Smoking Related Systemic and Oral Diseases

Do alternative tobacco products induce less adverse respiratory risk than cigarettes?

RATIONALE

Due to the relatively short existence of alternative tobacco products, gaps exist in our current understanding of their long-term respiratory health effects. We therefore undertook the first-ever side-by-side comparison of the impact of chronic inhalation of aerosols emitted from electronic cigarettes (EC) and heated tobacco products (HTP), and combustible cigarettes (CC) smoke.

OBJECTIVES

To evaluate the potential differential effects of alternative tobacco products on lung inflammatory responses and efficacy of vaccination in comparison to CC.

METHODS

Mice were exposed to emissions from EC, HTP, CC, or air for 8 weeks. BAL and lung tissue were analyzed for markers of inflammation, lung damage, and oxidative stress. Another group was exposed for 12 weeks and vaccinated and challenged with a bacterial respiratory infection. Antibody titers in BAL and sera and pulmonary bacterial clearance were assessed.

MAIN RESULTS

EC- and HTP-aerosols significantly augmented lung immune cell infiltrates equivalent to that achieved following CC-exposure. HTP and CC significantly increased neutrophil numbers compared to EC. All products augmented numbers of B cells, T cells, and pro-inflammatory IL17A+ T cells in the lungs. Decreased lung antioxidant activity and lung epithelial and endothelial damage was induced by all products. EC and HTP differentially augmented inflammatory cytokines/chemokines in the BAL. Generation of immunity following vaccination was impaired by EC and HTP but to a lesser extent than CC, with a CC > HTP > EC hierarchy of suppression of pulmonary bacterial clearance.

CONCLUSIONS

HTP and EC-aerosols induced a proinflammatory pulmonary microenvironment, lung damage, and suppressed efficacy of vaccination.

Color stability of resin-based composites exposed to smoke. A systematic review

OBJECTIVE

To conduct a systematic review on color stability of dental resin-based composites (RBC) exposed to conventional and electronic cigarettes.

MATERIALS AND METHODS

In vitro studies reporting on the color stability of RBC exposed to conventional cigarettes or to e-cigarettes: both Tobacco Heating Systems (THS) and Electronic Nicotine Delivery Systems (ENDS). The quality of the included studies was assessed with the QUIN tool (risk-of-bias tool for assessing in vitro studies conducted in dentistry). A systematic search, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed on four (n = 4) databases (Embase, Medline, Scopus, Web of Science) for articles published until March 28th, 2022.

RESULTS

Of the 365 screened articles, 13 were included in this review. All the included articles analyzed conventional cigarette smoke (CS), four analyzed Electronic Nicotine Delivery Systems (ENDS) and two Tobacco Heating Systems (THS). In terms of study design, smoke exposure time, smoke flow, type and number of cigarettes a high variability was reported.

CONCLUSIONS

The available evidence suggests that CS smoke significantly affects color stability. Electronic cigarettes show less color change that seems to be easily recovered under clinical acceptability thresholds, although evidence is scarce.

CLINICAL SIGNIFICANCE

Clinicians should be aware, and should therefore warn their patients, that RBCs are subjected to irreversible color change if exposed to smoke. Electronic cigarettes (both ENDS and THS) induce less color change that can be recovered with repolishing or whitening procedures.

Tobacco Use and Cessation Counseling among Dental Professionals in Saudi Arabia

The study aimed to assess the prevalence of tobacco use among dental professionals and their attitudes and behaviors about tobacco cessation counseling in Saudi Arabia. A total of 359 male and female dental professionals participated in this cross-sectional study. A pretested self-administered questionnaire was administered among study participants by visiting dental hospitals and clinics in Saudi Arabia. In the study, 15.9% of the participants were current tobacco users and 50.4% had a tobacco user at home or the workplace. Most participants reported that tobacco use is associated with bad breath (88.9%), oral cancer (88.3%), dryness of the mouth (80.8%), and bad taste (79.9%). Most participants asked patients about their tobacco habits (86.6%), mentioned tobacco habits in patient records (71.3%), and explained the benefits of quitting tobacco (79.9%). Less than half the sample (47.1%) referred patients to tobacco quitting services/programs. Male gender (Adjusted odds ratio (AOR) 5.50, 95% CI 2.48−12.23, p < 0.001), having a tobacco user at home/the workplace (AOR 3.18, 95% CI 1.57−6.45, p 0.001), and believing that tobacco cessation counseling was a waste of time (AOR 2.32, 95% CI 1.13−4.76, p 0.021) were associated with significantly increased odds of tobacco use among dental professionals. The study concluded that tobacco use was common among dental professionals despite their awareness of the adverse effects of tobacco. Reduction in tobacco use and promotion of counseling skills among dental professionals should be achieved through public health measures.

