The effect of smoking on individuals with minimal periodontal destruction

A study to evaluate the prevalence of teeth without clinically detectable mucogingival junction

Context:

The mucogingival junction (MGJ) is one of the important anatomical entities which mark the apical termination of attached gingiva, except that at palatal side. Its position is genetically determined like other organs and tissues in our body. There are certain anatomic aberrations such as abnormal teeth eruption or high frenal attachments and pathologies, such as periodontitis, leading to its absence. There are no studies on the prevalence of teeth having no clinically detectable MGJ. There is a resurgence of importance of attached gingiva, reflected by the definite presence of MGJ, through the field of dental implantology.

Aims:

We aim to evaluate the prevalence of teeth without clinically detectable MGJ on the buccal aspect of dentate alveolar processes.

Settings and Design:

This cross-sectional observational clinical study was conducted in the department of periodontology which was approved by the institutional ethical committee.

Materials and Methods:

Periodontally healthy as well as diseased patients of age 18–50 years were included in the study. The detection of MGJ was carried out by visual method, tension test, rolling probe method, and Lugol's iodine solution, and confirmation from any two methods was considered for the absence of MGJ. The etiology of MGJ absence (gingival recession, pocket till MGJ, trauma, abnormal frenal attachment, malposition of tooth, abnormal habits, severe abrasion, etc.,) was also evaluated.

Statistical Analysis Used:

Simple statistics in the form of averages and percentages were used for calculations.

Results:

A total of 130 subjects (3637 teeth) were examined out of which 32 (24.6%) subjects showed no clinically detectable MGJ. In all subjects, on an average, every subject has 28 teeth and out of the total 3637 teeth analyzed, only 91 (2.5%) teeth were without detectable MGJ.

Conclusion:

Almost 25% of the population may show a tooth or few teeth without a clinically detectable MGJ. The prevalence of teeth without clinically detectable MGJ per mouth is very low at 0.7 (approximately 1 tooth/subject).

Viability of Quercetin-Induced Dental Pulp Stem Cells in Forming Living Cellular Constructs for Soft Tissue Augmentation

Autogenous gingival grafts used for root coverage or gingival augmentation procedures often result in donor site morbidity. Living cellular constructs as an exogenous alternative have been proven to be associated with lower morbidity. With the available background information, the present study aims to assess if quercetin-induced living cell constructs, derived from dental pulp stem cells, have the potential to be applied as a tool for soft tissue augmentation. The characterized dental pulp stem cells (positive for CD73, CD90, and negative for CD34, HLA-DR) were expanded in Dulbecco's Modified Eagle's medium (DMEM) supplemented with 10 mM quercetin. The handling properties of the quercetin-induced dental pulp stem cell constructs were assessed by visual, and tactile sensation. A microscopic characterization using hematoxylin and eosin staining, and qRT-PCR-based analysis for stemness-associated genes (OCT4, NANOG, SOX2, and cMyc) was also performed. Dental pulp stem cells without quercetin administration were used as the control. Dental pulp stem cell constructs induced by quercetin easily detached from the surface of the plate, whereas there was no formation in the control cells. It was also simple to transfer the induced cellular construct on the flattened surface. Microscopic characterization of the constructs showed cells embedded in a tissue matrix. Quercetin also increased the expression of stemness-related genes. The use of quercetin-induced DPSC living constructs for soft tissue augmentation could provide an alternative to autogenous soft tissue grafts to lower patient morbidity and improve esthetic outcomes.

The impact of smoking on non-surgical periodontal therapy: A systematic review and meta-analysis

AIM

Smoking is a risk factor for periodontitis. This study aimed to evaluate the impact of smoking on clinical outcomes of non-surgical periodontal therapy.

MATERIALS AND METHODS

Electronic databases were searched to screen studies published before May 2020. The included studies had to have two groups: smokers (S) and non-smokers (NS) with periodontitis. The outcomes evaluated were differences between groups in probing depth (PD) reduction and clinical attachment level (CAL) gain after non-surgical periodontal therapy. Meta-regressions were conducted to evaluate correlations between outcomes and other contributing factors.

RESULTS

Seventeen studies were included. The post-treatment PD reduction in the S group was smaller than in the NS group (weighted mean difference in PD reduction: -0.33 mm, 95% confidence interval (CI): [-0.49, -0.17], p < .01). The CAL gain in the S group was also smaller than in the NS group (weighted mean difference in CAL gain: -0.20 mm, CI: [-0.39, -0.02], p < .01). Additionally, baseline PD significantly affected the difference in PD reduction between two groups.

CONCLUSIONS

Smoking negatively impacts clinical responses to non-surgical periodontal therapy. Smokers with periodontitis have significantly less PD reduction and CAL gain than non-smokers.

Evaluation of salivary biomarkers of periodontitis among smokers and nonsmokers: A novel study

Background:

The analysis of salivary enzymes contributes to the clarification of pathogenesis and improvement in the diagnosis of periodontal disease. The present study aimed to examine the prospective association between smoking and periodontal disease progression and the effects of smoking on the following salivary biomarkers related to periodontitis: Alkaline phosphatase (ALP), acid phosphatase (ACP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), lactate dehydrogenase (LDH), creatinine (CRE), blood urea nitrogen (BUN), urea (UA), free-hemoglobin (f-Hb), and neopterin.

