Molar furcation involvement associated with cigarette smoking in periodontal referrals

Different application procedures of Nd:YAG laser as an adjunct to scaling and root planning in smokers with stage III grade C periodontitis: a single-blind, randomized controlled trial

BACKGROUND

The aim of the present study was to evaluate whether different Nd:YAG laser applications as an adjunct to scaling and root planning (SRP) improve the healing response to periodontal therapy in smokers with periodontitis.

METHODS

This clinical trial included eighty systemically healthy smokers with periodontitis. Patients were randomly allocated to a treatment group: SRP alone (group 1), SRP+low-level laser therapy (LLLT) with Nd:YAG laser (group 2), SRP+pocket debridement with ND:YAG laser (group 3), and SRP+combined pocket debridement and LLLT with Nd:YAG laser (group 4). Gingival index (GI), plaque index (PI), bleeding on probing (%), probing depth (PD), and clinical attachment level (CAL) were recorded, and gingival crevicular fluid (GCF) samples for metalloproteinase-8 (MMP-8) levels were collected at baseline, 1 month and 3 months after treatment.

RESULTS

There were no significant differences between the treatment groups for the GI, PI, and BOP (%) parameters and MMP-8 levels at any time points (p > 0.05). For moderately deep pockets, PD and CAL reductions were significantly greater in all test groups compared to group 1 (p ˂ 0.05). For deep pockets, these reductions were significantly greater in group 2 and group 4 compared to group 1 (p ˂ 0.05). PD and CAL reductions were generally similar between test groups (p > 0.05) except PD reduction between baseline and 3 months in deep pockets (p ˂ 0.05).

CONCLUSIONS

The findings of this clinical trial suggest that Nd:YAG laser applications may be beneficial on the healing response of smokers to non-surgical therapy compared to SRP alone.

The Radiographic Assessment of Furcation Area in Maxillary and Mandibular First Molars while Considering the New Classification of Periodontal Disease

This study aimed to evaluate the radiographic reliability in the diagnosis of furcation involvement in first molars. A total of 52 subjects were included in the current study. Personal history regarding smoking was recorded and a periodontal examination was performed. Pocket depth (PD), clinical attachment level (CAL), gingival recession, and furcation involvement in all first molars were assessed for each patient. Periodontal staging and grading were evaluated using the new classification of periodontal disease. Class II and Class III furcation classification were more frequently observed in radiographs than the Class I furcation; however, no significant differences were observed. Radiographic observation of the furcation was seen more when PD and CAL were >5 mm in all molars. The presence of gingival recession and its relation to the radiographic assessment did not reveal any statistically significant association (p > 0.05) except for tooth #16. The trend of visibility of furcation radiographically was more as the grade of staging was increased. Moreover, the presence of smoking habits and visibility of furcation radiographically did not have any statistical significance. Smoking may not be a factor in the furcation involvement. There is a direct relationship between the staging and grading of the periodontitis and furcation involvement.

Associations of electronic and conventional cigarette use with periodontal disease in South Korean adults

BACKGROUND

The aim of this study was to examine the association of conventional cigarette smoking and electronic cigarette vaping with periodontal disease in South Korean adults.

METHODS

For this study, data from 13,551 participants, a subset derived from the Korean National Health and Nutrition Examination Survey conducted between 2013 and 2015, were examined. Participants were divided into four categories: electronic cigarettes vapers, conventional cigarettes smokers, ex-users, and non-users. Periodontal status was measured by the Community Periodontal Index. Multiple logistic regression analysis was performed to examine the association of periodontal disease with smoking and vaping individually.

RESULTS

Out of 187 men and 35 women who vape electronic cigarette, 67 (35.8%) men and 10 (28.6%) women had periodontal diseases. Out of 1,957 men and 363 women who smoke conventional cigarettes, 861 (44.0%) men and 121 (35.3%) women had periodontal diseases. Periodontal disease was more prevalent in each vapers and smokers than non-users in men (electronic cigarettes: odds ratio [OR] = 2.34, 95% confidence interval [CI] = 1.52 to 3.59, conventional cigarettes: OR = 2.17, 95% CI = 1.76 to 2.68). Furthermore, both vaping and smoking had significant relation to dental caries, toothache, and dental damages.

