimeters or more.

RESULTS

In a binary logistic regression model, adjusted odds of severe periodontitis for those exposed to secondhand smoke 1 to 25 hours per week increased 29% (95% confidence interval = 1.0, 1.7); for those exposed to secondhand smoke 26 hours per week, the odds were twice as high (95% confidence interval = 1.2, 3.4) as for those who were unexposed.

CONCLUSIONS

Exposure to secondhand smoke and severe periodontitis among nonsmokers had a dose-dependent relationship.

Smoking and the outcome of infection

Smoking has substantial local and systemic adverse effects on the immune system, respiratory tract and skin and soft tissues. Smokers are at increased risk of invasive pneumococcal disease, pneumonia, periodontitis, surgical infections, tuberculosis, influenza and meningococcal disease. The results of several studies indicate that smokers with periodontitis or tuberculosis suffer more severe disease. Data on the impact of smoking on sepsis and pneumonia are controversial and limited, and systematic data regarding the outcome of the majority of infections in smokers are scarce. Abundant data indicate that children exposed to environmental tobacco smoke (ETS) suffer from more severe infections. However, information regarding the effects of ETS on the outcome of infections in adults is limited. Various aspects of the relation between smoking and the outcome of bacterial infection (e.g. potential dose-dependent effects and the interactions between smoking and other environmental factors that may affect the course of infectious diseases) remain to be established.

Effect of smoking on subgingival microflora of patients with periodontitis in Japan

Background

Smoking is a risk factor for periodontitis. To clarify the contribution of smoking to periodontitis, it is essential to assess the relationship between smoking and the subgingival microflora. The aim of this study was to gain an insight into the influence of smoking on the microflora of Japanese patients with periodontitis.

Methods

Sixty-seven Japanese patients with chronic periodontitis (19 to 83 years old, 23 women and 44 men) were enrolled in the present study. They consisted of 30 smokers and 37 non-smokers. Periodontal parameters including probing pocket depth (PPD) and bleeding on probing (BOP) and oral hygiene status were recorded. Detection of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, Fusobacterium nucleatum/periodonticum, Treponema denticola and Campylobacter rectus in subgingival plaque samples was performed by polymerase chain reaction. Association between the detection of periodontopathic bacteria and smoking status was analyzed by multiple logistic regression analysis and chi-square test.

Results

A statistically significant association was found between having a PPD ≥ 4 mm and detection of T. denticola, P. intermedia, T. forsythia, or C. rectus, with odds ratios ranging from 2.17 to 3.54. A significant association was noted between BOP and the detection of C. rectus or P. intermedia, and smoking, with odds ratios ranging from 1.99 to 5.62. Prevalence of C. rectus was higher in smokers than non-smokers, whereas that of A. actinomycetemcomitans was lower in smokers.

Conclusions

Within limits, the analysis of the subgingival microbial flora in smokers and non-smokers with chronic periodontitis suggests a relevant association between smoking and colonization by the specific periodontal pathogens including C. rectus.

[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.

Nicotine and periodontal tissues

Tobacco use has been recognized to be a significant risk factor for the development and progression of periodontal disease. Its use is associated with increased pocket depths, loss of periodontal attachment, alveolar bone and a higher rate of tooth loss. Nicotine, a major component and most pharmacologically active agent in tobacco is likely to be a significant contributing factor for the exacerbation of periodontal diseases. Available literature suggests that nicotine affects gingival blood flow, cytokine production, neutrophil and other immune cell function; connective tissue turnover, which can be the possible mechanisms responsible for overall effects of tobacco on periodontal tissues. Inclusion of tobacco cessation as a part of periodontal therapy encourages dental professionals to become more active in tobacco cessation counseling. This will have far reaching positive effects on our patients' oral and general health.

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.

The effect of smoking on early bone remodeling on surface modified Southern Implants®

INTRODUCTION

Smoking affects the survival of turned titanium implants. Although smoking has less impact on the failure rate of rough surface implants, the effect on bone loss on rough surface implants has not been studied yet and may be an important factor in biological stability.

AIM

To determine the effect of smoking on early implant failures and bone remodeling around moderately rough implants (Southern Implants®, Southern Implants, Irene, South Africa).