Psychological distress and smoking behaviors of Chinese college students: mediating effects of the dimensions of learning burnout

Objectives

Smokers or never smokers exposed to environmental tobacco use are usually associated with various diseases and cancers. In order to better help college students prevent the tobacco use and thus lower the incidence of avoidable diseases, this study explored the predictive power of different variables including demographic and psychological variables in relation to smoking behaviors.

Methods

Maslach Burnout Inventory-Student Survey and Kessler Psychological Distress Scale (K10) were used in this study.

Results

There were 1449 college students participating in the study with 1340 pieces of valid data left, the effective ratio was 92.48%. The valid data included 37.1% male and 62.9% female aged 18.83 on average with 1.55 standard deviation. The multivariate logistic regression indicated that college students who were male (versus female, OR = 9.55), majoring in medicine and sports (versus nursing, OR_medicine = 2.19, OR_sports = 2.81), born in the non-singleton family (versus singleton family, OR = 0.63) with higher family income (versus lower family income, OR = 0.45), surrounded with smoking friends (versus without smoking friends, OR = 0.18), were more vulnerable to smoke. In addition, combined with the theory of planned behavior, the dimensions of learning burnout had full mediation effects between psychological distress and smoking behavior.

Conclusions

Psychological distress can only indirectly affect smoking behavior via learning efficacy, cynicism and emotional exhaustion. Adjustments from different dimensions of learning burnout such as avoiding cynicism about learning, enhancing learning efficacy and emotion exhaustion will help college students better prevent the tobacco use.

Effect of Cigarette and E-Cigarette Smoke Condensates on Candida albicans Biofilm Formation and Gene Expression

Smoking triggers environmental changes in the oral cavity and increases the risk of mucosal infections caused by Candida albicans such as oral candidiasis. While cigarette smoke has a significant impact on C. albicans, how e-cigarettes affect this oral pathogen is less clear. Here, we investigated the effect of cigarette and e-cigarette smoke condensates (CSC and ECSC) on C. albicans growth, biofilm formation, and gene expression. Whereas pure nicotine (N) at the minimum inhibitory concentration (MIC, 4 mg/mL) prevented C. albicans growth, enhanced biofilm formation was observed at 0.1 mg/mL. In contrast, at this nicotine sub-MIC (0.1 mg/mL) concentration, CSC and ECSC had no significant effect on C. albicans biofilm formation. Additionally, N, CSC, and ECSC increased the expression of HWP1 and SAP2 genes. The ECSC group exhibited elevated expression levels of the EAP1 and ALS3 genes, compared to the nicotine-free ECSC (-) control. Moreover, our in vitro study illustrated that the antifungal drugs, fluconazole and amphotericin B, alleviated the effect of nicotine on C. albicans gene expression. Overall, the results of the study indicated nicotine from different sources may affect the pathogenic characteristics of C. albicans, including hyphal growth, biofilm formation, and particularly the expression of virulence-related genes.

Evaluation of Anti-Inflammatory Effect of Moringa oleifera Lam. and Cyanthillium cinereum (Less) H. Rob. Lozenges in Volunteer Smokers

Smokers have high plaque accumulation that initiates gingival inflammation and progresses to periodontitis. Thus, oral hygiene to control microbial plaque formation is an effective method of preventing gingivitis. Medicinal plants such as Moringa oleifera Lam. (MO) and Cyanthillium cinereum (Less.) H. Rob. (CC) have an anti-inflammatory effect that might improve oral health in smokers. This study evaluated the effect of MO leaf and CC extracts using MO lozenges and a combination of MO + CC lozenges on oral inflammation and gingivitis in volunteer smokers. Lozenges consisting of MO and CC extracts were developed and studied in vivo. The results showed that lozenges significantly reduced oral inflammation and gingivitis in volunteers. The gingival index (GI) of group III (MO + CC lozenges) significantly decreased, while the percentage decrease of oral inflammation in group II (MO lozenges) was significantly higher than the other groups. The percentage decrease of GI values in group II (MO lozenges) and group III (MO + CC lozenges) were significantly higher than the placebo group I. Our findings indicated that MO and MO + CC lozenges reduced oral inflammation and gingivitis and showed potential to improve oral health in smokers.