CONCLUSIONS

Electronic and conventional cigarette use was each significantly associated with increased periodontal disease rates. After adjusting for demographic, socioeconomic, and health-related characteristics, both vaping and smoking each had significant association with periodontal diseases. Therefore, this study suggests that vaping may not be a safe alternative to smoking. Cessation of both types of cigarettes is necessary for maintaining oral health.

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.

Risk factors associated with the longevity of multi-rooted teeth. Long-term outcomes after active and supportive periodontal therapy

AIM

To investigate risk factors for the loss of multi-rooted teeth (MRT) in subjects treated for periodontitis and enrolled in supportive periodontal therapy (SPT).

MATERIAL AND METHODS

A total of 172 subjects were examined before (T0) and after active periodontal therapy (APT)(T1) and following a mean of 11.5 ± 5.2 (SD) years of SPT (T2). The association of risk factors with loss of MRT was analysed with multilevel logistic regression. The tooth was the unit of analysis.

RESULTS

Furcation involvement (FI) = 1 before APT was not a risk factor for tooth loss compared with FI = 0 (p = 0.37). Between T0 and T2, MRT with FI = 2 (OR: 2.92, 95% CI: 1.68, 5.06, p = 0.0001) and FI = 3 (OR: 6.85, 95% CI: 3.40, 13.83, p < 0.0001) were at a significantly higher risk to be lost compared with those with FI = 0. During SPT, smokers lost significantly more MRT compared with non-smokers (OR: 2.37, 95% CI: 1.05, 5.35, p = 0.04). Non-smoking and compliant subjects with FI = 0/1 at T1 lost significantly less MRT during SPT compared with non-compliant smokers with FI = 2 (OR: 10.11, 95% CI: 2.91, 35.11, p < 0.0001) and FI = 3 (OR: 17.18, 95% CI: 4.98, 59.28, p < 0.0001) respectively.

CONCLUSIONS

FI = 1 was not a risk factor for tooth loss compared with FI = 0. FI = 2/3, smoking and lack of compliance with regular SPT represented risk factors for the loss of MRT in subjects treated for periodontitis.

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.

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.

Investigation of periodontal destruction patterns in smokers and non-smokers

BACKGROUND

Previous work has suggested that tobacco smoking has a local as well as a systemic effect on the severity of periodontal disease.

OBJECTIVE

To test the hypothesis that smokers have more disease in the upper anterior region.

METHODS

A retrospective stratified random sample of 49 non-smokers and 39 heavy smokers (>or=20 cigarettes/day) was obtained from a total of 3678 referred patients with adult periodontitis. Probing depth data were collected from clinical records and radiographic measurements were carried out on existing dental panoramic tomographs to assess the inter-proximal bone levels.

RESULTS

The proportion of sites with "bone loss" 4.5 mm or greater was higher in smokers, the greatest difference being observed in upper anterior sites (smokers: 73.3+/-25.5%, non-smokers: 48.3+/-31.2%, p<0.001). A difference was also observed when the number of palatal sites probing 4 mm or greater in the upper anterior region was expressed as a proportion of all such sites in the mouth (smokers: 12.3+/-6.8%, non-smokers: 9.8+/-8.8%; p=0.050).

CONCLUSION

The overall pattern of tissue destruction was consistent with a systemic effect of smoking. The suggestion of a marginal local effect of the smoking habit in maxillary anterior palatal sites requires further investigation.

Tooth loss during maintenance following periodontal treatment in a periodontal practice in Norway

BACKGROUND

Periodontal therapy coupled with careful maintenance has been shown to be effective in maintaining periodontal health; however, a small number of teeth are still lost because of progressive periodontitis.

AIM

To investigate factors associated with tooth loss due to periodontal reasons during maintenance following periodontal treatment in patients in a Norwegian specialist periodontal practice. The study also examined how initial prognosis related to actual outcome as measured by periodontal tooth loss.

METHODS

Hundred consecutive patients (68 females, 32 males) who had comprehensive periodontal treatment and attended for 9.8 (SD: 0.7), range: 9-11 years of maintenance care, were studied. All teeth classified as being lost due to periodontal disease over the period were identified.

