Potential impact of subject-based risk factor control on periodontitis

Perception of tobacco hazards on general and periodontal health and tobacco cessation counseling among dental students

INTRODUCTION

Tobacco use is one of the leading worldwide health risk factors and a primary cause of premature death and disability. Tobacco cessation programs might work well if provided by all healthcare providers. This study aimed to evaluate dental students' knowledge, attitudes, beliefs, and practices towards tobacco hazards on general and periodontal health and tobacco cessation councling.

METHODS

A descriptive cross-sectional study was conducted among dental students who were in their clinical years (the fourth, fifth and sixth year of study), in Saudia Arabia in 2022. A self-administered questionnaire derived from the TCC questionnaire survey was carried out among 315 dental students. Knowledge was considered poor if correct answers were below the median value. Attitude was on a five-point Likert scale. Adjusted logistic regression analyses were performed.

RESULTS

The study revealed that about 52% have poor knowledge, 64% have negative attitudes, 69% have negative beliefs, and 44% poor practice. All these ratings were below median values. It also showed that younger dental students were 2 times more likely to have poor knowledge (AOR=1.97; 95% CI: 1.1-3.53) and smokers were less likely to have poor knowledge (AOR=0.34; 95% CI: 0.12-0.95). One third of students perceived patient resistance as a barrier to TCC while 50% reported lack of knowledge, 32% lack of time, and 24% lack of materials.

CONCLUSIONS

The study findings urge the inclusion of programs to encourage dental students to help patients quit tobacco use and to make educational material available to them.

Distribution and influencing factors on residual pockets of the teeth in patients with periodontitis following non-surgical periodontal treatment: a retrospective observational study

BACKGROUND

Periodontitis is a chronic and multi-factorial infectious disease. A notable difference exists in the prognosis of patients with severe periodontitis after non-surgical periodontal treatment. Thus, a retrospective study was conducted to identify common and specific factors that impact the prognosis of patients with periodontitis stage III-IV following non-surgical periodontal treatment at different tooth sites.

METHODS

A total of 977 teeth were included in the study, comprising 266 patients diagnosed with periodontitis stage III-IV. This sample included 330 anterior teeth, 362 maxillary posterior teeth, and 285 mandibular posterior teeth. Following treatment, the teeth were categorized into two groups based on residual pocket depth [probing depth (PD) ≥ 5 mm] at 3 months post-treatment. The prognosis of periodontitis stage III-IV was assessed through multivariate analysis employing logistic regression to determine the association of various risk factors.

RESULTS

The PD values of each site and the deepest PD values of each tooth significantly decreased at 3 months post-treatment. Residual pockets were predominantly found in the mesio/disto-buccal and mesio/disto-lingual regions. Multivariate analysis revealed that gender, PD, sulcus bleeding index (SBI) and plaque index (PLI) at baseline, and crown-root ratio in anterior teeth had a significant influence on periodontitis stage III-IV (P < 0.05). Smoking, PD, PLI and furcation involvement (FI) at baseline, PLI at 3 months post-treatment, grades of periodontitis, and crown-root ratio were prediction factors for maxillary posterior teeth. Factors such as PD, PLI and FI at baseline, PLI at 3 months post-treatment, and crown-root were significant in mandibular posterior teeth.

CONCLUSIONS

The outcome of non-surgical treatment varies depending on the tooth positions for patients with periodontitis stage III-IV. Dentists must accurately identify the affected teeth that have periodontal pockets of more than 5 mm, taking into consideration the positions of the affected teeth, as well as various local and systemic factors. This comprehensive assessment will enable dentists to develop a customized and effective treatment plan.

Association between periodontal diseases and COVID-19 infection: a case-control study with a longitudinal arm

Some studies have suggested potential relationships between periodontal disease and COVID-19, explained by many possible pathological pathways. The aim of this case-control study with a longitudinal arm was to investigate this association. 80 systemically healthy individuals (apart from COVID-19) were involved in this study, divided into 40 patients who had recently had COVID-19 (test, divided into severe and mild/moderate cases) and 40 who had not had COVID-19 (control). Clinical periodontal parameters and laboratory data were recorded. Mann-Whitney U test, Wilcoxon test, and chi-square test were performed to compare variables. Multiple binary logistic regression method was used to estimate adjusted ORs and 95% confidence interval. Hs-CRP-1 and 2, Ferritin-1 and 2, lymphocyte count-1 values, and neutrophil/lymphocyte ratio-1 were higher in patients with severe COVID-19 than patients with mild/moderate COVID-19 (p < 0.05). All of these laboratory values significantly decreased after COVID-19 treatment (p < 0.05) in the test group. Presence of periodontitis (p = 0.015) was higher and periodontal health was lower (p = 0.002) in the test group than in the control group. All clinical periodontal parameters were significantly higher in the test group than in the control group (p < 0.05), except plaque index. Prevalence of periodontitis was associated with increased odds of having COVID-19 infection (PR = 1.34; 95% CI 0.23-2.45) in the multiple binary logistic regression. COVID-19 is associated with periodontitis prevalence, through a series of possible mechanisms including local and systemic inflammatory responses. Further studies should investigate whether the maintenance of periodontal health may be a factor in the reduction of the severity of COVID-19 infections.

Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review

This systematic review aimed to investigate the impact of different psychological models, strategies, and methods to improve plaque control and/or gingival inflammation in patients with periodontal diseases. Methods: The PubMed/MEDLINE, Cochrane Library, and Embase online databases were explored to identify relevant studies published before October 2022. Articles investigating the effects of different psychological approaches and intervention strategies on periodontitis patients’ oral hygiene (OH) behavioral change were screened. Results: 5460 articles were identified, and 21 fulfilled the inclusion criteria. In total, 2 studies tested audio-visual modalities, and the remaining 19 publications involved six psychological models of health-related behavioral interventions, including Social Cognitive Theory, the Theory of Planned Behavior, the Health Action Process Approach, Leventhal’s self-regulatory theory, Motivational Interviewing, and Cognitive Behavioral Therapy. A meta-analysis of the results was not carried out due to the high heterogeneity among the interventions. Conclusions: Considering the limitations of the available studies, psychological interventions based on social cognitive models that combine some of the techniques of this model (goal setting, planning, self-monitoring, and feedback) may improve OH in periodontitis patients, having a positive impact on periodontal clinical outcomes. Delivering cognitive behavioral therapy in combination with motivational interviewing may result in an improvement in OH as evaluated by decreasing plaque and bleeding scores.

The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy

Tobacco smoking has been implicated in periodontal pathology through various mechanisms, including perturbations of the inflammatory and host responses to putative periodontal pathogens, alterations in the subgingival microbial communities, and a compromised healing potential of the tissues leading to imbalance of tissue homeostasis. This review provides the evidence for the relationship between cigarette smoking and periodontal disease in an attempt to explain possible mechanisms of how tobacco smoking may exert its negative effects on the periodontal tissues via systemic and localized pathways. Early and more recent studies explore cigarette smoking-induced changes in periodontal clinical indices; in subgingival microbial flora by employing traditional detection methods for selected microorganisms, in addition to modern techniques such as deep sequencing and bioinformatics analyses that are able to fully characterize the microbial communities; and in inflammatory and immune responses critically appraising study limitations and differences in study protocol designs. Periodontal treatment outcomes and implant therapy outcomes are reviewed in an attempt to shed light on possible mechanisms for the inferior treatment outcome noted in smokers. The potential harmful effects of passive smoking are also reviewed, providing evidence for the advantages of smoking cessation. Quitting cigarette smoking should be recommended by the dentist, and effort should be made to inform smokers about the negative effects of smoking on the periodontal status and implant therapy outcomes.

Perception of Tobacco Counseling and Cessation among Dental Practitioners

Objective

To investigate the knowledge and practice of tobacco cessation and counseling (TCC) among dental practitioners and their attitude and perceived barriers.

Methods

A cross-sectional study targeted licensed dental practitioners in Jeddah, Saudi Arabia. Participants answered a pretested and validated self-administered questionnaire consisted of demographic data; smoking status; knowledge of tobacco hazards, attitude, and practice; and perceived barriers of tobacco cessation counseling.

Result

Among the total sample of 529, response rate was 72.2% (mean age (34.20 ± 9.38 years), males (42.4%), and current smokers (23.8%)). Only 13.2% received formal training on TCC. Around (57.1%) reported smoking of dental team as an obstacle for TCC. Half of the participants (49.9%) reported patient's resistance as barrier to TCC. Others (45%-48%) reported insufficient time, knowledge, or training for TCC. Professional responsibility and willingness to provide cessation services constituted the highest median.

Conclusion

The majority showed willingness to participate in TCC. Lack of training, smoking status of providers, females, inadequate materials, and patients' resistance were the most common barriers. Education and training on TCC are recommended and should be allowed as a routine practice in dentistry.

