Respective Effects of Oral Hygiene Instructions and Periodontal Nonsurgical Treatment (Debridement) on Clinical Parameters and Patient-Reported Outcome Measures with Respect to Smoking

Establishment of a Quantitative Method for the Extraction of Nicotine and Cotinine in Gingival Tissue and Relationship Between Gingival Intoxication With Conventional Smoking Biomarkers: A Pilot Study

OBJECTIVES

Smoking is considered a major risk factor for periodontitis genesis and progression. In clinical studies, specific indicators have been used to characterize the smoking status of the patient as the number of cigarettes consumed (NCC), the pack-years (PY), or Fagerström Test for Nicotine Dependence (FTND). However, available literature is missing on the relationship between cotinine gingival intoxication and smoking indicators. First, the development of a quantitative method for the extraction of nicotine and cotinine in gingival tissue. Second, to investigate the relationship between gingival intoxication and conventional smoking biomarkers.

MATERIAL AND METHODS

Fourteen smoker patients were included in the study. After clinical data collection, salivary and gingival samples collection, toxicological analyses were performed using liquid extraction after enzymatic digestion (subtilisin) and ultra-performance liquid chromatography coupled to mass spectrometry (UPLC-MS/MS).

RESULTS

Gingival cotinine quantification was successfully performed in 14 samples (100%) with a mean of 0.280 ng/mg (range = 0.094-0.505). Only FTND was statistically associated with gingival cotinine levels (p = 0.0072; r² = 0.60). Gingival nicotine quantification was achieved in 12 of the 14 gingival samples (86%) with a mean of 0.384 ± 1.00 ng/mg (range = 0.03-3.84). Gingival nicotine was statistically associated with NCC (p = 0.032; r² = 0.55), PY (p = 0.0011; r² = 0.76), and FTND (p = 0.016; r² = 0.60). Salivary nicotine and cotinine levels were statistically associated with, respectively, NCC (p = 0.030; r² = 0.34), and NCC (p = 0.0094; r² = 0.63) + PY (p = 0.0078; r² = 0.64).

CONCLUSIONS

This pilot study established a quantitative extraction method for nicotine and cotinine from human gingival samples. Additionally, FTND was associated with gingival cotinine. However, further large-scale studies are needed to confirm the relationship between nicotine dependence and gingival intoxication.

Microbiological and Salivary Biomarkers Successfully Predict Site-Specific and Whole-Mouth Outcomes of Nonsurgical Periodontal Treatment

Background/Objectives: Nonsurgical periodontal treatment (NSPT) is the gold-standard technique for treating periodontitis. However, an individual's susceptibility or the inadequate removal of subgingival biofilms could lead to unfavorable responses to NSPT. This study aimed to assess the potential of salivary and microbiological biomarkers in predicting the site-specific and whole-mouth outcomes of NSPT. Methods: A total of 68 periodontitis patients exhibiting 1111 periodontal pockets 4 to 6 mm in depth completed the active phase of periodontal treatment. Clinical periodontal parameters, saliva, and subgingival biofilm samples were collected from each patient at baseline and three months after NSPT. A quantitative PCR assay was used to detect the presence of Fusobaterium nucleatum and Porphyromonas gingivalis in the biofilm samples. Salivary biomarkers including matrix metalloproteinase (MMP)-9, glutathione S-transferase (GST), and Annexin-1 were assayed both qualitatively (Western blot analysis) and quantitively (ELISA). Results: NSPT yielded significant improvements in all clinical parameters, including a reduction in bacterial load and decreased levels of MMP-9 together with increased concentrations of GST and Annexin-1. The binary logistic regression suggested that the overall accuracy of P. gingivalis identification, probing pocket depth, and interproximal sites was 71.1% in predicting successful site-specific outcomes. The salivary biomarker model yielded an overall accuracy of 79.4% in predicting whole-mouth outcomes following NSPT. Conclusions: At baseline, the presence of shallow periodontal pockets at interdental locations with a lower abundance of P. gingivalis is predictive of a favorable response to NSPT at the site level. Decreased salivary MMP-9 associated with increased GST and Annexin-1 levels can predict successful whole-mouth outcomes following NSPT.

Predicting probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence and the number of cigarette consumed

Introduction

Smoking is considered as a risk factor for the poor outcomes after periodontitis non-surgical treatment (PNST). The aim of this short communication is to predict probing depth reduction after periodontal non-surgical treatment in smokers according to the nicotine dependence (FTND) and the number of cigarette consumed (NCC).

Methods

This work is a post-hoc study of a prospective controlled study on the effect of oral hygiene instructions and PNST on periodontal outcomes. This short communication focused only on the current conventional smokers (N = 34), based on specific smoking indicators, and on probing depth (PD) parameter that were recorded at baseline (time 0), after oral hygiene instruction (time 1) and 3 months after PNST (time 2).

Results

The 34 smokers had a mean age 46.5 ± 11.5 years. The NCC- and FTND-based predictions allowed to show in a specific nomogram the PD values 3 months after PNST for each NCC and FTND category.

Conclusion

Two nomograms are proposed for prognostic purposes and allow patients to understand the impact of smoking on periodontitis according to the number of cigarette consumed and the level of nicotine dependence. These nomograms might be also used for supporting smoking cessation.

Clinical significance

In smoker patients with periodontitis, there is a need to predict, for both patient and clinicians, the impact of the number of cigarettes consumed and the level of nicotine dependence on probing depth after oral hygiene instructions and debridement. Two nomograms are proposed for prognostic purposes.

Prospective Longitudinal Changes in the Periodontal Inflamed Surface Area Following Active Periodontal Treatment for Chronic Periodontitis

Periodontal disease is a chronic inflammatory disease of the periodontal tissue. The periodontal inflamed surface area (PISA) is a proposed index for quantifying the inflammatory burden resulting from periodontitis lesions. This study aimed to investigate longitudinal changes in the periodontal status as evaluated by the PISA following the active periodontal treatment. To elucidate the prognostic factors of PISA, mixed-effect modeling was performed for clinical parameters, tooth-type, and levels of periodontal pathogens as independent variables. One-hundred-twenty-five patients with chronic periodontitis who completed the active periodontal treatment were followed-up for 24 months, with evaluations conducted at 6-month intervals. Five-times repeated measures of mean PISA values were 130+/−173, 161+/−276, 184+/−320, 175+/−417, and 209+/−469 mm². Changes in clinical parameters and salivary and subgingival periodontal pathogens were analyzed by mixed-effect modeling. Plaque index, clinical attachment level, and salivary levels of Porphyromonas gingivalis were associated with changes in PISA at the patient- and tooth-level. Subgingival levels of P. gingivalis and Prevotella intermedia were associated with changes in PISA at the sample site. For most patients, changes in PISA were within 10% of baseline during the 24-month follow-up. However, an increase in the number of bleeding sites in a tooth with a deep periodontal pocket increased the PISA value exponentially.