Acute Effects of Heated Tobacco Product (IQOS) Aerosol Inhalation on Lung Tissue Damage and Inflammatory Changes in the Lungs

INTRODUCTION

Emerging heated tobacco products (HTPs) were designed to reduce exposure to toxicants from cigarette smoke (CS) by avoiding burning tobacco and instead heating tobacco. We studied the effects of short-term inhalation of aerosols emitted from HTP called IQOS, on lung damage and immune-cell recruitment to the lungs in mice.

METHODS

Numerous markers of lung damage and inflammation including albumin and lung immune-cell infiltrates, proinflammatory cytokines, and chemokines were quantified in lungs and bronchoalveolar (BAL) fluid from IQOS, CS, or air-exposed (negative control) mice.

RESULTS

Importantly, as a surrogate marker of lung epithelial-cell damage, we detected significantly increased levels of albumin in the BAL fluid of both HTP- and CS-exposed mice compared with negative controls. Total numbers of leukocytes infiltrating the lungs were equivalent following both IQOS aerosols and CS inhalation and significantly increased compared with air-exposed controls. We also observed significantly increased numbers of CD4+IL-17A+ T cells, a marker of a T-cell immune response, in both groups compared with air controls; however, numbers were the highest following CS exposure. Finally, the numbers of CD4+RORγt+ T cells, an inflammatory T-cell subtype expressing the transcription factor that is essential for promoting differentiation into proinflammatory Th17 cells, were significantly augmented in both groups compared with air-exposed controls. Levels of several cytokines in BAL were significantly elevated, reflecting a proinflammatory milieu.

CONCLUSIONS

Our study demonstrates that short-term inhalation of aerosols from IQOS generates damage and proinflammatory changes in the lung that are substantially similar to that elicited by CS exposure.

IMPLICATIONS

Exposure of mice to IQOS, one of the candidate modified-risk tobacco products, induces inflammatory immune-cell accumulation in the lungs and augments the levels of proinflammatory cytokines and chemokines in the BAL fluid. Such an exacerbated pulmonary proinflammatory microenvironment is associated with lung epithelial-cell damage in IQOS-exposed mice, suggesting a potential association with the impairment of lung function.

Association between salivary s-IgA concentration and dental caries: A systematic review and meta-analysis

OBJECTIVE

To determine the levels of s-IgA in saliva of caries patients and healthy controls, and to evaluate whether there is a correlation between it and caries by systematic review and meta-analysis.

METHODS

 Eight databases were searched initially in April 2020 and repeated in August 2020. Two independent evaluators screened the literature and extracted the data according to the inclusion and exclusion criteria. I2 test was commonly reflected the heterogeneity. Subgroup analysis and meta-regression analysis explore the sources of heterogeneity. Sensitivity analysis, funnel diagram, Begg's rank correlation and Egger's linear regression were used to determine the possibility of publication bias.

RESULTS

A total of 30 case-control studies were included, with a total sample size of 1545 patients, including 918 caries patients and 627 healthy controls. Salivary s-IgA levels in caries patients were significantly lower than those in healthy controls. In addition, the results of subgroup analysis showed that the significant decrease of salivary s-IgA level was correlated with children patients, mixed dentition and Asian people. The funnel diagram included in the study was symmetrically distributed, and the sensitivity analysis confirmed the robustness of the results.  Conclusion: Salivary s-IgA levels in caries patients were significantly lower than in healthy controls. It has also been demonstrated that salivary s-IgA may be used as an alternative measure to identify subjects at risk of caries susceptibility, suggesting that salivary s-IgA may be a protective factor for dental caries.