Materials and Methods:

A total of 64 male patients aged 21–60 years were recruited and grouped as Group 1: 16 healthy nonsmokers, who had never smoked. Group 2: 16 smokers with gingivitis. Group 3: 16 smokers with moderate periodontitis. Group 4: 16 smokers with severe periodontitis. Stimulated saliva was collected for at least 5 min and clinical measurements; salivary biomarkers were assessed in automated analyzer.

Results:

Data showed significant correlation among salivary ACP, AST, LDH, CRE, BUN, UA, and f-Hb and neopterin levels showed higher in group 4 compared with other groups.

Conclusion:

This study indicated that smoking has several detrimental effects on periodontal tissues. A higher level of salivary biomarkers was seen in smokers with severe periodontitis. Hence, these biomarkers are helpful in future for the earlier detection of periodontal diseases progression and can also be used as potential salivary biomarkers for assessing smoking status and severity in chronic periodontitis.

The Effect of Smoking Habit on Apical Status of Adequate Endodontically Treated Teeth with and Without Periodontal Involvement

Background

The possible connection between apical periodontitis (AP), periodontal disease (PD) and the bad habit of smoking is among the most interesting aspects faced by the dental scientific community. The aim of this study was to pinpoint the effect of smoking on the status of the apical region, in properly root-filled teeth with and without periodontal involvement of Iraqi males.

Materials and methods

Total number of 75 patients were chosen, divided into 3 groups of 25’s, teeth were subdivided into 6 subgroups (G-a: Light smokers without Periodontal involvement, G-b: Heavy smokers without Periodontal involvement, G-c: Non-smokers without Periodontal involvement, G-d: Light smokers with Periodontal involvement, G-e: Heavy smokers with Periodontal involvement, G-f: Non-smokers with Periodontal involvement), examination involved: clinical periodontal parameters, coronal restoration fitness. Panoramic and periapical radiographs were used to judge the quality of periodontal tissue in the apical region (AP) of root canal treated teeth.

Results

Among all the examined teeth (1859), only (89) were found with fitted both coronal and endodontic restorations. Rates of AP were: (G-a: 11.1%, G-b: 25%, G-c: 0%, G-d: 18.8%, G-e: 35.7%, G-f: 4.8%). Statistically, in related to the AP, there was a highly significant difference between heavy smokers’ groups (G-b, G-e). Moreover, heavy smokers with PD (G-e) showed a significant difference with light smokers without PD (G-a) and non-smokers without PD (G-c), also, there was a significant difference between heavy smokers without PD (G-b) and non-smokers with PD (G-f). While, there was a non-significant difference relationship between non–smokers’ groups (G-c, G-f), and light smokers’ groups (G-a, G-d).

Conclusion

There is a noticeable negative effect of smoking on the severity and prognosis of AP and this negative effect worsens when it is accompanied by lateral periodontitis.

Experimental and clinical studies on plastic periodontal procedures

We have compiled, in this Periodontology 2000 review, all Latin American literature on experimental and clinical studies of periodontal plastic procedures. The body of literature on this subject has led to a discussion of the features and treatment outcomes of root-coverage procedures. Over time, knowledge on periodontal plastic procedures has become less empirical and more supportive of the clinical management of recession-type defects. Gingival recession etiology, animal studies, free gingival grafts, pedicle flaps (semilunar, laterally positioned, and coronally positioned), and subepithelial connective tissue grafts are extensively reviewed. The use of allografts as an alternative to subepithelial connective tissue grafts, the treatment of multiple gingival recessions, and the rationale for use of guided tissue regeneration and enamel matrix derivative in plastic periodontal procedure is discussed. We also assess how smoking can affect the treatment outcomes in plastic surgery procedures. Minimally invasive procedures are of great value in improving the features of the final tissues. The following aspects identified in this compilation were of great interest: (a) some factors, anatomical in nature, favor the formation of root recessions, but it is the inflammatory process (caused by the presence of biofilm and/or by traumatic toothbrushing) that is responsible for the development of root recessions; and (b) pedicle flap procedures (especially the coronally positioned flap) are extremely versatile and have the most predictable outcome of all root-coverage procedures, especially when combined with subepithelial connective tissue grafting and/or allogeneic grafts. In summary: subepithelial connective tissue grafting is considered as the first option to augment gingival width and thickness, and it may provide better long-term results; the same principles of root-coverage procedures in individual sites appear be used in clinical practice also for multiple-recession type defects; an allograft is an efficient alternative to a subepithelial connective tissue graft and, when it is the treatment option of choice, the use of wide, extended flaps should be considered; because of the superiority of plastic periodontal procedures over guided tissue regeneration and the technical difficulty of the latter, guided tissue regeneration has become obsolete for root-coverage procedures; there is rather a large body of evidence attesting that smoking negatively influences root-coverage procedures, especially subepithelial connective tissue grafts; and minimally invasive techniques may be of great value for improving the results obtained with plastic periodontal procedures, but these techniques need to be better addressed in clinical trials, both in terms of the quality and quantity of the new tissue generated.

Hidden truth of circulating neutrophils (polymorphonuclear neutrophil) function in periodontally healthy smoker subjects

Context:

Tobacco smoking is considered to be a major risk factor associated with periodontal disease. Smoking exerts a major effect on the protective elements of the immune response, resulting in an increase in the extent and severity of periodontal destruction.

Aims:

The aim of the present study was to assess viability and phagocytic function of neutrophils in circulating blood of the smokers and nonsmokers who are periodontally healthy.