RESULTS

Only 36 (1.5%) of the 2436 teeth present at baseline were subsequently lost due to periodontal disease. There were 26 patients who lost at least one tooth. Logistic regression analysis showed that tooth loss was significantly related to male gender (p=0.049; adjusted odds ratio: 2.8; confidence interval (c.i.): 1.0-8.1), older age, i.e.>60 years (p=0.012; adjusted odds ratio: 4.0; c.i.: 1.3-12.0) and smoking (p=0.019; adjusted odds ratio: 4.2; c.i.: 1.4-13.8). The majority 27 (75%) of the teeth lost due to periodontal disease had been assigned an uncertain, poor or hopeless initial prognosis; however, nine teeth (25%) lost had been assigned a good prognosis at baseline. The prognosis for 202 teeth was judged to have worsened over the period of the study.

CONCLUSION

Compliance with maintenance following periodontal treatment was associated with very low levels of tooth loss in a referral practice in rural Norway. Male gender, older age (>60 years) and smoking were predictors of tooth loss due to progressive periodontitis.

The influence of tobacco smoking on the onset of periodontitis in young persons

This paper reviews the evidence for cigarette smoking as a risk factor for the development of severe destructive periodontal disease in young adults. A high prevalence of cigarette smoking has been identified among young individuals with aggressive periodontitis and tobacco usage increases the risk of periodontal destruction most significantly in young populations. The effect appears to be dose related and is independent of levels of plaque accumulation. Young smokers have more alveolar bone loss and attachment loss than non smoking equivalents. Prolonged and heavy smoking can reduce gingival bleeding and therefore mask the clinical marker of bleeding on probing often used by dentists to monitor periodontal health. This has implications for potential misdiagnosis and failure to detect periodontitis at an early stage. Nicotine metabolites concentrate in the periodontal tissues and can have local effects as well as the potential to affect the systemic host response. Dentists are well placed to assess the smoking status of their young patients and have a role to play in the delivery of smoking cessation advice especially as it pertains to periodontal health. In this way the dental profession can also make a significant contribution to the general health and well being of our youth and future generations.

NEUROPEPTIDES AND NEUROGENIC MECHANISMS IN ORAL AND PERIODONTAL INFLAMMATION

It is generally accepted that the nervous system contributes to the pathophysiology of peripheral inflammation, and a neurogenic component has been implicated in many inflammatory diseases, including periodontitis. Neurogenic inflammation should be regarded as a protective mechanism, which forms the first line of defense and protects tissue integrity. However, severe or prolonged noxious stimulation may result in the inflammatory response mediating injury rather than facilitating repair. This review focuses on the accumulating evidence suggesting that neuropeptides have a pivotal role in the complex cascade of chemical activity associated with periodontal inflammation. An overview of neuropeptide synthesis and release introduces the role of neuropeptides and their interactions with other inflammatory factors, which ultimately lead to neurogenic inflammation. The biological effects of the neuropeptides substance P (SP), calcitonin gene-related peptide (CGRP), vasoactive intestinal polypeptide (VIP), and neuropeptide Y (NPY) are summarized, and evidence for their involvement in the localized inflammatory lesions which characterize periodontitis is presented. In this context, the role of CGRP in bone metabolism is described in more detail. Recent research highlighting the role of the nervous system in suppressing pain and inflammation is also discussed.

Effect of triclosan on healing following non-surgical periodontal therapy in smokers

BACKGROUND

Tobacco smoking is an established risk factor for periodontitis, and is associated with periodontal attachment and tooth loss. Clinical studies have indicated that smoking may adversely affect and impede healing following periodontal therapy. Adjunctive antimicrobials, on the other hand, have been shown to enhance the effect of non-surgical periodontal therapy. The objective of this study was to evaluate the effect of a triclosan/copolymer/fluoride dentifrice on healing following non-surgical periodontal therapy in smokers.

METHODS

Sixty smokers (aged 35-59 years; 23 females) with chronic periodontal disease volunteered to participate in a double-blind, randomized, controlled, clinical trial. The subjects were randomly assigned to use a triclosan/copolymer/fluoride (30 subjects) or a standard fluoride (30 subjects) dentifrice and received detailed information on proper techniques for self-performed plaque control. The participants then received non-surgical periodontal therapy followed by periodontal maintenance care every 6 months over 24 months. Clinical recordings included evaluation of oral hygiene standards, gingival health, and periodontal status.