MATERIALS AND METHODS

Three hundred twenty-nine patient records, containing information on 712 installed implants, were scrutinized retrospectively and periapical radiographs were analyzed for interproximal bone level. Mann-Whitney U-test and Fisher's exact test were performed to compare bone level and implant survival in smokers and nonsmokers. Only implants with at least 6 months of function time were analyzed for bone level changes.

RESULTS

The overall survival rate was 98.3%. Implants in smokers had a threefold higher failure rate compared with nonsmokers (5/104 = 4.8% vs 7/608 = 1.2%). This was statistically significant on implant level (p = .007) but not on patient level (1/41 vs 7/288, p = .997). Readable radiographs from 363 implants in 169 patients were available with a mean follow-up of 12 months (SD 5.11; range 6-28). The mean interproximal bone level was 1.36 mm (n = 363; SD 0.41; range 0.48-3.70). Bone levels were independent of jaw location. Sixty implants from 21 smokers lost statistically significantly (p = .001) more bone (mean 1.56; SD 0.53; range 0.75-3.22) than the 303 implants in 148 nonsmokers (mean 1.32 mm; SD 0.38; range 0.48-3.7). The maxilla is especially prone to bone loss compared with the mandible (1.70 mm vs 1.26 mm, p < .001).

CONCLUSION

The Southern Implants® system demonstrated a high absolute survival rate. Although smokers are not more prone to implant loss, more pronounced peri-implant bone loss was observed, especially in the maxilla. Whether this affects future biological complications remains to be investigated in prospective long-term studies.

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.

Resolution of oral lesions after tobacco cessation

BACKGROUND

Dentists and other health care professionals are familiar with the impact of tobacco on oral and general health. However, oral health care professionals do not often provide tobacco-cessation counseling to their patients, thus reflecting a significant disconnect between research and clinical practice. This report demonstrates the benefits of tobacco cessation in resolving oral lesions and improving overall periodontal and oral health.

METHODS

A 51-year-old white male presented to the University at Buffalo, School of Dental Medicine clinic requesting an oral and periodontal examination as part of a presurgical protocol prior to cardiac surgery. A review of the patient's history from a health questionnaire revealed that he was using smokeless tobacco every day. An oral examination revealed several white lesions (5 x 10 mm) on the maxillary right and left labial mucosa. The patient was provided with tobacco-cessation counseling as well as oral hygiene instructions and professional dental prophylaxis.

RESULTS

An oral examination 2 weeks after tobacco cessation revealed complete resolution of the oral lesions and overall improvement of periodontal and oral health.

CONCLUSION

Although the findings presented in this article are based only on a single case report, the improvement in the patient's oral health after cessation of tobacco use was dramatic and reinforces the belief that tobacco-cessation counseling should be a routine component of the standard of care for tobacco-using patients.

Serum antibody levels in smoker and non-smoker saudi subjects with chronic periodontitis

BACKGROUND

Cigarette smoking is a significant risk factor for the initiation and progression of periodontal disease. Studies have shown altered serum and gingival crevicular fluid inflammatory cytokine profiles, immune cell function, and altered proteolytic regulation in smokers. The observations are not consistent, and to date, there is no clear mechanism to explain how smoking may affect periodontal disease. Hence, the present study was undertaken to assess the alterations of serum immunoglobulin levels in smokers with periodontitis and its potential role as a risk indicator of the disease process.

METHODS

In this study, 30 patients who smoked and 30 patients who did not smoke with chronic periodontitis and 30 healthy subjects were enrolled. Serum immunoglobulin (Ig) G, IgA, and IgM levels were estimated with immunoturbidimetric assay. The IgG subclass (IgG1, IgG2, IgG3, and IgG4) levels were performed using single radial immunodiffusion assay.

RESULTS

Levels of serum IgG and IgA were significantly lower in smokers compared to non-smokers and healthy controls (P <0.001). Although IgM levels were low in smokers, it was not significant. Of the four subclasses of IgG studied, the IgG2 was found to be significantly lower among smokers with periodontitis.