Settings and Design:

Two hundred subjects in the mean range of 20–30 years of age were included in the study population. It was a retrospective study carried out for 6 months.

Materials and Methods:

Two hundred subjects were divided into four groups: 50 nonsmokers, 50 light smokers (<5 cigarettes/day), 50 moderate smokers (5–15 cigarettes/day), and 50 heavy smokers (>15 cigarettes/day). Full mouth plaque index, sulcus bleeding index, and probing depths were measured. Percentage viability of circulating neutrophils and average number of phagocytosed Candida albicans were recorded.

Statistical Analysis Used:

Means and standard deviations were calculated from data obtained within the groups. Comparison between the smokers and nonsmokers was performed by Kruskal–Wallis ANOVA analysis. Comparison between smoker groups was performed using Mann–Whitney–Wilcoxon test.

Results:

Percentage viability of neutrophils was significantly less in heavy smokers (66.9 ± 4.0), moderate (76.6 ± 4.2), light smokers (83.1 ± 2.5) as compared to nonsmokers (92.3 ± 2.6) (P < 0.01). The ability of neutrophils to phagocytose, i.e., mean particle number was significantly less in light smokers (3.5 ± 0.5), moderate smokers (2.3 ± 0.5), and heavy smokers (1.4 ± 0.5) compared to nonsmokers (4.9 ± 0.7) (P < 0.01) with evidence of dose-response effect.

Conclusions:

Smoking significantly affects neutrophils viability and phagocytic function in periodontally healthy population.

Exploring the versatility of gingiva-colored composite

Gingival recession has a diverse etiology. The consequences may include gingivitis, periodontitis, and hypersensitivity. Whereas the management can include surgical treatment options, sometimes a more conservative, yet still esthetic approach may be required. The use of gingiva-colored composites provides one such alternative and can be applied to varying presentations of the problem. While surgical treatment can be successful in re-creating favorable esthetic anatomy as well as achieving accurate tissue contour in cases when minor amounts of tissue are reconstructed, long-term results vary because of the vascularity and complexity of the interdental space. Factors such as cost, healing time, discomfort, and variable long-term results make surgery an unpopular choice. If tooth-colored restorative materials are utilized to restore cervical tooth exposure as a result of severe recession, the disproportionate appearance of the visible crown may give a dissatisfying result. Gingiva-colored composite provides dental practitioners with a versatile material that can be used to directly restore cervical defects caused by gingival recession, thus correcting the appearance of the gingival anatomy. It offers a treatment option that may increase patient satisfaction through the provision of a cost-effective, minimally invasive solution with highly esthetic results.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

OBJECTIVES

Cell-based therapies for bone augmentation after tooth loss and for the treatment of periodontal defects improve healing defects. Usually, osteogenic cells or stem cells are cultivated in 2D primary cultures, before they are combined with scaffold materials, even though this means a loss of the endogenous 3D microenvironment for the cells. Moreover, the use of single-cell suspensions for the inoculation of scaffolds or for the direct application into an area of interest has the disadvantages of low initial cell numbers and susceptibility to unwanted cellular distribution, respectively.

MATERIALS AND METHODS

We addressed the question whether an alternative to monolayer cultures, namely 3D microtissues, has the potential to improve osteogenic tissue engineering and its clinical outcome.

RESULTS

By contrast, to monolayer cultures, osteogenic differentiation of 3D microtissues is enhanced by mimicking in vivo conditions. It seems that the osteogenic differentiation in microtissues is enhanced by strong integrin-extracellular matrix interaction and by stronger autocrine BMP2 signaling. Moreover, microtissues are less prone to wash out by body fluids and allow the precise administration of large cell numbers.

CONCLUSION

Microtissue cultures have closer characteristics with cells in vivo and their enhanced osteogenic differentiation makes scaffold-free microtissues a promising concept in osteogenic tissue engineering.

CLINICAL RELEVANCE

Microtissues are particularly suitable for tissue engineering because they improve seeding efficiency of biomaterials by increasing the cell load of a scaffold. This results in accelerated osteogenic tissue formation and could contribute to earlier implant stability in mandibular bone augmentation.

Gingival recession: review and strategies in treatment of recession

One of the most common esthetic concerns associated with the periodontal tissues is gingival recession. Gingival recession is the exposure of root surfaces due to apical migration of the gingival tissue margins; gingival margin migrates apical to the cementoenamel junction. Although it rarely results in tooth loss, marginal tissue recession is associated with thermal and tactile sensitivity, esthetic complaints, and a tendency toward root caries. This paper reviews etiology, consequences, and the available surgical procedures for the coverage of exposed root surfaces, including three case reports.

Chairside quantitative immunochromatographic evaluation of salivary cotinine and its correlation with chronic periodontitis

BACKGROUND

Cigarette smoking is an established and modifiable risk factor for periodontitis. Periodontitis appears to be dose-dependent on smoking. The purpose of this study was to assess a reliable marker of tobacco smoke exposure (salivary cotinine) chairside and to confirm the quantitative association between smoking and chronic periodontitis.

MATERIALS AND METHODS

Saliva samples from 80 males, aged 30-60 years, with chronic periodontitis, were evaluated chairside using NicAlert™ cotinine test strips (NCTS). Patients were divided into two groups: A (cotinine negative) and B (cotinine positive). Plaque index (PI), Gingival index (GI), gingival bleeding index (GBI), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession (GR) were compared between the two groups and among the subjects of group B.