RESULTS

Subjects using the triclosan/copolymer/fluoride dentifrice exhibited significantly improved oral hygiene conditions, gingival health, and periodontal status compared with those using the standard fluoride dentifrice over the 24-month maintenance interval.

CONCLUSIONS

The results suggest that an oral hygiene regimen including a triclosan/copolymer/fluoride dentifrice may sustain the short-term effect of non-surgical periodontal therapy in smokers.

Guided tissue regeneration in human Class II furcation defects using a diphenylphosphorylazide-cross-linked collagen membrane: a consecutive case series

BACKGROUND

Several bioabsorbable collagen membranes are either currently available or under investigation for use in guided tissue regeneration (GTR) procedures. The aim of this 12-month reentry study was to evaluate a diphenylphosphorylazide (DPPA)-cross-linked bovine type I collagen membrane in the healing of mandibular Class II furcation defects. The DPPA technique prevents the inclusion of foreign cytotoxic cross-linking substances in the reticulated molecules, thus providing a more biocompatible product.

METHODS

Forty non-smoking periodontally compromised adult subjects volunteered for this study, and one defect was randomly selected in each patient. At baseline, plaque index (PI), gingival index (GI), probing depth (PD), gingival margin location (GML), clinical attachment level (CAL), and width of the attached gingiva (AG) were measured. Intrasurgical hard tissue measurements consisted of the vertical open probing attachment level (V-OPAL) and horizontal open probing attachment level (H-OPAL), as well as furcation entrance width (FW) and height (FH) and subclassification of defects according to vertical bone loss. All soft tissue measurements were repeated 12 months after membrane placement using conservative flap reentry surgeries; hard tissue parameters were also assessed at this time.

RESULTS

DPPA-cross-linked collagen membranes demonstrated good handling characteristics, and no postoperative adverse tissue reactions or clinically detectable localized allergic responses were observed. GI and PI remained low during the entire study period. When the one year reentry values were compared to the baseline measurements, a significant reduction in PD (1.9 +/- 1.4), FW (2.1 +/- 1.7), FH (2.9 +/- 1.6), and gain in CAL (1.7 +/- 1.5), V-OPAL (2.1 +/- 1.9), and H-OPAL (4.7 +/- 1.4) were observed (P < or = 0.05). However, there were no significant differences in GML or AG. Hard tissue improvements resulted in the complete closure of 30% (12) of the defects, and transformation of 67.5% (27) of the defects to Class I, while one defect remained a Class II (2.5%).

CONCLUSIONS

Based on this 12-month clinical reentry study, a DPPA-cross-linked collagen membrane could be beneficial in GTR treatment of Class II mandibular furcation involvements, both in terms of soft and hard tissue improvements.

Tobacco smoking and risk for periodontal disease

OBJECTIVE

The magnitude of risk for periodontal disease associated with smoking was investigated by exploring the interrelationships between definition of disease, prevalence and relative risk in a population of dentally aware individuals.

MATERIALS AND METHODS

A total of 133 smokers and 242 non-smokers in the age range 20-69 years served as the database. Criteria based on clinical probing of pocket depth and radiographic measurement of bone height were used for the purpose of disease definition. Various pocket frequency cutoff points for two probing depth levels, > or =5 and > or =6 mm, and, in addition, the 30th, 25th, and 20th percentiles of the bone height distribution were alternately selected as criteria.

RESULTS

Disease definition had an impact on the prevalence, and the relative risk varied as a function of the prevalence. For a broad definition of disease such as 1% of pockets > or =5 mm, the prevalence for smokers was approximately twice the prevalence for non-smokers and the odds ratio (OR) was 3.0. A narrower definition such as 15% of pockets > or =5 mm resulted in decreased prevalences for both smokers and non-smokers and an OR of 12.1. Increasing exposures correlated with greater magnitudes of risk. Heavy exposure was associated with greater risk than light exposure. For the combination of a narrow disease definition and heavy exposure, the relative risk was considerable (OR 9.8-20.3).