CONCLUSIONS

Current observations indicate that cigarette smoking may be associated with the suppression of B-cell function and immunoglobulin production. The alteration of antibody levels further explains the potential mechanism by which smoking exacerbates periodontal disease. Further studies at the molecular level may highlight the specific mechanism by which tobacco can interact with cells of the immune system and its impact on periodontal disease process.

Surgical treatment of peri-implantitis using a bone substitute with or without a resorbable membrane: a prospective cohort study

OBJECTIVES

The aim of this prospective cohort study was to compare two regenerative surgical treatment modalities for peri-implantitis.

MATERIAL AND METHODS

Thirty-six patients having a minimum of one osseointegrated implant, with a progressive loss of bone amounting to > or =3 threads (1.8 mm) following the first year of healing, combined with bleeding and/or pus on probing, were involved in this study. The patients were assigned to two different treatment strategies. After surgical exposure of the defect, granulomatous tissue was removed and the infected implant surface was treated using 3% hydrogen peroxide. The bone defects were filled with a bone substitute (Algipore). In 17 patients (Group 1), a resorbable membrane (Osseoquest) was placed over the grafted defect before suturing. In 19 patients (Group 2), the graft was used alone.

RESULTS

One-year follow-up demonstrated clinical and radiographic improvements. Probing depths were reduced by 2.9 mm in Group 1 and by 3.4 mm in Group 2. Defect fill amounted to 1.5 and 1.4 mm, respectively. There was no significant difference between the groups.

CONCLUSION

It is possible to treat peri-implant defects with a bone substitute, with or without a resorbable membrane.

A histologic and histometric assessment of the influence of nicotine on alveolar bone loss in rats

BACKGROUND

Cigarette smoking has long been recognized as a risk factor for periodontal disease. The aim of this study was to perform quantitative and qualitative analyses of bone loss in the furcation region of periodontally healthy rats after daily systemic administration of nicotine or saline solution.

METHODS

Thirty adult male Wistar rats were assigned randomly to twice daily subcutaneous injections of saline solution (control, group C) or nicotine (group N). The animals were sacrificed at 37, 44, or 51 days after the first subcutaneous injection. The specimens were processed for serial histologic sections, and the area of bone loss in the furcation region of the second molar was analyzed histometrically.

RESULTS

Greater bone loss was detected in group N compared to group C on day 37 (16.36 +/- 5.84 mm(2) and 7.24 +/- 2.66 mm(2)), day 44 (15.12 +/- 4.57 mm(2) and 7.76 +/- 1.35 mm(2)), and day 51 (18.80 +/- 3.71 mm(2) and 8.74 +/- 2.61 mm(2)), respectively (P <0.05). Extension of bone loss appeared greater in the furcation region of group N where a thinner trabeculae bone was found. After day 37, bone loss did not increase significantly.

CONCLUSIONS

Daily systemic administration of nicotine resulted in significantly greater bone loss in the furcation region compared to saline solution. This indicated a close association between nicotine and periodontal morbidity in rats.

Lipopolysaccharide enhances the production of nicotine-induced prostaglandin E2 by an increase in cyclooxygenase-2 expression in osteoblasts

Previous studies have indicated that lipopolysaccharide (LPS) from Gram-negative bacteria in plaque induces the release of prostaglandin E(2) (PGE(2)), which promotes alveolar bone resorption in periodontitis, and that tobacco smoking might be an important risk factor for the development and severity of periodontitis. We determined the effect of nicotine and LPS on alkaline phosphatase (ALPase) activity, PGE(2) production, and the expression of cyclooxygenase (COX-1, COX-2), PGE(2) receptors Ep1>4, and macrophage colony stimulating factor (M-CSF) in human osteoblastic Saos-2 cells. The cells were cultured with 10(-3) M nicotine in the presence of 0, 1, or 10 mug/ml LPS, or with LPS alone. ALPase activity decreased in cells cultured with nicotine or LPS alone, and decreased further in those cultured with both nicotine and LPS, whereas PGE(2) production significantly increased in the former and increased further in the latter. By itself, nicotine did not affect expression of COX-1, COX-2, any of the PGE(2) receptors, or M-CSF, but when both nicotine and LPS were present, expression of COX-2, Ep3, Ep4, and M-CSF increased significantly. Simultaneous addition of 10(-4) M indomethacin eliminated the effects of nicotine and LPS on ALPase activity, PGE(2) production, and M-CSF expression. Phosphorylation of protein kinase A was high in cells cultured with nicotine and LPS. These results suggest that LPS enhances the production of nicotine-induced PGE(2) by an increase in COX-2 expression in osteoblasts, that nicotine-LPS-induced PGE2 interacts with the osteoblast Ep4 receptor primarily in autocrine or paracrine mode, and that the nicotine-LPS-induced PGE(2) then decreases ALPase activity and increases M-CSF expression.