Electronic Nicotine Delivery Systems (ENDS) and Their Relevance in Oral Health

The number and popularity of electronic nicotine delivery systems (ENDS) and especially e-cigarettes (e-cigs) have been increasing in the last decade. Although ENDS owe their popularity to excluding the harmful chemicals that are present in tobacco smoke, there is a debate whether they are safe, regulated, and as harmless as they are assumed to be and have potential unknown long-term effects. Involvement of cigarette smoking to the progression of periodontal diseases, other adverse oral health outcomes, and its detrimental effects to oral health are well-described. ENDS producer companies claim that these products can improve oral health by providing alternatives to smoking. However, the effect of e-cigs on oral health is not fully understood and is still debated among many scientists and clinicians. The number of studies addressing the potential toxic effect of ENDS or e-cig aerosol on oral cells is limited along with the clinical studies which are still preliminary, and their sample size is limited. The long-term effects of inhaled aerosols and the potential synergistic effect of the e-cigs components are not known. It is essential and of utmost importance to determine whether exposure to ENDS aerosol contributes to the progression of periodontal diseases and how it affects periodontal ligament and gingival cells which are believed to be its first targets. This review briefly summarizes the available evidence about the effects of e-cigs on periodontal health including several pathophysiological events, such as oxidative stress, DNA damage, inflammation, cellular senescence, dysregulated repair, and periodontal diseases.

Caracterización epidemiológica de pacientes fumadores invertidos en Cartagena, Colombia

Objetivo: el presente estudio se propone describir las características epidemiológicas de pacientes fumadores invertidos que asisten a consulta en la Facultad de Odontología de la Universidad de Cartagena. Métodos: se llevó a cabo un estudio observacional descriptivo de corte transversal, realizado en 40 fumadores invertidos activos, escogidos mediante muestreo por conveniencia en bola de nieve. Se describieron las características sociodemográficas y epidemiológicas de los sujetos de estudio y se realizaron diagnósticos mediante biopsia de las lesiones encontradas. El análisis estadístico consistió en el hallazgo de frecuencias y porcentajes. Resultados: el sexo femenino (90%), el oficio de ama de casa (55%) y la raza negra (97,5%) fueron las características más frecuentes en los sujetos; en relación con el motivo de la práctica, la aceptación social fue la causa más prevalente (60%); y el diagnóstico más reportado fue el paladar del fumador invertido (85%). Adicionalmente, se encontraron tres casos de cáncer oral (7,5%), y el sitio anatómico más comprometido fue el paladar duro (85%). Conclusiones: el hábito del tabaquismo invertido está asociado a un marcado deseo de aceptación social de quienes lo practican, que tiene origen en las tradiciones de su comunidad, derivadas de la adaptación a su zona geográfica de residencia y a la realización de las labores diarias. Dicho hábito se presenta predominantemente en mujeres de raza negra, amas de casa y mayores de 45 años. En cavidad bucal, los sitios más afectados son el paladar duro y la lengua; mientras que los diagnósticos más frecuentes son palatitis nicotínica y melanosis del fumador.

Estomatitis nicotínica asociada al hábito de fumar cigarro invertido en paciente ecuatoriana

Introducción: la estomatitis nicotínica es un trastorno benigno de la mucosa oral del paladar duro, que puede extenderse al paladar blando y que comúnmente está presente en individuos fumadores de tabaco y cigarrillo. Esta lesión se manifiesta por la presencia de pápulas blanquecinas, aplanadas y generalmente asintomáticas. Objetivo: evaluar las lesiones en paladar causadas por el hábito de fumar cigarrillo de manera invertida y los beneficios de la supresión de esta práctica. Caso: paciente de 69 años, de sexo femenino, habituada a fumar cigarro de manera invertida desde la adolescencia. Examen clínico extraoral normal. En la exploración intraoral se observó edentulismo parcial y placas blanquecinas en paladar, con un tiempo de evolución desconocido. Se realizó diagnóstico clínico e histológico de estomatitis nicotínica. Conclusiones: la paciente fue diagnosticada con estomatitis nicotínica causada por la costumbre de fumar de manera invertida, lo que convierte a este en el primer caso reportado en Ecuador. La supresión de la práctica de tabaquismo invertido permitió una recuperación de la mucosa sin secuelas.