CONCLUSION

Smoking-associated relative risk is dependent on definition of disease and prevalence. Given other factors, a narrow definition will result in a low prevalence and a high risk and, vice versa, for a broader definition, prevalence will be high and the risk moderate.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Impaired healing response of periodontal furcation defects following flap debridement surgery in smokers. A controlled clinical trial

OBJECTIVES

The purpose of the present parallel-design, controlled clinical trial was to evaluate the treatment outcome of periodontal furcation defects following flap debridement surgery (FDS) procedure in cigarette smokers compared to non-smokers.

MATERIALS AND METHODS

After initial therapy, 31 systemically healthy subjects with moderate to advanced periodontitis, who presented at least one Class I or II molar furcation defect, were selected. Nineteen patients (mean age: 40.3 years, 15 males) were smokers (>or=10 cigarettes/day) and 12 patients (mean age: 44.8 years, 3 males) were non-smokers. Full-mouth plaque score (FMPS) and full-mouth bleeding score (FMBS), probing pocket depth (PPD), vertical clinical attachment level (v-CAL), and horizontal clinical attachment level (h-CAL) were assessed immediately before and 6 months following surgery.

RESULTS

Overall, statistically significant v-CAL gain was observed in smokers (1.0 +/- 1.3 mm) and non-smokers (1.3+/-1.1 mm), the difference between groups being statistically significant (p=0.0003). In proximal furcation defects, v-CAL gain amounted to 2.3+/-0.7 mm in non-smokers as compared to 1.0+/-1.1 mm in smokers (p=0.0013). At 6 months postsurgery, non-smokers presented a greater h-CAL gain (1.3+/-1.1 mm) than smokers (0.6+/-1.0 mm), with a statistically significant difference between groups (p=0.0089). This trend was confirmed in both facial/lingual (1.4+/-1.0 versus 0.8+/-0.8 mm) and proximal furcation defects (1.2+/-1.3 versus 0.5+/-1.2 mm). The proportion of Class II furcations showing improvement to postsurgery Class I was 27.6% in smokers and 38.5% in non-smokers. After 6 months, 3.4% of presurgery Class I furcation defects in smokers showed complete closure, as compared to 27.8% in non-smokers.

CONCLUSIONS

The results of the present study indicated that (1) FDS produced clinically and statistically significant PPD reduction, v-CAL gain, and h-CAL gain in Class I/II molar furcation defects, and (2) cigarette smokers exhibited a less favorable healing outcome following surgery in terms of both v-CAL and h-CAL gain.

Relationship of cigarette smoking to the subgingival microbiota

BACKGROUND

The relationship of cigarette smoking to the composition of the subgingival microbiota is not clear. Some studies indicated higher levels of certain species in smokers, while other studies failed to detect differences in the microbiota between subjects with different smoking histories. Thus, the purpose of the present investigation was to examine the prevalence, proportions and levels of the subgingival species in adult subjects who were current, past or never smokers.

METHOD

272 adult subjects ranging in age from 20-86 years with at least 20 teeth were recruited for study. Smoking history was obtained using a questionnaire. Clinical measures were taken at 6 sites per tooth at all teeth excluding third molars at a baseline visit. Subgingival plaque samples were taken from the mesial surface of all teeth excluding third molars in each subject at baseline and assayed individually for counts of 29 subgingival species using checkerboard DNA-DNA hybridization. Subjects were subset according to smoking history into never (n=124), past (n=98) and current smokers (n=50). Uni-variate and multi-variate analyses were used to seek associations between smoking category and the counts, proportions and prevalence of subgingival species.

RESULTS

Greater differences were observed for the prevalence (% of sites colonized) of the test species in the 3 smoking groups than were observed for counts or proportions of total counts. Members of the orange and red complexes including E. nodatum, F. nucleatum ss vincentii, P. intermedia, P. micros, P. nigrescens, B. forsythus, P. gingivalis and T. denticola were significantly more prevalent in current smokers than in the other 2 groups. The difference in prevalence between smokers and non-smokers was due to greater colonization at sites with pocket depth <4 mm. Stepwise multiple linear regression analysis indicated that combinations of the prevalence of 5 microbial species and pack years accounted for 44% of the variance for mean pocket depth (p<0.000001), while the prevalence of 3 microbial taxa along with age, pack years, current smoking and gender accounted for 31% of the variance in mean attachment level (p<0.000001). The difference in prevalence between current and never smokers of all members of the red complex and 8 of 12 members of the orange complex was significantly greater in the maxilla than in the mandible.