Factors affecting tooth loss among rural Khon Kaen adults: analysis of two data sets

BACKGROUND

Tooth loss is an oral health problem affecting Thai people and people of other nations as well. Not much of epidemiologic evidence concerning factors affecting tooth loss among Thai people has been reported although severity of tooth loss among Thai people has never been decreased.

METHODS

This study employed two existing data sets to evaluate the role of health behaviors such as tobacco smoking and betel quid chewing (a common habit prevalent among rural Thai females), together with other factors in relation to tooth loss among rural Thai people. The study population in the first (phase I) and second (phase II) data sets included 1484 and 3471 male and female adults residing in rural areas of Khon Kaen province, Thailand during 1990-1991 and 1992-1994, respectively. The data were obtained through oral examination and interview. Employing descriptive, bivariate, and multivariable Poisson regression, key risk indicators of tooth loss were identified for both data sets.

RESULTS

The findings from final multivariable Poisson regression models were consistent in that tobacco smoking, betel quid chewing, age, dental caries (defined as decayed plus filled teeth) and periodontitis were significantly related to tooth loss among these rural populations.

CONCLUSION

Therefore, preventive programs aiming at discouraging Thai people from smoking tobacco and/or chewing betel quid should be established so that healthy natural teeth can be maintained.

Percentile curves for present teeth in smokers and non-smokers in an adult male population

The purpose of this study was to obtain percentile curves for present teeth in smokers and non-smokers for use in oral health education. Dental examinations were carried out by two dentists. The number of present teeth in each subject was counted, excluding the third molars. Subjects consisted of 2,283 men aged between 25 and 54 years enrolled in the health insurance union of a bank in Yokohama, Japan. Each subject completed a questionnaire on smoking habits and number of cigarettes smoked. They were classified into two groups: smokers and non-smokers. The mean number of present teeth in both groups was compared with the Mann-Whitney's U test. Smokers had fewer teeth than non-smokers in all age groups (p<0.05). At the age of 50, the 50th percentile for present teeth was 26 for smokers and 27 for non-smokers. However, the 3rd percentile for smokers' present teeth was 20.5 at 40 years of age and 14 at 50 years of age, while for non-smokers it was 22.5 at 40 years of age and 19 at 50 years of age. The 3rd percentile curve for smokers' present teeth decreased in those aged 45 years and over. The percentile curves in this analysis showed a clear difference between the two groups. These data should be made available for use in adult oral health education.

Aggressive Periodontitis Among Young Israeli Army Personnel

BACKGROUND

The aim of this study was to assess the prevalence of aggressive periodontitis among young Israeli army recruits and to evaluate its association with smoking habits and ethnic origin.

METHODS

The study population consisted of 642 young army recruits (562 men [87.5%] and 80 women [12.5%]), aged 18 to 30 years (average: 19.6 +/- 1.6 years), who arrived at a military dental clinic for dental examinations between January and December 2004. Subjects filled out a questionnaire regarding their ethnic origin and family periodontal history, followed by radiographs and a clinical periodontal examination of four first molars and eight incisors.

RESULTS

Aggressive periodontitis was found in 5.9% of the subjects (4.3% localized and 1.6% generalized). At least one site with a probing depth > or =5 mm was found in 20.1% of the subjects. A radiographic distance between crestal bone height and the cemento-enamel junction >3 mm was found in 43 (6.7%) subjects. Current smokers (39.9%) (P = 0.03) and subjects of North African origin (P <0.0001) correlated with a high prevalence of aggressive periodontitis.

CONCLUSION

A relatively high prevalence of aggressive periodontitis was found in young Israeli army recruits, which was particularly associated with smoking and ethnic origin.