RESULTS

Comparison showed that the severity of PPD (P<0.001), CAL (P<0.001), and GR (P<0.001) was more in group B than in group A. Severity of all periodontal parameters increased with increased salivary cotinine among the subjects in group B.

CONCLUSION

Quantitative direct association can be established between salivary cotinine and the severity of periodontitis. Immunochromatography-based cotinine test strips are a relatively easy method for quantification of salivary cotinine chairside. Immediate and personalized feedback from a chairside test can improve compliance, quit rates, and ease reinforcing smoking cessation.

Scaffold-free microtissues: differences from monolayer cultures and their potential in bone tissue engineering

Objectives

The paper’s aim is to review dentin hypersensitivity (DHS), discussing pain mechanisms and aetiology.

Materials and methods

Literature was reviewed using search engines with MESH terms, DH pain mechanisms and aetiology (including abrasion, erosion and periodontal disease).

Results

The many hypotheses proposed for DHS attest to our lack of knowledge in understanding neurophysiologic mechanisms, the most widely accepted being the hydrodynamic theory. Dentin tubules must be patent from the oral environment to the pulp. Dentin exposure, usually at the cervical margin, is due to a variety of processes involving gingival recession or loss of enamel, predisposing factors being periodontal disease and treatment, limited alveolar bone, thin biotype, erosion and abrasion.

Conclusions

The current pain mechanism of DHS is thought to be the hydrodynamic theory. The initiation and progression of DHS are influenced by characteristics of the teeth and periodontium as well as the oral environment and external influences. Risk factors are numerous often acting synergistically and always influenced by individual susceptibility.

Clinical relevance

Whilst the pain mechanism of DHS is not well understood, clinicians need to be mindful of the aetiology and risk factors in order to manage patients’ pain and expectations and prevent further dentin exposure with subsequent sensitivity.

Periodontal status in smokers and nonsmokers: a clinical, microbiological, and histopathological study

A case-control study was done to assess the influence of smoking on clinical, microbiological, and histopathological parameters. Methods. Two hundred dentate male patients (100 smokers and 100 nonsmokers) ranging between 25 and 50 years were enrolled in the study. Periodontal parameters were recorded. Plaque samples were collected for microbial analysis for BANA test. Gingival biopsies were obtained from selected site for assessing histopathological changes. Results. Both groups showed almost similar plaque levels (P=0.258), but smokers had reduced gingival (0.62 ± 0.31) and bleeding indices (28.53 ± 17.52) and an increased calculus index (1.62 ± 0.36). Smokers had an increased probing depth of 4-7 mm (P=0.009) and overall increased CAL. No difference in microbiota was found between the two groups. Histopathologically smokers showed a decreased blood vessel density (8.84 ± 0.96) and inflammatory cells (52.00 ± 9.79). Conclusions. It is quite possible that many of the pathogenic mechanisms involved in tissue degradation in periodontitis in smokers could be quite different from those in nonsmokers.

Free gingival grafts: graft shrinkage and donor-site healing in smokers and non-smokers

BACKGROUND

This prospective clinical study aims to evaluate the influence of cigarette smoking on free gingival graft (FGG) healing, by assessing FGG dimensional changes and donor-site wound healing.

METHODS

Twelve non-smokers and 10 smokers treatment planned for FGG to augment keratinized tissue dimensions in the mandibular incisor area completed the study. All subjects received standardized FGG of same dimensions. Probing depth, gingival margin position, clinical attachment level, keratinized tissue (KT) width, gingival thickness, and FGG dimensions (width, length, and area) were assessed and recorded before surgery, and 7, 15, 30, 60, and 90 days postoperatively. The palatal donor area was evaluated for immediate bleeding and complete wound epithelialization. Differences between the two groups (smokers and non-smokers) were statistically analyzed.

RESULTS

FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in non-smokers and by 44%, 25%, and 58% in smokers (no significant differences between groups; P >0.05). Significant KT increases were observed in both non-smokers and smokers (5.4 and 4.8 mm, respectively). Donor-site immediate bleeding was significantly more prevalent in non-smokers (75%) compared to smokers (30%) (P = 0.04). At 15 days postoperatively, donor-site complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P <0.002).

CONCLUSION

Smoking alters FGG donor-site wound healing by reducing immediate bleeding incidence and by delaying epithelialization, although it does not have discernible effects on postoperative FGG dimensional changes.

Presence of Aggregatibacter actinomycetemcomitans in young individuals: a 16-year clinical and microbiological follow-up study

AIM

To look for clinical signs of periodontal disease in young adults who exhibited radiographic bone loss and detectable numbers of Aggregatibacter actinomycetemcomitans in their primary dentition.

MATERIAL AND METHODS

Periodontal status and radiographic bone loss were examined in each of the subjects 16 years after the baseline observations. Techniques for anaerobic and selective culture, and checkerboard, were used to detect periodontitis-associated bacterial species. The isolated A. actinomycetemcomitans strains were characterized by polymerase chain reaction.

RESULTS

Signs of localized attachment loss were found in three out of the 13 examined subjects. A. actinomycetemcomitans was recovered from six of these subjects and two of these samples were from sites with deepened probing depths and attachment loss. Among the isolated A. actinomycetemcomitans strains, serotypes a-c and e, but not d or f, were found. None of the isolated strains belonged to the highly leucotoxic JP2 clone, and one strain lacked genes for the cytolethal distending toxin.

