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

What is the impact of nicotine pouches on oral health: a systematic review

BACKGROUND

Increase in nicotine pouch (NP) users, particularly among the young, is a matter of concern requiring a comprehensive understanding of its short- and long-term oral health implications. The objective of this research was to systematically review potential oral side-effects associated with NP usage.

METHODS

This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Scopus, Cochrane Trial, and Google Scholar) were searched for relevant studies up to February 2024. Modified Newcastle-Ottawa Scale (NOS) and the Risk Of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool were used to assess the quality and bias of the included studies.

RESULTS

Three studies were included for this review, two from Europe and one from USA, and considered of a total of 190 participants. All studies were deemed to have a high risk of bias. Participants used NP for periods ranging from 1 month to 10 years. Among these studies, only one study provided information on the usage pattern between 1 and 5 units for an average of 11 ± 7 min per session. Oral mucosal changes at the site of placement were common among NP users. Oral lesions varied from slight wrinkling to various white lesions, seemingly related to the NP units consumed per day and their duration of usage. Other oral side effects included dry mouth, soreness, gingival blisters, and a strange jaw sensation.

CONCLUSIONS

Research on the use of NP and its effect on oral health are currently limited. The use of NP should take into consideration the short-and-long-term effects, especially on oral health. Further studies are crucial to understand oral health implications associated with NP usage.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO Registration number CRD 42,024,500,711.

Factors Associated with the Extent of Clinical Attachment Loss in Periodontitis: A Multicenter Cross-Sectional Study

Periodontitis has significant public health implications, affecting individuals' overall health, well-being, and quality of life. This study aimed to assess the risk factors associated with the extent of clinical attachment loss (CAL) in a population diagnosed with periodontitis. Six hundred and sixty-seven patients with different degrees of CAL (mild, n = 223; moderate, n = 256; and advanced, n = 188) were enrolled. Socio-demographics, lifestyle, microbiological profiles, specific immune response, obesity, and single-nucleotide polymorphism of the IL1 gene were determined. Unconditional logistic regression models were conducted to determine the factors associated with the extent of CAL. Aging, smoking, microbial factors, plaque index, and IgG2 antibodies against Aggregatibacter actinomycetemcomitans were associated with advanced CAL. IgG2 antibodies against A. actinomycetemcomitans (OR 1.50; CI 95% 1.23-1.81), plaque accumulation (OR 2.69; CI 95% 2.20-3.29), Porphyromonas gingivalis (OR 1.93; CI 95% 1.35-2.76), Tanerella forsythia (OR 1.88; CI 95%1.30-2.70), and current smoking (OR 1.94; CI 95% 1.31-2.87) were associated with advanced CAL. Gene IL polymorphisms, obesity, and stress were not associated with the extent of CAL. Aging, plaque accumulation, smoking, and having antibodies against A. actinomycetemcomitans were the most critical factors associated with advanced CAL. In contrast, obesity, stress, and gene polymorphisms were not associated with the extent of CAL.

Association between Body Mass Index and Severity of Periodontal Disease among Adult South Indian Population: A Cross-sectional Study

Background

Periodontal disease is one of the top six chronic noncommunicable diseases (NCDs) and is recognized as a severe global public health problem. This study aimed to assess the association between various levels of body mass index (BMI) and periodontal disease severity in Indian adults.

Material and Methods

The study was designed as a hospital-based cross-sectional study involving 212 participants aged between 18 and 65. A questionnaire assessed by an investigator was used to assess oral health-associated risky behavior and demographical factors. Participants were also assessed using full-mouth clinical periodontal and anthropometric measurements. The mean number of sites with pocket probing depth (PPD) ≥4 mm and the presence of periodontal disease were used as outcome measures. Bivariate analysis and multiple logistic regressions were performed.

Results

The overall proportion of participants with periodontal disease was 50%, that is, sites with PPD ≥4 mm (n = 106). Multivariate analysis showed that BMI (odds ratio (OR) = 0.77, 95% confidence interval (CI): 0.43, 1.37) was not associated with periodontal disease, but smoking (OR = 3.90, 95% CI: 1.63, 5.89), alcohol consumption (OR = 1.24, 95% CI: 0.72, 2.13), age (OR = 2.51, 95% CI: 1.08, 5.84), and diabetic mellitus (OR = 1.69, 95% CI: 0.92, 3) were positively associated with periodontal disease.

Conclusion

A positive association was found between smoking, alcohol consumption, age, gender, history of diabetic mellitus, and periodontal disease. No significant association exists between obesity and periodontal disease in South Indian adults.

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.