CONCLUSIONS

The major difference between the subgingival microbiota in subjects with different smoking history was in the prevalence of species rather than counts or proportions. The greater extent of colonization in smokers appeared to be due to greater colonization at pocket depths <4 mm. Differences in colonization patterns between current and never smokers were greater in the maxilla than in the mandible.

Immunohistochemical study of vestibular gingival blood vessel density and internal circumference in smokers and non-smokers

BACKGROUND

This study was undertaken to determine: 1) if sections stained with monoclonal antibody to CD34 can be used for measurement of gingival blood vessel density and circumference and 2) if long-term smoking affects either of these 2 parameters.

METHODS

Vestibular gingival biopsy samples were obtained from 17 adults (5 smokers and 12 non-smokers) who were undergoing routine periodontal surgery independently of this study. Hematoxylin and eosin staining was used for histological assessment of inflammation, while immunohistochemical staining with CD34 mouse monoclonal antibody was used to mark the endothelial cells of the blood vessels within each sample. Stringent selection criteria were applied to the 17 biopsy samples, and 7 (from 3 smokers and 4 non-smokers) were chosen to have their vascular density (number of vessels/unit area) and internal vessel circumference (IC) measured under a blinded protocol.

RESULTS

Repeated measurements of vascular density and internal circumference showed small standard deviations, indicating the high reproducibility of the measurement technique. The smoker group showed a higher proportion of small (IC < 50 microns) and a lower proportion of large blood vessels (IC > 100 microns), which was statistically significant (P = 0.0403 and P < 0.001, respectively). The difference between the vascular density of smokers and non-smokers was not significant (P = 0.092).

CONCLUSIONS

The present study indicates that the CD34 immunohistochemical staining technique is a simple and reproducible method for the measurement of density and internal circumference of gingival blood vessels. Based on this technique, cigarette smokers show a higher percentage of smaller blood vessels and a lower percentage of larger vessels, but similar vascular density, to non-smokers.

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

BACKGROUND, AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

Relationship of cigarette smoking to attachment level profiles

OBJECTIVES

The present investigation examined clinical features of periodontal disease and patterns of attachment loss in adult periodontitis subjects who were current, past or never smokers.

MATERIAL AND METHODS

289 adult periodontitis subjects ranging in age from 20-86 years with at least 20 teeth and at least 4 sites with pocket depth and/or attachment level >4 mm were recruited. Smoking history was obtained using a questionnaire. Measures of plaque accumulation, overt gingivitis, bleeding on probing, suppuration, probing pocket depth and probing attachment level were taken at 6 sites per tooth at all teeth excluding 3rd molars at a baseline visit. Subjects were subset according to smoking history into never, past and current smokers and for certain analyses into age categories <41, 41-49, >49. Uni- and multi-variate analyses examined associations between smoking category, age and clinical parameters.

RESULTS

Current smokers had significantly more attachment loss, missing teeth, deeper pockets and fewer sites exhibiting bleeding on probing than past or never smokers. Current smokers had greater attachment loss than past or never smokers whether the subjects had mild, moderate or severe initial attachment loss. Increasing age and smoking status were independently significantly related to mean attachment level and the effect of these parameters was additive. Mean attachment level in non smokers <41 years and current smokers >49 years was 2.49 and 4.10 mm respectively. Stepwise multiple linear regression indicated that age, pack years and being a current smoker were strongly associated with mean attachment level. Full mouth attachment level profiles indicated that smokers had more attachment loss than never smokers particularly at maxillary lingual sites and at lower anterior teeth.

CONCLUSIONS

In accord with other studies, smokers had evidence of more severe periodontal disease than past or never smokers. At all levels of mean attachment loss, smokers exhibited more disease than never smokers. Difference in mean attachment level between smokers and never smokers at individual sites was not uniform. Significantly more loss was observed at maxillary lingual sites and lower anterior teeth suggesting the possibility of a local effect of cigarette smoking.