Gender Differences in the Levels of Periodontal Destruction, Behavioral Risk Factors and Systemic Oxidative Stress in Ischemic Stroke Patients: A Cohort Pilot Study

Background: Due to the higher frequency of ischemic stroke in men compared to women, we aimed to determine if gender differences exist regarding periodontal status and several plasma biomarkers in patients with a recent large artery atherosclerosis ischemic stroke (IS). Material and methods: Patients with their first IS within less than six weeks who were able to undergo periodontal examinations were evaluated. Demographic data, periodontal status, oxidative stress parameters/plasma antioxidant capacity, and C-reactive protein in patients who suffered a recent large artery atherosclerosis ischemic stroke were reccorded. Results: 93 patients were included in the study. More men were smokers (12/57 vs. 3/36) and consumed alcohol (17/57 vs. 3/36), and more women had higher glycemic values (p = 0.023), total cholesterol (p < 0.001), LDL (low-density lipoprotein)-cholesterol (p = 0.010), and HDL (high-density lipoprotein)-cholesterol (p = 0.005) levels. Significantly more men than women had moderate plus severe periodontal disease (p = 0.018), significantly higher levels of nitric oxide (p = 0.034), and significantly lower levels of total antioxidant capacity (p = 0.028). Conclusions: In this pilot study, men seem to be more prone to oxidative stress and to develop more severe forms of periodontitis among patients with stroke, but the results need validation on a larger sample.

Impact of Smoking Cessation on Periodontitis: A Systematic Review and Meta-analysis of Prospective Longitudinal Observational and Interventional Studies

AIMS

This systematic review aimed to estimate the effect of tobacco smoking cessation on the risk for periodontitis compared to the risk among never-smokers and to evaluate the effect of tobacco smoking cessation on the clinical outcomes of nonsurgical periodontal treatment.

METHODS

Electronic searches were performed in PubMed, Scopus, and Embase. Search strategy included MeSH and free terms: periodontitis, periodontal diseases, smoking, tobacco use, tobacco, tobacco products, cigarette, pipe, and cigar. Only original prospective longitudinal observational and interventional studies that investigated the association between smoking cessation and periodontitis onset or progression were included. Meta-analyses were conducted to summarize the evidence.

RESULTS

A total of 2743 articles were identified in electronic searches; out of which only six were included in the meta-analysis. Pooled estimates showed that the risk of periodontitis incidence or progression among those who quit smoking was not significantly different from the risk for never-smokers (risk ratio [RR] = 0.97; 95% confidence interval [CI] = 0.87% to 1.08%). Smokers had approximately 80% higher risk of periodontitis than quitters (RR = 1.79; 95% CI = 1.36% to 2.35%) and never-smokers (RR = 1.82; 95% CI = 1.43% to 2.31%). Periodontal therapy resulted in up to 0.2 mm (95% CI = -0.32% to -0.08%) higher gain in attachment level and extra 0.32 mm (95% CI = 0.07% to 0.52%) reduction in pocket depth among quitters over nonquitters after short follow-up (12-24 months).

CONCLUSIONS

Few studies on the topic were identified. Smoking cessation reduced the risk for periodontitis onset and progression, and improved the outcomes of nonsurgical periodontal therapy.

IMPLICATIONS

This review provides the first quantitative evidence of the impact of smoking cessation on the risk for periodontitis onset and progression. The findings have demonstrated that the risk for periodontitis becomes comparable to that of never-smokers and that nonsurgical periodontal treatment outcomes improve after smoking cessation. Dental professionals ought to consider smoking cessation interventions as a relevant component of the periodontal therapy.

[Temporal and spatial distribution of Gli1+ cells and their function during periodontal development]

OBJECTIVE

This study aimed to investigate the distribution of Gli1+ cells in the periodontal ligament (PDL) and to evaluate their contribution in the development of periodontal tissue by using transgenic mouse lines.

METHODS

Gli1lacZ/+ mice were harvested at different ages (3, 6, and 8 weeks), and the temporal and spatial distribution patterns of Gli1+ PDL cells were revealed by X-gal staining. Afterward, 3-week-old Gli1-CreERT2/+;R26RtdTomato/+ mice were administered with tamoxifen, and the fates of Gli1+ cells and their descendants were traced during periodontal development.

RESULTS

A large number of Gli1+ cells were detected in the PDL of the 3-week-old mice; however, their number significantly decreased from 3 weeks to 8 weeks (P<0.05). Cell lineage tracing data showed that the descendants of Gli1+ cells dramatically increased from 3 weeks to 8 weeks (P<0.05) and gradually differentiated into fibroblasts, cementocytes, and osteocytes.

CONCLUSIONS

The multi-differentiation potential of Gli1+ PDL cells was revealed, indicating that Gli1+ cells are an important cell source for periodontal development.