Effect of Heavy Metals Contamination from Cigarette Smoke on Sound and Caries-Like Enamel

In this study, we sought to evaluate the influence of cigarette smoke and pH cycling on the chemical composition and surface/cross-sectional enamel microhardness. A total of 40 dental blocks obtained from bovine incisors were divided into four groups (n=10): no treatment (control); exposure to cigarette smoke (CS); exposure to pH cycling (PC); and exposure to cigarette smoke and pH cycling (CS-PC). The samples were analyzed by synchrotron radiation micro X-ray fluorescence, bench mode X-ray fluorescence, as well as surface microhardness (SMH) and cross-sectional microhardness (CSMH) testing. The SMH results were submitted to analysis of variance (ANOVA) and Tukey's test. The CSMH results were evaluated using split-plot ANOVA and Tukey's test. A high amount of Cd and Pb and traces of Ni and As were observed in enamel and dentin after exposure to cigarette smoke (CS and CS-PC). The SMH and CSMH of CS were statistically higher when compared with the control. The PC and CS-PC showed lower SMH and CSMH. We conclude that exposure to cigarette smoke promoted heavy metal deposition in enamel/dentin. In addition, it increased the enamel microhardness but did not promote a protective effect on the in vitro development of caries. The clinical significance of this work is that there is significant bioaccumulation of heavy metals from cigarette smoke on the surface and in the enamel and dentin.

Effects of nicotine on the metabolism and gene expression profile of Sprague‑Dawley rat primary osteoblasts

Smoking is a risk factor associated with bone and oral diseases, particularly periodontitis. Nicotine, the major toxic component of tobacco, is able to affect the quality and quantity of bone. Osteoblasts serve an important role in bone formation. Thus far, the effects of nicotine on metabolism‑associated gene and protein expression in osteoblasts have been controversial and the mechanisms remain unclear. The present study assessed alterations in osteogenic activity by performing a Cell Counting kit‑8 assay to investigate proliferation, Annexin V‑fluorescein isothiocyanate/propidium iodide staining to investigate apoptosis, alizarin red staining to investigate the formation of mineralized nodules, reverse transcription‑quantitative polymerase chain reaction and western blotting to investigate the mRNA and protein levels of collagen I, alkaline phosphatase, bone osteocalcin, bone sialoprotein and osteopontin; and mRNA microarray expression analysis, Kyoto Encyclopedia of Genes and Genomes and Gene Ontology analysis to investigate the whole genome expression profile of Sprague‑Dawley (SD) rat primary osteoblasts following treatment with different concentrations of nicotine. The results demonstrated that nicotine inhibited proliferation, promoted early apoptosis and inhibited mineralized nodule formation in a dose‑dependent manner by regulating alkaline phosphatase activity and the expression of osteoblast metabolism‑associated genes and proteins. According to microarray analysis, several genes associated with bone metabolism and genes in the Hedgehog and Notch signaling pathways were downregulated significantly in nicotine‑treated osteoblasts. The results of the present study indicated that nicotine may serve an inhibitory, dose‑dependent role in SD rat primary osteoblasts that may be caused by the perturbation of genes and signaling pathways associated with bone formation. These results may provide a theoretical basis for future research regarding bone metabolism and targeted treatment of oral diseases associated with smoking.

Comparison of gingival depigmentation with Er,Cr:YSGG laser and surgical stripping, a 12-month follow-up

Gingival melanin hyperpigmentation is an esthetic concern for many individuals. In this study, we compared the standard surgical removal method with two different Er,Cr:YSGG laser settings in order to find the best treatment method. In 33 dental arches, the following three treatment groups were comparatively evaluated: (1) surgical stripping, (2) removal with laser setting 1 (4.5 W, 50 Hz, 100% water, 80% air, 60 μs, 800 μm Tip; MZ8), and (3) laser setting 2 (2.5 W, 50 Hz, 20% water, 40% air, 700 μs, 800 μm Tip; MZ8). We comparatively evaluated pain, patient satisfaction and wound healing, treatment time, and the amount of bleeding. Re-pigmentation was evaluated after 1 and 12 months by Hedin and Dummet pigmentation scores. Laser setting 1 had the best results regarding pain and patient satisfaction, although not statistically significant (P > 0.05). Wound healing results were better using lasers compared to surgical stripping (P < 0.05). Laser setting 1 was a faster procedure with mild amounts of bleeding. The least amount of bleeding was seen with laser setting 2. After 1 month, only two cases of the laser setting 2-treated areas showed an isolated pigmented area in the papilla; at 12 months, the mean Hedin indexes were still less than 2 and mean Dummett index less than 1 in all treatment techniques, with the lowest scores seen in the laser setting 1 sites. Based on our results, Er,Cr:YSGG laser can be more convenient for gingival depigmentation compared to surgical blade. Although not statistically significant, laser setting 1 with shorter pulse duration and higher water spray showed better overall results. However, laser setting 2, with longer pulse duration and less water spray, resulted in better coagulative effects and can be used to control bleeding wherever necessary in clinical practice.