CONCLUSIONS

This study indicates that the presence of A. actinomycetemcomitans and early bone loss in the primary dentition does not necessarily predispose the individual to periodontal attachment loss in the permanent dentition.

Assessment of the etiologic factors of gingival recession in a group of patients in northwest iran

BACKGROUND AND AIMS

Gingival recession (GR), a common problem in periodontium, is associated with various etiologic factors. There is controversy over the role and importance of these factors. The aim of this study was to evaluate the etiologic factors of GR in a group of subjects in Northwest Iran.

MATERIALS AND METHODS

In this case-control study, patients referring to a university clinic (123 patients with GR and 123 patients without GR) were evaluated. Patients were examined by an experienced periodontist. A checklist assessing the history of systemic disease, smoking, radiotherapy, orthodontic treatment, chemical and mechanical trauma, tooth-brushing method, type of occlusion, axial inclination of tooth, width and thickness of keratinized gingiva, presence of calculus, prosthesis, faulty restorations and food impaction, and frenum pull was completed for each patient. Chi-square test was used for data analysis.

RESULTS

Presence of calculus was significantly associated with GR in the evaluated patients (P = 0.000). Low width and thickness of keratinized gingiva, smoking and traumatic tooth brushing were other significant factors (P < 0.05). The type of occlusion, axial inclination of teeth, existence of prosthesis, high frenal attachment, radiotherapy, systemic diseases and chemical trauma were not significantly associated with GR in the evaluated patients (P > 0.05).

CONCLUSION

Supra- and sub-gingival calculus, inadequate width and thickness of keratinized tissue, and incorrect tooth brushing techniques are most important etiologic factors of GR. Oral hygiene instructions including correct tooth brushing techniques as well as scaling and root planing with periodic recalls can play a significant role in prevention of GR.

Atherogenic lipoprotein parameters in patients with aggressive periodontitis

BACKGROUND AND OBJECTIVE

Certain types of chronic infection increase the plasma level of very-low-density lipoprotein, leading to formation of the particularly atherogenic low-density lipoprotein subclass, small dense low-density lipoprotein. In the present study, we examined whether aggressive forms of periodontitis are associated with these atherogenic lipoprotein parameters.

MATERIAL AND METHODS

Twelve healthy control subjects without periodontitis, 12 subjects with localized aggressive periodontitis and 12 subjects with generalized aggressive periodontitis were studied. Lipoprotein subclass levels were determined using nuclear magnetic resonance methodology.

RESULTS

Healthy control subjects, localized aggressive periodontitis subjects and generalized aggressive periodontitis subjects had progressively higher plasma levels of very-low-density lipoprotein and progressively smaller average low-density lipoprotein size (p < 0.05, one-way analysis of variance). In pairwise comparisons, differences were only significant between healthy controls and generalized aggressive periodontitis subjects (p < 0.05, Tukey's post test). After adjustment for body mass index, the mean periodontal pocket depth correlated positively with plasma very-low-density lipoprotein levels (p = 0.047). Very-low-density lipoprotein concentrations correlated positively with small dense low-density lipoprotein levels and negatively with average low-density lipoprotein size. Prevalence of the atherogenic lipoprotein pattern-B in healthy controls, localized aggressive periodontitis subjects and generalized aggressive periodontitis subjects was 8.3%, 33.3% and 66.6%, respectively.

CONCLUSION

These results indicate that periodontal infection is associated with elevated plasma levels of atherogenic lipoprotein species. This association may account for the increased risk of periodontitis patients for cardiovascular disease.

The challenge of implant therapy in the posterior maxilla: providing a rationale for the use of short implants

Rehabilitating patients with a resorbed maxilla presents several challenges when the desired treatment plan involves the placement of endosseous implants. Correct diagnosis requires knowledge on jaw healing patterns, systemic effects, and the impact of bone quality changes on implant success rates. Appropriate treatment planning requires an in-depth understanding of the materials and methods available to the contemporary implant surgeon. The clinician must be able to persist on evidence-based techniques and adhere to those proven methods. Successful surgical placement requires correct use of the available armamentarium and acceptance of the limitations that implant dentistry still presents. Especially challenging is the implant treatment of maxillary molars due to the plethora of complicating factors such as limited bone availability, interarch space challenges, sinus problems, etc. These are just a few of the factors that may lead us to placement of short implants in these sites. An extensive review of the literature that is available for short implants (implants < 10 mm in length) indicates that although they are commonly used in areas of the mouth under increased stress (posterior region), their success rates mimic those of longer implants when careful case selection criteria have been used. The available studies and case-series offer a valid rationale for placement of short implants so long as one understands the limitations, indications, risk factors, and limited studies that actually follow-up success rates of short implants for over 5 years. This review of the literature will provide the reader an in-depth view of the evidence in using short implants as an alternative treatment modality for the maxillary molar region.

Coronally Positioned Flap for Root Coverage in Smokers and Non-Smokers: Stability of Outcomes Between 6 Months and 2 Years

BACKGROUND

Smoking adversely affects the short-term outcomes of coronally positioned flap (CPF) root coverage procedures, but the long-term stability of this procedure in smokers has not been studied. The objective of this study was to evaluate the effect of smoking on the long-term outcomes of CPF in recession treatment.

METHODS

CPF was used to treat a Miller Class I defect in a maxillary canine or premolar in 10 current smokers (> or =10 cigarettes daily for > or =5 years) and 10 non-smokers (never smokers). At baseline and 6, 12, and 24 months, clinical parameters, including probing depth (PD), clinical attachment level (CAL), recession depth (RD), and width of keratinized tissue (KT), were determined.