GoPerio - impact of a personalized video and an automated two-way text-messaging system in oral hygiene motivation: study protocol for a randomized controlled trial

Background

Oral hygiene is of paramount importance for the preservation of oral health, and for patients affected by periodontal disease establishing an effective oral hygiene routine is the first step of therapy. Several clinical frameworks have been developed to foster behavior change, such as motivational interviewing. However, two obstacles can be identified. First, patients tend to forget the advice they were given during the consultation. Second, it is hard to maintain motivation in the long term, thus leading to relapse. An innovative eHealth solution was designed with the aim to tackle both obstacles and supplement the current clinical standard of care. The primary objective is to compare the full mouth plaque scores of study groups (eHealth plus standard of care versus standard of care only) at 8 weeks of follow up. The main secondary objective is to compare the full mouth bleeding score at 8 weeks of follow up.

Methods/design

The “GoPerio” study is a multicenter, randomized, controlled trial assessing the impact of a novel eHealth concept for oral hygiene motivation (personalized video of oral hygiene routine available for the patient via a cloud server plus interactive text messages) in addition to the current standard of care (motivational interviewing plus tooth scaling and polishing). The minimum sample size required is 86 patients. Participants will be randomized (allocation ratio 1:1): test group (eHealth plus standard of care) versus control group (standard of care only). The primary outcome is oral hygiene as measured by the full mouth (six sites per tooth) plaque control record (PCR) index. The main secondary outcome is gingival inflammation as measured by the full mouth (six sites per tooth) bleeding on probing (BOP) index. Both the primary and the main secondary outcomes are evaluated by blinded and calibrated examiners at 8 weeks of follow up. The other secondary outcomes are patient satisfaction and patient behavior change and motivation.

Discussion

The study will investigate the value of an innovative eHealth approach to strengthen patient motivation for oral hygiene. If proven effective, such an approach would supplement the current clinical standard of care, resulting in improved clinical outcomes with negligible impact on productivity in a dental practice.

Trial registration

ClinicalTrials.gov, NCT03109808. Registered on 12 April 2017.

Sponsor: Hospices Civils de Lyon. BP 2251, 3 quai des Célestins, 69,229 Lyon cedex 02.

Protocol version: 1.0 as of 21 September 2016.

Risk factors of chronic periodontitis on healing response: a multilevel modelling analysis

Background

Chronic periodontitis is a multifactorial polygenetic disease with an increasing number of associated factors that have been identified over recent decades. Longitudinal epidemiologic studies have demonstrated that the risk factors were related to the progression of the disease. A traditional multivariate regression model was used to find risk factors associated with chronic periodontitis. However, the approach requirement of standard statistical procedures demands individual independence. Multilevel modelling (MLM) data analysis has widely been used in recent years, regarding thorough hierarchical structuring of the data, decomposing the error terms into different levels, and providing a new analytic method and framework for solving this problem. The purpose of our study is to investigate the relationship of clinical periodontal index and the risk factors in chronic periodontitis through MLM analysis and to identify high-risk individuals in the clinical setting.

Methods

Fifty-four patients with moderate to severe periodontitis were included. They were treated by means of non-surgical periodontal therapy, and then made follow-up visits regularly at 3, 6, and 12 months after therapy. Each patient answered a questionnaire survey and underwent measurement of clinical periodontal parameters.

Results

Compared with baseline, probing depth (PD) and clinical attachment loss (CAL) improved significantly after non-surgical periodontal therapy with regular follow-up visits at 3, 6, and 12 months after therapy. The null model and variance component models with no independent variables included were initially obtained to investigate the variance of the PD and CAL reductions across all three levels, and they showed a statistically significant difference (P < 0.001), thus establishing that MLM data analysis was necessary. Site-level had effects on PD and CAL reduction; those variables could explain 77–78% of PD reduction and 70–80% of CAL reduction at 3, 6, and 12 months. Other levels only explain 20–30% of PD and CAL reductions. Site-level had the greatest effect on PD and CAL reduction.

Conclusions

Non-surgical periodontal therapy with regular follow-up visits had a remarkable curative effect. All three levels had a substantial influence on the reduction of PD and CAL. Site-level had the largest effect on PD and CAL reductions.

Electronic supplementary material

The online version of this article (10.1186/s12911-017-0533-2) contains supplementary material, which is available to authorized users.

Motivational Interviewing As an Adjunct to Periodontal Therapy-A Systematic Review

Aim: Periodontal therapy is highly dependent on a patient's long-term adherence with regard to oral hygiene, diet, and regular check-ups at the dentist. Motivational Interviewing (MI) is a client-centered, directive method for encouraging a patients' behavioral health change. The aim of this systematic review was to reveal the effects of MI as an adjunct to periodontal therapy.