Crosstalk between oral and general health status in e-smokers

Electronic cigarette (e-cigarette) simulates the act of tobacco smoking by vaporizing a mixture of propylene glycol, nicotine, and flavoring agents. e-cigarette has been proposed as a product able to aid to stop smoking. The aim of the study is to verify the clinical variations of periodontal health induced by e-cigarettes use and, moreover, to investigate about the awareness of the e-smokers about their health variations and about their hypothetical need to turn back to smoke combustible cigarettes.This clinical observational pilot study involved 110 out of 350 smokers, who switched to e-cigarette. Patients were subjected to oral examinations. A questionnaire to self-assess the variations of some parameters of general health, and to self-assess the need to smoke combustible cigarettes, was distributed to such subjects involved in the study.At the end of the study, we registered a progressive improvement in the periodontal indexes, as well as in the general health perception. Finally, many patients reported an interesting reduction in the need to smoke.In the light of this pilot study, the e-cigarette can be considered as a valuable alternative to tobacco cigarettes, but with a positive impact on periodontal and general health status.

Respiratory Illness and Allergy Related to Work and Home Environment among Commercial Pilots

The aim was to study associations between work and home environment and prevalence and incidence of respiratory health and a history of atopy in a 3-y cohort of commercial pilots. A questionnaire was mailed in 1997 to all pilots in a Scandinavian airline company (N = 622); 577 (93%) participated. The same questionnaire was sent to the participants 3 years later, 436 participated (76%). There were questions on asthma, respiratory symptoms and infections, allergies, the cabin environment, psychosocial environment and the home environment. Associations were analyzed by multiple logistic regression, calculating odds ratios (OR) with 95% confidence intervals (95%CI). The incidence of doctors' diagnosed asthma and atopy were 2.4 and 16.6 per 1000 person years, respectively. Pilots changing type of flight during follow-up got more airway infections (OR = 11.27; 95% CI 2.39-53.14). Those reporting decreased work control (OR = 1.85; 95% CI 1.03-3.31 for 1 unit change) and those with environmental tobacco smoke (ETS) at home (OR = 3.73; 95% CI 1.09-12.83) had a higher incidence of atopy during follow up. Dampness or mould at home was associated with a higher prevalence of asthma symptoms (OR = 3.55; 95% CI 1.43-8.82) and airway infections (OR = 3.12 95% CI 1.27-7.68). Window pane condensation in winter at home, reported at baseline, was associated with increased incidence of asthma symptoms (OR = 4.14; 95% CI 1.32-12.97) and pilots living in newer buildings at baseline had a higher incidence of airway infections (OR = 5.23; 95% CI 1.43-19.10). In conclusion, lack of work control and ETS at home can be a risk factors for development of allergic symptoms in pilots. Window pane condensation at home can be a risk factor for incidence of asthma symptoms. Dampness and mould at home can be a risk factor for prevalence of asthma symptoms and airway infections and living in newer buildings can be a risk factor for incidence of airway infections.

Time controlled pulsatile transdermal delivery of nicotine: A phase I feasibility trial in male smokers

Nicotine substitution is a mainstay component in smoking cessation schemes. Current products including patches are poorly effective mainly because they do not give smokers the same pharmacokinetic profile of nicotine as cigarette consumption. This work evaluates a new computer operated delivery system for time controlled pulsatile transdermal administration of nicotine in a phase I clinical trial with twelve heavy smoking male volunteers. The device was affixed to the ventral side of the leading lower arm of the subjects and was programmed to deliver two pulses of drug within 16h with three delivery rates in a consecutive dose escalation study. Tolerability of the three increasing doses of nicotine was established. Plasma concentration of nicotine exhibited two peaks and one trough and reached therapeutically effective levels that behaved linearly with the drug load concentration of the device. In vivo input rate, delivered amount and elimination kinetics were deduced by pharmacokinetic modeling to analyze device performance. Timing, dose and duration of delivery were controlled by system operation parameters. Hence, feasibility of controlled pulsatile delivery of nicotine at predetermined intervals was demonstrated. After additional optimization, preprogrammed or on demand administration to meet individualized and circadian replacement needs should improve smoking cessation efficacy.