RESULTS

Intragroup analysis showed that CPF failed to maintain the gingival margin at the initially achieved position. RD significantly increased in smokers (from 0.84 +/- 0.49 to 1.28 +/- 0.58 mm) and in non-smokers (from 0.22 +/- 0.29 to 0.50 +/- 0.41 mm) between 6 and 24 months. Further analysis showed that 50% of smokers and 10% of non-smokers lost between 0.5 and 1.0 mm of root coverage in the same period. Intergroup analysis showed that smokers had significantly greater residual recession (P = 0.001) at 24 months. Both smokers and non-smokers lost CAL and experienced decreases in KT.

CONCLUSIONS

The long-term stability of CPF outcomes is less than desirable, particularly in smokers. Two years after a CPF procedure, smokers have significantly greater residual recession compared to non-smokers both statistically and clinically.

Effect of smoking on crevicular polymorphonuclear neutrophil function in periodontally healthy subjects

BACKGROUND

Polymorphonuclear neutrophils (PMNs) represent the first line of cellular defences in the gingival crevice. Smoking, as probably the most important environmental risk factor for periodontitis, has been shown to adversely affect many neutrophil functions.

OBJECTIVE

The aim of this study was to investigate the influence of smoking on PMN numbers and function in periodontally healthy smokers and non-smokers.

METHODS

Sixty subjects were recruited: 15 non-smokers, 15 light smokers (< 5 cigarettes/day), 15 moderate smokers (5-15 cigarettes/day) and 15 heavy smokers (> 15 cigarettes/day). Full mouth plaque index, sulcus bleeding index and probing depths were measured. Crevicular washings were obtained from all subjects to harvest PMNs. Numbers of PMNs, percentage viability, and percentage phagocytosis of opsonized Candida albicans were recorded.

RESULTS

Mean plaque scores and probing depths were (non-significantly) increased in smokers compared to non-smokers. Mean sulcus bleeding index scores were significantly lower in moderate (0.10 +/- 0.10) and heavy (0.07 +/- 0.11) smokers compared to non-smokers (0.14 +/- 0.13) (p < 0.05). Compared to non-smokers (1.73 +/- 1.08 x 10(6)/ml), the numbers of PMNs were higher in light (1.98 +/- 0.96 x 10(6)/ml) and moderate (2.03 +/- 1.43 x 10(6)/ml) smokers and were lower in heavy smokers (1.68 +/- 1.18 x 10(6)/ml), though there were no significant differences in PMN counts between the groups (p > 0.05). Percentage viability of PMNs was significantly lower in light (77.6 +/- 7.8%), moderate (76.5 +/- 8.2%) and heavy (75.0 +/- 6.5%) smokers compared to non-smokers (85.5 +/- 6.0%) (p < 0.05). Furthermore, the ability of PMNs to phagocytose was significantly impaired in light (58.3 +/- 4.1%), moderate (51.9 +/- 2.33%) and heavy (40.9 +/- 3.5%) smokers compared to non-smokers (74.1 +/- 4.1%) (p < 0.05), with evidence of a dose-response effect.

CONCLUSION

Cigarette smoking adversely affected PMN viability and function in this periodontally healthy population.

Coronally Positioned Flap for Root Coverage: Poorer Outcomes in Smokers

BACKGROUND

Gingival recession is significantly more common among smokers, while the relative outcome of various root coverage procedures in smokers, compared to non-smokers, is debatable. The objective of this study was to evaluate the influence of cigarette smoking on the outcome of coronally positioned flap (CPF) in the treatment of Miller Class I gingival recession defects.

METHODS

Ten current smokers (> or = 10 cigarettes daily for at least 5 years) and 10 non-smokers (never smokers), each with one 2- to 3-mm Miller Class I recession defect in an upper canine or bicuspid, were treated with CPF. At baseline and 6 months, clinical parameters, probing depth (PD), clinical attachment level (CAL), recession depth (RD), and apico-coronal width of keratinized tissue (KT) were determined.

RESULTS

Intragroup analysis showed that CPF was able to reduce RD and improve CAL in both groups (P <0.05). Intergroup analysis demonstrated that smokers presented greater residual RD at 6 months and lower percentage of root coverage (69.3% versus 91.3%; P <0.05). No smokers obtained complete root coverage compared to 50% of non-smokers (P <0.05).

CONCLUSIONS

Within the limits of the present study, it can be concluded that CPF provides benefits for both smokers and non-smokers in terms of root coverage of shallow Miller Class I recession defects. However, cigarette smoking negatively impacts the clinical outcomes, specifically residual recession, percent root coverage, and frequency of complete root coverage.

Smoking, periodontal disease and the role of the dental profession

Epidemiological investigations support a firm relationship between smoking and periodontal disease. The likely benefits of smoking cessation programmes are considerable for periodontal disease, cancers and nearly all chronic systemic diseases. The mechanisms by which smoking may influence the development and progression of periodontal disease are as yet unclear, but may include changes in the vasculature, the immune and inflammatory systems, tissue oxygenation and the healing processes. Unfortunately, although dental professionals have more opportunities to encourage smokers to quit (most people visit their dentist more frequently than their doctor), dentists claim that they are not well informed on this subject. The purpose of this review is to describe the evidence for a link between smoking and periodontal disease, the possible pathology induced by smoking on the periodontal tissues and its impact on therapy, and to outline the smoking cessation techniques that are currently available.