Methods: Three databases (PubMed, Cochrane Library, and Web of Science) were reviewed for randomized controlled clinical trials. Articles were included when using MI as an adjunct to periodontal therapy and presenting clinical periodontal and oral hygiene related parameters. Two authors independently coded the relevant articles.

Results: The search yielded 496 articles. After analysis and exclusion, a total of five papers could be included. The quality of the articles ranged between 72–88%. The two independent raters showed a high inter-rater reliability (Cohens-Kappa = 0.89). In two studies MI showed a significant positive effect on bleeding on probing and plaque values. One study showed improvement of self-efficacy in interdental cleaning. Two studies showed no influence of MI on periodontal parameters of the patients.

Conclusion: The use of MI as an adjunct to periodontal therapy might have a positive influence on clinical periodontal parameters (plaque values, gingival, and periodontal inflammation) and psychological factors related to oral hygiene (self-efficacy). Due to the low body of evidence further studies are needed. Future studies should include fidelity measures of the applied MI, a high number of counselors, several MI sessions, and long-term study follow-up to show potential effects.

Behaviour change counselling for tobacco use cessation and promotion of healthy lifestyles: a systematic review

AIM

To systematically assess the efficacy of oral health behaviour change counselling for tobacco use cessation (TUC) and the promotion of healthy lifestyles.

MATERIALS AND METHODS

Systematic Reviews, Randomized (RCTs), and Controlled Clinical Trials (CCTs) were identified through an electronic search of four databases complemented by manual search. Identification, screening, eligibility and inclusion of studies were performed independently by two reviewers. Quality assessment of the included publications was performed according to the AMSTAR tool for the assessment of the methodological quality of systematic reviews.

RESULTS

A total of seven systematic reviews were included. With the exception of inadequate oral hygiene, the following unhealthy lifestyles related with periodontal diseases were investigated: tobacco use, unhealthy diets, harmful use of alcohol, physical inactivity, and stress. Brief interventions for TUC were shown to be effective when applied in the dental practice setting while evidence for dietary counselling and the promotion of other healthy lifestyles was limited or non-existent.

CONCLUSIONS

While aiming to improve periodontal treatment outcomes and the maintenance of periodontal health current evidence suggests that tobacco use brief interventions conducted in the dental practice setting were effective thus underlining the rational for behavioural support.

Training of Dental Professionals in Motivational Interviewing can Heighten Interdental Cleaning Self-Efficacy in Periodontal Patients

Background: The success of periodontal therapy depends on the adherence of patients to professional recommendations. The aim of this study was to investigate the influence of a workshop in motivational interviewing (MI) on non-surgical periodontal treatment performed by dental students.

Materials and Methods: In the experimental group patients with periodontitis were treated by students trained in MI, while in the control group patients were treated by students who had not been trained in MI. Clinical oral parameters were assessed by a blinded periodontist in addition to the evaluation of psychological questionnaires given before and after the non-surgical periodontal treatment (6 months). Conversations between patients and students were recorded and rated with the Motivational Treatment Integrity Code (MITI-d) by a blinded psychologist.

Results: There were 73 patients in the MI group and 99 patients in the control group. The MI group showed significantly higher scores in the MITI-d analysis. Regression analysis showed that there were no significant differences between groups with regard to plaque level, gingival bleeding, pocket depth reduction or bleeding upon probing. However, patients in the MI-group showed significantly higher interdental cleaning self-efficacy than patients in the control group (MI = 19.57 ± 4.7; control = 17.38 ± 6.01; p = 0.016).

Conclusion: Teaching MI to dental students resulted in a significant improvement in the self-efficacy of interdental cleaning in patients compared to a control group of non-trained students, but no improvement in other aspects of non-surgical periodontal therapy. The study also showed that an 8-h workshop with supervision significantly improved the MI-compliant conversations of dental students without requiring more conversation time.

The impact of oral health on daily performances and its association with clinical variables in a population in Zambia

OBJECTIVE

The aim of this study was to investigate oral impacts on daily performance and to relate these data to oral clinical variables.

MATERIAL AND METHODS

The study was performed at a dental clinic in Livingstone, Zambia, and included 78 subjects (mean age 28, range 15-48 years) consecutively recruited in connection with a dental care visit. Data were collected through a structured interview using the Oral Impacts on Daily Performances (OIDP) index measuring oral health-related quality of life followed by a clinical examination.