Describing the role of Australian community pharmacists in oral healthcare

OBJECTIVES

To investigate community pharmacist's attitudes, beliefs and practices towards oral health in the Australian setting, describe the frequency and nature of consumer enquiries relating to oral health, and gain insight regarding smoking cessation support for people experiencing oral health problems.

METHODS

An online questionnaire was developed based on previous research, validated to ensure accuracy and reliability, and convenience sampling used to advertise across major pharmacy organisational websites and newsletters to maximise community pharmacist responses.

KEY FINDINGS

One hundred and forty-four valid community pharmacist responses were descriptively analysed. The majority of pharmacists (93%) believed it was their role to deliver oral health advice in the community and almost all (97%) pharmacists believed further education would benefit their practice. The top four consumer enquiries pharmacists reported confidence in handling related to analgesic medication to relieve oral-related pain (95.8%), mouth ulcers (95.1%), oral thrush (94.4%) and toothache (93.8%); and the most frequently reported consumer enquires were those where the majority of pharmacists reported high confidence in handling. A small proportion of pharmacists (8%) always enquired about patient smoking status, and nearly all pharmacists (97%) desired further education and training to benefit their practice in oral healthcare.

CONCLUSION

This study highlights that Australian pharmacists have an important role in oral health and there is opportunity to enhance this role, and address risk factors such as smoking with further training, support and education. The findings from this study can guide future research into the development of appropriate training programmes, standards, and best oral healthcare practices for Australian pharmacists.

Implications of tobacco smoking on the oral health of older adults

Cigarette smoking is the foremost health risk issue affecting individuals of all age groups globally. It specifically influences the geriatric population as a result of chronic exposure to toxins. Its role in various systemic and oral diseases including cancer, premalignant lesions, periodontitis, tooth loss, dental caries and implant failures is well established. Smoking causes immuno-inflammatory imbalances resulting in increased oxidative stress in the body. The latter hastens the immunosenescence and inflammaging process, which increases the susceptibility to infections. Thus, implementation of smoking cessation programs among older adults is imperative to prevent the development and progression of oral and systemic diseases. The present review focuses on smoking-associated oral health problems in older adults, and the steps required for cessation of the habit.

Association of dental caries and salivary sIgA with tobacco smoking

BACKGROUND

Salivary secretory IgA (sIgA) is said to play an important role in the immune response against dental caries. This study aimed to determine the salivary sIgA levels in healthy smokers and non-smokers, and its correlation with dental caries.

METHODS

A total of 70 healthy subjects were selected and classified into four groups according to dental caries and tobacco smoking habits: smoking with caries (Group 1, n = 15); smoking without caries (Group 2, n = 15); non-smoking with caries (Group 3, n = 15); and non-smoking without caries (Group 4, n = 25). Salivary sIgA was measured using ELISA. The fissure and proximal caries were examined clinically and radiographically. Caries status was determined according to the decay surface index.

RESULTS

Smokers showed a higher number of caries and the lowest concentration of sIgA. The highest levels of sIgA were observed in non-smoking and caries-free subjects compared to caries-active smokers (123.2 ± 19.9 vs. 13.3 ± 4.1 μg/ml respectively, p < 0.001). Also, the mean level of sIgA in Group 4 was significantly higher than Group 3 (p = 0.009). More importantly, higher and significant levels of sIgA were found in Group 3 versus Group 1 (p < 0.0001) and Group 2 (p = 0.0004).

CONCLUSIONS

Our findings indicate that low concentrations of salivary sIgA are correlated with a higher prevalence of dental caries in smokers.

Treatment strategies for oropharyngeal candidiasis

BACKGROUND

Oropharyngeal candidiasis (OPC) is a common oral disease that may cause oral symptoms, lead to regional infection (e.g., esophageal candidiasis) and increase the risk of systemic fungal infection in the compromised host.