Gingival Recession: Epidemiology and Risk Indicators in a Representative Urban Brazilian Population

BACKGROUND

Gingival recession is a common manifestation of periodontal disease, but it is also associated with other risk factors. A few studies have investigated the epidemiology and risk factors of this condition. This study describes the epidemiology of gingival recession in a representative, urban Brazilian population and assesses various risk indicators.

METHODS

A representative sample of 1,460 subjects was selected using a multi-stage, probability, cluster sampling strategy. The subjects were interviewed using a structured questionnaire and had a full-mouth clinical examination in a mobile examination center.

RESULTS

More than half (51.6%) and 22.0% of the individuals and 17.0% and 5.8% of teeth per individual showed gingival recession > or = 3 mm and > or = 5 mm, respectively. The prevalence, extent, and severity of recession correlated with age. Recession showed a nonlinear relationship with age, with 25 to 50 year olds showing the highest level of recession. Males aged > or = 30 years showed significantly higher prevalence and extent of gingival recession than females. The percentage of teeth with recession was significantly higher in the lower socioeconomic groups irrespective of age, and in subjects > or = 30 years of age with irregular dental care than in subjects with regular care. Using a multivariable model, cigarette smoking and presence of supragingival calculus were the factors most significantly associated with localized and generalized recession, whereas gender, dental visits, and socioeconomic status were not significant risk indicators.

CONCLUSIONS

The high level of gingival recession in this Brazilian population may be primarily related to destructive periodontal disease and is significantly associated with a high level of supragingival dental calculus and cigarette smoking. Population-based programs aimed at the prevention of periodontal diseases may reduce the prevalence of severe gingival recession in this and similar populations.

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.

Quantitative evaluation of the vasculature and fibronectin localization in gingival connective tissue of smokers and non-smokers

BACKGROUND

It has been shown that tobacco is a significant risk factor for periodontal disease. The reason for decreased gingival bleeding in smokers is not known. The aim of the present study was to demonstrate the localization of fibronectin in the extracellular matrix of the inflamed gingiva of smokers and non-smokers and to evaluate the chronic effect of smoking on the gingival microvessel number (NVES) and vascular surface density (VSD).

METHODS

Seventy-four (74) adult patients with periodontitis were included in this investigation. Of these patients, 38 were smokers and 36 were non-smokers. Probing depths (PD), papillary bleeding index (PBI) of both groups, and the smoking habits of the smokers were recorded. Biopsy specimens obtained during periodontal surgery were prepared to evaluate fibronectin distribution and to quantitate the vasculature.

RESULTS

The mean VSD values of smokers and non-smokers were 6.721 +/- 1.845 and 5.721 +/- 3.118 (mean +/- SD), and the mean NVES of smokers and non-smokers was 31.582 +/- 11.810 and 30.145 +/- 15.442, respectively. The difference between the mean PD and PBI values of the 2 groups was not statistically significant. The location of the biopsy specimen, whether in the anterior or posterior area of the mouth, did not lead to any statistically significant differences between the groups. In addition, the number of years smoked and the tobacco brand used did not result in statistically significant differences. The most intense staining of fibronectin was observed beneath the epithelium around the blood vessels of the uppermost region of the connective tissue, showing a fibrillar and diffuse distribution; however, there was no significant difference between smokers and non-smokers.

CONCLUSION

The results of the present study indicate that smoking does not affect the vascular surface density, number of vessels per mm2 stroma, or fibronectin distribution in subepithelial gingival connective tissue.

Effects of smoking on periodontal tissues

BACKGROUND/AIMS

Most studies about the association between tobacco and periodontal disease have shown that tobacco negatively affects periodontal tissues, although some authors have failed to demonstrate such association. Very few studies have tried to find out whether the effect of tobacco on periodontal tissues was similar for women and men. The aims of this investigation were to confirm the possible relationship between tobacco consumption and periodontitis, to study the correlation between intensity of smoking and disease severity, and to investigate any differences between genders related to the effects of tobacco consumption in periodontal health.

MATERIAL AND METHODS

In this case-control study, 240 dental patients were selected according to previously defined criteria and were divided in two groups according to their periodontal status. Patients with established periodontitis constituted the case group. The remaining patients constituted the control group. Smoking status, probing depth, gingival recession, clinical attachment level, tooth mobility, periodontal bleeding index and plaque index were determined for each participant. Generated data were processed for statistical analysis using multiple comparisons, covariance analysis and logistic regression analysis.

RESULTS

Logistic regression analysis showed that smokers had 2.7 times and former smokers 2.3 times greater probabilities to have established periodontal disease than non-smokers, independent of age, sex and plaque index. Among cases, probing depth, gingival recession and clinical attachment level were greater in smokers than in former smokers or non-smokers, whereas plaque index did not show differences. Bleeding on probing was less evident in smokers than in non-smokers. There was a dose-effect relationship between cigarette consumption and the probability of having advanced periodontal disease. The association between tobacco smoking and periodontal disease was more evident after 10 years of smoking, independent of age, gender and plaque index. Finally, it was observed that tobacco affected periodontal tissues more severely in men than in women.

CONCLUSIONS

Smoking is a risk factor strongly associated with periodontitis. The effects of smoking on periodontal tissues depend on the number of cigarettes smoked daily and the duration of the habit. The effect of tobacco on periodontal tissues seems to be more pronounced in men than in women.