RESULTS

Oral health affected one or more daily performances during the last 6 months for 61.5% of the subjects. 'Difficulty of eating and enjoying food' was the performance reported most frequently (42.3%), and 'speaking and pronouncing clearly' was least often reported (10.3%). DMFT was 3.8, ±3.6 (mean ± SD; range 0-15). A majority of the individuals had periodontal pockets ≥4 mm (mean 4.3, ±2.6) (94.9%) and gingival bleeding on probing >20% (88.5%). Two or more decayed teeth were shown to be significantly associated (OR 4.6, CI 1.2-17.1) with one or more oral impacts on daily performances in a multivariate logistic regression analysis.

CONCLUSIONS

This study shown that there is a significant association between decayed teeth and oral impacts on daily performances. More research is needed, however, for deeper understanding of oral health problems and their impacts on daily life in Zambia.

Resistance to cigarette smoke is increased in periodontal ligament cells by attachment to collagen and fibronectin

BACKGROUND

The toxic effects of cigarette smoke often presents in smokers as increased incidence and severity of periodontal disease. These patients demonstrate symptomatic inflammation, increased probing depth, and tooth loss likely attributable to the direct effects of cigarette smoke on periodontal ligament (PDL) fibroblasts. The goal of this in vitro study is to investigate the direct effects of smoking on PDL fibroblasts, focusing on cell-extracellular matrix (ECM) interactions and cell survival.

METHODS

PDL cells were plated for various times on tissue culture plastic, PDL-derived ECMs, collagen Type I, or fibronectin. Cells were exposed to various concentrations of cigarette smoke extract (CSE) at different times during the cell attachment process. Subsequently, cell survival was quantified using calcein-acetoxymethyl ester compound and a fluorescent plate reader.

RESULTS

After exposure to CSE, PDL cell survival increased with increased cell attachment time to plastic. These observations were independent of soluble factors present in PDL cell-conditioned media. PDL-derived ECMs and collagen Type I-pretreated plates promoted increased cell survival after 1 day of cell attachment. Fibronectin-pretreated plates demonstrated increased cell survival after 3 days of cell attachment.

CONCLUSIONS

Cell-ECM interactions increase survival of PDL cells exposed to CSE. It is suggested that the increased survival is attributable to PDL cells altering their ECM, potentially by depositing collagen and fibronectin. This may imply that cells embedded in an ECM would be more resistant to the toxic effects of cigarette smoke, leading to increased cell death near the exposed edges of a wound.

Oral hygiene behaviour change during the nonsurgical periodontal treatment phase

The purpose of the present study was to investigate the frequency of smoking cessation and the use of proximal tooth cleaning routines after a nonsurgical periodontal treatment phase in a Specialist clinic of Periodontology and to evaluate if these behaviour changes had any influence on the periodontal healing results. The investigation was conducted as a retrospective longitudinal study on a randomly selected population of 100 patients referred for periodontal treatment. The variables were registered from the dental records and the radiographs. Forty-six individuals declared that they were smokers at baseline and one individual of those quitted smoking during the nonsurgical treatment period. The percentage of individuals who performed proximal tooth cleaning daily was significantly increased from 56% to 72% during the treatment period. The patients practising proximal tooth cleaning daily had significantly lower Plaque index before as well as after the nonsurgical periodontal treatment phase compared to those without the routine. The subjects who did not perform tooth cleaning daily before the treatment and who did not introduce this routine had significantly deeper periodontal pockets compared to those who performed inter-dental cleaning daily before treatment or who had adopted the routine during the treatment phase. However, there were no significant differences according to number of deepened periodontal pockets after nonsurgical treatment irrespective of proximal cleaning routines. In the future, motivational interviewing may be a more effective method to achieve a behaviour change if an extended education of dental hygienists within this area will be implemented.

Oral hygiene and cardiometabolic disease risk in the survey of the health of Wisconsin

OBJECTIVES

Poor oral health is an increasingly recognized risk factor for cardiovascular disease (CVD) and type 2 diabetes (T2D), but little is known about the association between toothbrushing or flossing and cardiometabolic disease risk. The purpose of this study was to examine the degree to which an oral hygiene index was associated with CVD and T2D risk scores among disease-free adults in the Survey of the Health of Wisconsin.

METHODS

All variables were measured in 2008-2010 in this cross-sectional design. Based on toothbrushing and flossing frequency, an oral hygiene index (poor, fair, good, excellent) was created as the primary predictor variable. The outcomes, CVD and T2D risk score, were based on previous estimates from large cohort studies. There were 712 and 296 individuals with complete data available for linear regression analyses in the CVD and T2D samples, respectively.