Effects of smoking on periodontal health: a review

Cigarette smoking is a risk factor for several diseases, and recent evidence strongly suggests an adverse effect on periodontal health. Nevertheless, the nature of the relationship between smoking and periodontal disease is not clear. Smoking causes defects in neutrophil function, impairs inflammatory and immune responses to periodontal pathogens, and exerts both systemic and local effects. Smoking is associated with an increased rate of periodontal disease in terms of alveolar bone loss and attachment loss, as well as pocket formation. Nicotine, the major component of cigarette smoke, may weaken host defenses to the bacterial invasion induced by plaque.

Effect of smoking on periodontal health in molar teeth

BACKGROUND

It is generally accepted that the primary cause of periodontitis is bacterial infection of long duration. In addition, there are several risk factors that may increase the probability and severity of periodontitis. For example, an increased breakdown of alveolar bone has been observed in smokers compared to never-smokers. The objective of this study was to investigate the association between cigarette smoking and periodontal health, in particular, furcation involvement in molar teeth.

METHODS

One hundred twenty (120) adult regular dental patients, presenting with at least 20 teeth each, third molars excluded, were evaluated. Sixty of the subjects consumed an average (+/- SD) of 16.8 +/- 3.8 cigarettes daily and had smoked for 21.4 +/- 5.7 years. The remaining subjects presented a negative history of smoking. Periodontal conditions for the molar teeth were recorded at the first and second mandibular molar buccal furcation area.

RESULTS

Oral hygiene standards and dental care habits did not differ notably between smokers and never-smokers. Smokers exhibited significantly fewer molar teeth than never-smokers (2.2 +/- 1.1 versus 3.0 +/- 0.8; P<0.01). Also, smokers exhibited significantly advanced gingival recession, probing depth, clinical attachment loss, furcation involvement, and tooth mobility compared to never-smokers (P<0.01).

CONCLUSIONS

The results of this study suggest that long-term cigarette smoking significantly worsens periodontal health including degree and incidence of furcation involvement in molar teeth.

Position paper: tobacco use and the periodontal patient. Research, Science and Therapy Committee of the American Academy of Periodontology

This paper was prepared by the Research, Science and Therapy Committee of The American Academy of Periodontology and is intended for the information of the dental profession. The purpose of the paper is to provide the reader with a general overview of the relationship of tobacco use and periodontal diseases. This paper will review the epidemiological and clinical findings that have led to our understanding of the role of tobacco use in relation to periodontal diseases and their treatment. In addition, this paper will review the possible underlying mechanisms for these effects from tobacco use. The practitioner can use this information in treatment decisions and in giving advice to the patients who use tobacco products.

Smoking and patterns of bone loss in early-onset periodontitis

BACKGROUND

The aims of this study were to investigate the extent and distribution of bone loss in subjects with early-onset periodontitis (EOP) referred for periodontal care and to study the relationship between smoking and EOP.

METHODS

A total of 71 consecutive referrals (21 male, 50 female) under 35 years old, who were otherwise healthy, with a clinical diagnosis of severe periodontitis were recruited for the study. Bone loss was measured from available radiographs using a Schei ruler to identify 2 patterns of destruction: localized (LEOP) in 41 (58%) and generalized early-onset periodontitis (GEOP) in 30 (42%) subjects.

RESULTS

The study population had a mean of 25.0 (SD 2.4) teeth, excluding third molars, and mean bone loss of 28.7% (SD 13.0). Bone loss was more severe in the maxilla, 30.9% (SD 13.8) compared with 26.6% (SD 14.0) in the lower arch. More than one-third (36%) of the teeth examined had at least 30% bone loss. Mean smoking experience was 9.2 pack years (SD 5.6), and 39 (55%) of the EOP subjects smoked. Smokers had significantly more maxillary bone loss than non-smokers. A much higher proportion of GEOP (70%) currently smoked compared with 44% of LEOP, P = 0.029.

CONCLUSIONS

It is concluded that young adults with early-onset forms of periodontitis often have advanced periodontal destruction before they are referred for specialist care. In addition, there was a relationship between smoking and severe bone destruction in subjects with EOP, particularly those with generalized disease.

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

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