OBJECTIVE

Critical review of the literature of prevention and therapy.

METHODS

The literature was reviewed using PubMed, and specific keywords from the MeSH Database were used.

RESULTS/CONCLUSION

Management of OPC requires that the underlying risk factors of infection be diagnosed and managed whenever possible. Antimicrobials may be provided as topical or systemic therapy. Topical therapies may provide effective management for candidiasis in the non-compromised host and increase the control of colonization in the compromised host. Advances in prevention and management include new agents and improved mechanisms of topical drug delivery.

Olfaction in dentistry

Practitioners of oral medicine frequently encounter patients with complaints of taste disturbance. While some such complaints represent pathological processes specific to the gustatory system, per se, this is rarely the case. Unless taste-bud mediated qualities such as sweet, sour, bitter, salty, umami, chalky, or metallic are involved, 'taste' dysfunction inevitably reflects damage to the sense of smell. Such 'taste' sensations as chicken, chocolate, coffee, raspberry, steak sauce, pizza, and hamburger are dependent upon stimulation of the olfactory receptors via the nasopharynx during deglutition. In this paper, we briefly review the anatomy, physiology, and pathophysiology of the olfactory system, along with means for clinically assessing its function. The prevalence, etiology, and nature of olfactory disorders commonly encountered in the dental clinic are addressed, along with approaches to therapy and patient management.

Assessment of cytological atypia, AgNOR and nuclear area in epithelial cells of normal oral mucosa exposed to toombak and smoking

The purpose of this study was to assess cellular proliferative activity of clinically healthy oral mucosal epithelial cells of toombak dippers and smokers by means of AgNOR counts and nuclear areas via nuclear morphometry. Smears were collected from normal-appearing mouth floor mucosa and tongue of 75 toombak dippers, 75 smokers and 50 non-tobacco users between the ages of 20 and 70 with a mean age of 36 years. AgNORs were counted in the first 50 well-fixed, nucleated squamous cells and nuclear areas were calculated via microscopic stage micrometer. Cytological atypia was ascertained in 6 tobacco users and could not be ascertained in non-tobacco users. Statistically mean AgNOR numbers per nucleus in the non-tobacco users (2.45±0.30) was lower than the toombak dippers (3.081±0.39, p<0.004), and the smokers (2.715±0.39, p<0.02), and mean nuclear areas of epithelial cells of toombak dippers (6.081±0.39, p<0.009) and smokers (5.68±10.08, p<0.01) was also significantly higher than non-smokers (5.39±9.4). The mean number of nuclei having more than 3 AgNORs was 28%, 19% and 7% in toombak dippers, smokers and non-tobacco users, respectively. These findings support the view that toombak dipping and smoking are severe risk factors for oral mucosal proliferative lesions and exfoliative cytology is valid for screening of oral mucosal lesions.

Tobacco habits and oral health status in selected Indian population

This cross-sectional study was aimed at possible relationships between tobacco habits and selected behavior characteristics in an adult sample from India. Contemporaneous clinical examination comprised an intra-oral examination with specific emphasise to dental caries status in the form of DMFT (Decayed, Missing, and Filled Teeth) index. The study comprised 805 subjects in the age group from 30 to 69 years (72% of males and 28% of females). The participants were divided into regular smokers, occasional smokers, ex-smokers, tobacco chewers and non-tobacco users. The highest prevalence of oral mucosal lesions were found in tobacco chewers (22.7%) followed by regular smokers (12.9%), occasional smokers (8.6%), ex-smokers (5.1%) and non tobacco users (2.8%) (p < 0.001). The mean number of decayed teeth was highest in tobacco chewers (6.96) followed by regular smokers (6.44) and ex-smokers (5.5) (p < 0.001). The mean number of missing teeth was highest in the group of regular smokers (1.9) and lowest in non-tobacco users (1.53), but the results were not statistically significant (p = 0.529). The mean number of filled teeth were highest in the group of tobacco chewers (3.67) followed by regular smokers (3.29) (p < 0.001). DMFT value of tobacco chewers, regular smokers and ex-smokers is higher when compared to non-tobacco users (p < 0.001). The study documents that chewing tobacco and smoking can present significant risk factors for dental caries. However, the conclusions are burdened by some limitations. Further studies for investigation of the effect of tobacco using on dental caries are needed.