RESULTS

After covariate adjustment, the final model indicated that participants in the excellent (β ± SE = -0.019 ± 0.008, P = 0.020) oral hygiene category had a significantly lower CVD risk score as compared to participants in the poor oral hygiene category. Sensitivity analyses indicated that both toothbrushing and flossing were independently associated with CVD risk score, and various modifiable risk factors. Oral hygiene was not significantly associated with T2D risk score.

CONCLUSIONS

Regular toothbrushing and flossing are associated with a more favorable CVD risk profile, but more experimental research is needed in this area to precisely determine the effects of various oral self-care maintenance behaviors on the control of individual cardiometabolic risk factors. These findings may inform future joint medical-dental initiatives designed to close gaps in the primary prevention of oral and systemic diseases.

Cigarette smoke extract induces select matrix metalloproteinases and integrin expression in periodontal ligament fibroblasts

BACKGROUND

The periodontal ligament (PDL) is the connective tissue that anchors the cementum of the teeth to the alveolar bone. PDL fibroblasts are responsible for the production of collagen and remodeling of the PDL. Periodontal disease is increased among smokers in both incidence and severity. This study examines the direct effect of smoking on PDL fibroblasts and their production of various matrix components and remodeling enzymes.

METHODS

PDL cells were plated for 1 day and then treated with various concentrations of cigarette smoke extract (CSE). Survival of PDL cells was quantified after exposure to CSE, and their ability to contract three-dimensional collagen gels was examined. Changes in transcript expression after CSE treatment was compared using reverse transcription-polymerase chain reaction analysis for matrix metalloproteinases (MMPs), collagens, and integrins.

RESULTS

Treatment with CSE-induced cell death at concentrations of ≥5%. PDL-cell-induced collagen gel contraction was reduced at concentrations of 1.5% CSE. Treatment with CSE selectively increased the expression of collagen Vα3 and decreased collagen XIα1. CSE increased the expression of MMP1 and MMP3 and, to a lesser extent, MMP2 and MMP8. CSE also increased the expression of integrins α1, α2, and α10 (collagen receptors) and α9 (a tenascin receptor).

CONCLUSIONS

This study shows that cigarette smoking has local effects on the cells of the PDL. CSE reduced survival of PDL cells and their ability to contract collagen matrices. CSE also altered the expression of molecules known to provide the structural integrity of the ligament by altering collagen synthesis and remodeling as well as cell adhesion.

Advanced reconstructive technologies for periodontal tissue repair

Reconstructive therapies to promote the regeneration of lost periodontal support have been investigated through both preclinical and clinical studies. Advanced regenerative technologies using new barrier-membrane techniques, cell-growth-stimulating proteins or gene-delivery applications have entered the clinical arena. Wound-healing approaches using growth factors to target the restoration of tooth-supporting bone, periodontal ligament and cementum are shown to significantly advance the field of periodontal-regenerative medicine. Topical delivery of growth factors, such as platelet-derived growth factor, fibroblast growth factor or bone morphogenetic proteins, to periodontal wounds has demonstrated promising results. Future directions in the delivery of growth factors or other signaling models involve the development of innovative scaffolding matrices, cell therapy and gene transfer, and these issues are discussed in this paper.

C-reactive protein measurement in the patient with vascular disease

C-reactive protein (CRP) is becoming more frequently measured in patients with vascular disease. Awareness of why CRP levels are measured, knowledge of normal versus elevated levels, ability to obtain accuracy in measurement, and teaching appropriate for patients with vascular disease may enhance the care given by vascular nurses. The purpose of this article is to provide a guide for vascular nurses in understanding the role of the serum marker CRP for patients with vascular disease.

Comparison of the effects of cetylpyridinium chloride with an essential oil mouth rinse on dental plaque and gingivitis ? a six-month randomized controlled clinical trial

OBJECTIVE

To compare the effects of an experimental mouth rinse containing 0.07% cetylpyridinium chloride (CPC) (Crest Pro-Health) with those provided by a commercially available mouth rinse containing essential oils (EOs) (Listerine) on dental plaque accumulation and prevention of gingivitis in an unsupervised 6-month randomized clinical trial.

MATERIAL AND METHODS

This double-blind, 6-month, parallel group, positively controlled study involved 151 subjects balanced and randomly assigned to either positive control (EO) or experimental (CPC) mouth rinse treatment groups. At baseline, subjects received a dental prophylaxis procedure and began unsupervised rinsing twice a day with 20 ml of their assigned mouthwash for 30 s after brushing their teeth for 1 min. Subjects were assessed for gingivitis and gingival bleeding by the Gingival index (GI) of Löe & Silness (1963) and plaque by the Silness & Löe (1964) Plaque index at baseline and after 3 and 6 months of rinsing. At 3 and 6 months, oral soft tissue health was assessed. Microbiological samples were also taken for community profiling by the DNA checkerboard method.