Assessment of oral health status amongst the Sevayats of Shree Jagannath Temple, Puri, Odisha: A cross sectional study

Aim

To assess the oral health status amongst the Sevayats of Shree Jagannath temple, Puri, Odisha.

Methodology

A cross-sectional study was conducted to evaluate the oral health status among 488 Sevayats of Shree Jagannath Temple, Puri, using a simple random sampling technique. Data were obtained by utilizing the WHO oral health assessment form for adults-2013. The documented data were assembled, entered into an MS Excel spreadsheet, and analyzed using SPSS version 26. The statistical tests applied for the analysis were one-way analysis of variance and the Chi-square test. The P value of < 0.05 was considered statistically significant.

Results

The majority of the participants, around 30.3%, had an educational qualification of higher secondary, followed by high school, 26.2%. A total of 84.4% of participants cleaned their teeth with a toothbrush. Around 48.0% of participants were consuming paan and 11.7% were gutkha. The majority, 77.8% of the participants had periodontal pockets, and 79.09% of them had 4-5 mm of periodontal loss of attachment. The mean DMFT of all the participants was 5.23 ± 4.71. In the 25-44 and 45-60 years of age groups, 34.2% and 31.4% of the participants had tobacco pouch keratosis. About 72% of the subjects had bleeding gums.

Conclusion

There was a higher prevalence of dental caries and periodontal disease among the subjects. The majority of the servitors who had a history of consuming paan were diagnosed with oral mucosal lesions.

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.

The barriers for tobacco cessation counseling in teaching health care institutions: A qualitative data analysis using MAXQDA software

Introduction:

Recently, Dental Council of India directed all the teaching dental institutions in the country to set up tobacco cessation centers (TCC). International experiences suggest that there are many barriers for the provision of tobacco cessation counseling at dental clinics. In this context, it is important to understand the dental students’ attitudes toward this initiative of tobacco cessation counseling at dental settings.

Materials and Methods:

This qualitative study to document the dental students’ perspectives toward the provision of tobacco cessation counseling using focus group interviews was conducted in two teaching dental institutions in the state of Andhra Pradesh, India. 133 house surgeons from two dental institutions participated in the study and were interviewed as 13 focus groups. MAXQDA (version 12, VERBI GmbH, Berlin, Germany) was used for data analysis. All the interviews were audio recorded and the transcripts were open coded by three independent investigators.

Results:

The response rate in this study was 78.45%. The following themes were extracted from the views and opinions shared by the students: the reluctance of patients to discuss tobacco-related problems; tobacco use among students discouraging them to actively participate in counseling; an opinion that dental clinics are not suitable for the provision of tobacco cessation counseling; belief among students that they are not qualified enough.

Conclusion:

The directives given by the Ministry of Health and Family Welfare in association with Dental council of India to set up TCC at every teaching dental institution are laudable and demonstrate the commitment at policy level toward bringing down tobacco consumption in the country. However, few reforms need to be made in the curriculum to better execute the delegated responsibilities, which include orientation programs for dental students on the scope of the dental profession and workshops on tobacco cessation counseling.

Prevalence, knowledge, attitude and nicotine dependence among ESI-insured populations of Delhi NCR region: Institutional study

Aim:

To assess the prevalence of tobacco consumption among the ESI-insured patients. The study also assessed the knowledge, practice, and attitude among industrial workers as well as nicotine dependence with different forms of tobacco products consumed.

Materials and Methods:

A cross-sectional study was conducted among industrial workers from various industries (small and large scale) insured under the employee state insurance corporation scheme. The study was conducted for 3 months included 500 workers of which 470 were males and 30 were females. A predesigned, pretested, and structured interviewed administered questionnaire was used to collect the data on sociodemographic factors, reasons for tobacco consumed, and level of dependencies among industrial workers. Questionnaire also included questions related to awareness regarding health hazards and lesion present in the oral cavity as a result of tobacco consumption. Fegarstrom scale was used to access nicotine dependency level. A Hindi translated version of Fegarstrom test for Nicotine dependence in the questionnaire was used which included six standard questions for both smokeless and smoked form.

Result:

Majority of both males and females consumed tobacco in smokeless (58.8%) form. Out of which 92.85% in males and 7.15% in females followed by the smoke (28.8%) form. 93.04% in males and (7%) in females (79.86%) of the tobacco users in our study were aware that consuming tobacco causes health related problems. 38.6% of the users have moderate dependency in both smoke and smokeless form. Seventy six percent of the consumers feel that they didn't have any changes in the mouth by consuming tobacco and thus never thought of quitting tobacco.

Conclusion:

Tobacco consumption among the ESI-insured patients is high. Execution of tobacco cessation programs are required to curb this trend.