RESULTS

Results show that after 3 and 6 months of rinsing, there were no significant differences (p=0.05) between the experimental (CPC) and the positive control mouth rinse treatment groups for overall gingivitis status, gingival bleeding, and plaque accumulation. At 6 months, the covariant (baseline) adjusted mean GI and bleeding sites percentages for the CPC and the EO rinses were 0.52 and 0.53 and 8.7 and 9.3, respectively. Both mouth rinses were well tolerated by the subjects. Microbiological community profiles were similar for the two treatment groups. Statistically, a significant greater reduction in bleeding sites was observed for the CPC rinse versus the EO rinse.

CONCLUSION

The essential findings of this study indicated that there was no statistically significant difference in the anti-plaque and anti-gingivitis benefits between the experimental CPC mouth rinse and the positive control EO mouth rinse over a 6-month period.

Smoking interferes with the prognosis of dental implant treatment: a systematic review and meta-analysis

AIM

This systematic literature review was performed to investigate if smoking interferes with the prognosis of implants with and without accompanying augmentation procedures compared with non-smokers.

METHODS

A systematic electronic and handsearch (articles published between 1989 and 2005; English and German language; search terms "dental or oral implants and smoking"; "dental or oral implants and tobacco") was performed to identify publications providing numbers of failed implants, related to the numbers of smokers and non-smokers for meta-analysis. Publications providing statistically examined data of implant failures or biologic complications among smokers compared with non-smokers were included for systematic review.

RESULTS

Of 139 publications identified, 29 were considered for meta-analysis and 35 for systematic review. Meta-analysis revealed a significantly enhanced risk for implant failure among smokers [implant-related odds ratio (OR) 2.25, confidence interval (CI(95%)) 1.96-2.59; patient-related OR 2.64; CI(95%) 1.70-4.09] compared with non-smokers, and for smokers receiving implants with accompanying augmentation procedures (OR 3.61; CI(95%) 2.26-5.77, implant related). The systematic review indicated significantly enhanced risks of biologic complications among smokers. Five studies revealed no significant impact of smoking on prognosis of implants with particle-blasted, acid-etched or anodic oxidized surfaces.

CONCLUSION

Smoking is a significant risk factor for dental implant therapy and augmentation procedures accompanying implantations.

The effect of smoking on periodontal treatment response: a review of clinical evidence

BACKGROUND

Smoking has been identified as a significant risk factor for periodontal diseases and is regarded as being responsible for incomplete or delayed healing in patients following treatment.

AIM AND METHOD

The aim of this conventional review was to review, collate and tabulate the relative effectiveness of treatments of chronic periodontitis in smokers, non-smokers and ex-smokers.

OBSERVATIONS

The majority of clinical trials show significantly greater reductions in probing depths and bleeding on probing, and significantly greater gain of clinical attachment following non-surgical and surgical treatments in non-smokers compared with smokers. This benefit is also seen at class I and II furcation sites and in patients prescribed systemic or local antimicrobial treatments.

CONCLUSIONS

Data from epidemiological, cross-sectional and case-control studies strongly suggest that quitting smoking is beneficial to patients following periodontal treatments. The periodontal status of ex-smokers following treatment suggests that quitting the habit is beneficial although there are only limited data from long-term longitudinal clinical trials to demonstrate unequivocally the periodontal benefit of quitting smoking.

A systematic review of professional mechanical plaque removal for prevention of periodontal diseases

AIM

To investigate the effect of professional mechanical plaque removal (PMPR) on the prevention of periodontal diseases.

METHODS

We searched for randomized controlled trials, controlled clinical trials and cohort studies from 1950 to October 2004. Screening and data abstraction were conducted independently and in duplicate. Critical appraisal of studies was based on objective criteria and evidence tables were constructed.

RESULTS

From 2179 titles and abstracts, 132 full-text articles were screened and 32 studies were relevant. Evidence exists that PMPR in adults, particularly in combination with oral hygiene instruction (OHI), may be more effective than no treatment judged by surrogate measures. The evidence for a benefit of PMPR+OHI over OHI alone is less clear. The optimum frequency of PMPR has not been investigated although more frequent PMPR is associated with improved markers of health. The strength of evidence for these results ranges from weak to moderate due to risk of bias, inconsistent results, lack of appropriate statistics and small sample size.

CONCLUSIONS

There appears to be little value in providing PMPR without OHI. In fact, repeated OHI might have a similar effect as PMPR. Some forms of PMPR might achieve greater patient satisfaction. There is little difference in beneficial or adverse effects of different methods of PMPR.