Dentine hypersensitivity in Jordanian dental attenders. A case control study

BACKGROUND

Dentine hypersensitivity (DH) is a common painful condition which affects a significant proportion of the adult population.

AIMS

To investigate the relationship between DH and factors such as gingival recession, oral hygiene practices and smoking in Jordanian adults.

METHODS

A case control study was performed on dental attenders in the Irbid region of Jordan. A DH group was composed of 126 subjects with a history of sensitivity who also reported discomfort of least two non-carious teeth after an air blast. Each case quantified their personal perception of the severity of pain associated with sensitivity by making a mark on a visual analogue scale The presence and extent of gingival recession was measured on plaster models. An age- and sex-matched control group of 134 subjects who complained of no discomfort was recruited.

RESULTS

Independent predictors of DH in multivariate analysis were whether an individual had noticed their teeth getting longer (P = 0.01), infrequent (less than once per day) toothbrushing (P = 0.001), smoking (P = 0.0006) and the presence of recession >or= 3 mm (P = 0.0005). Within the multivariate analysis, the odds ratio for recession of >or= 3 mm to be associated with sensitivity was 2.80 (confidence interval 1.57-4.99). The number of teeth which responded to an airblast was significantly higher in males (P = 0.0004), smokers (P < 0.0001) and those with recession of >or= 3 mm (P < 0.0001).

CONCLUSIONS

It is concluded that DH is associated with gingival recession in Jordanian dental attenders. However, the relationship is complex. Infrequent toothbrushing and smoking, which was almost exclusively a male habit, were also factors associated with DH.

Longitudinal association between plaque and gingival bleeding in smokers and non-smokers

BACKGROUND/AIMS

Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site-specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non-smoking young adults.

METHODS

65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non-smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site-specific analyses considering the correlated structure of data were performed.

RESULTS

At the outset and after 6 months, smokers had significantly more supragingival plaque than non-smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site-by-site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non-smokers (median Mantel-Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non-bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking.

CONCLUSIONS

In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non-bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.

Gingival recession in smokers and non-smokers with minimal periodontal disease

BACKGROUND/AIMS

Smoking is a major risk factor for destructive periodontal disease. There is limited information with regard to effects of smoking in subjects with minimal periodontal destruction. The aim of the present investigation was to assess the development of gingival recession in young adult smokers and non-smokers.

METHODS

61 systemically healthy young adults, 19 to 30 years of age completed the final examination. 30 volunteers smoked at least 20 cigarettes per day, whereas 31 subjects were non-smokers. Clinical periodontal conditions were assessed 4x within a time period of 6 months. Site-specific analyses considering the correlated structure of data were performed.

RESULTS

At the outset, 50% of subjects presented with gingival recession at 1 or more sites. There was no significant difference in the prevalence of gingival recession between non-smokers and smokers. Severe recession in excess of 2 mm affected about 23% non-smokers but only 7% smokers. Some further gingival recession developed during the 6-month observation period. In a multivariate logistic regression analysis, the risk for recession development appeared not to be influenced by smoking status after adjusting for periodontal probing depth, recession at baseline, tooth brushing frequency, gender, jaw, tooth type and site.

CONCLUSIONS

Present data did not support the hypothesis that smokers are at an increased risk for the development of gingival recession.

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.

Gingival recession-its significance and management

OBJECTIVES

To review the prevalence and current concepts of the mechanisms and aetiology of gingival recession and present the principles of assessment and management of the patient with gingival recession.

DATA AND SOURCES

The literature was searched for review and original research papers relating prevalence, mechanisms, aetiology, assessment, and treatment of gingival recession using Medline and manual tracing of references cited in key papers otherwise not elicited.

STUDY SELECTION

Studies with gingival recession as focus and pertinent to key aspects of review.

RESULTS

Gingival recession is a common condition and its extent and prevalence increase with age. Many factors including trauma and periodontal disease have a role in its aetiology. The patient may develop signs and symptoms including pain from exposed dentine, root caries and aesthetic concerns. Management of gingival recession requires thorough patient assessment, identification of aetiological factors, and recording and monitoring of the extent and severity of the condition. Treatment should be directed at prevention of further progression and the control of symptoms and disease. The patient's aesthetic concerns should be appreciated. Surgical treatment of recession may be indicated to cover exposed root surfaces. Many surgical techniques have been described with varied reported clinical effectiveness.

CONCLUSIONS

Gingival recession should be thoroughly assessed and evaluated in order to offer the most suitable management.

Validation of smoking status in clinical research into inflammatory periodontal disease

BACKGROUND

Tobacco smoking is an accepted risk factor for periodontal disease. Most studies in the periodontal literature rely on reported smoking habits which can be unreliable. This review specifically addresses this problem.

METHODS

Methods of assessing tobacco smoke exposure, variation in individual smoking habits, classification of former/ex-smokers, and validation of abstinence in smoking cessation studies receive attention.

DISCUSSION

Additionally, clinical studies that have examined periodontal health in subjects with validated smoking status are discussed.

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.

Smoking and periodontal disease

Numerous investigations of the relationship between smoking and periodontal disease have been performed over the last 15 years, and there now exists a substantial body of literature upon which this current review is based. From both cross-sectional and longitudinal studies, there appears to be strong epidemiological evidence that smoking confers a considerably increased risk of periodontal disease. This evidence is further supported by the data emanating from patients who stop smoking. These patients have levels of risk similar to those of non-smokers. Numerous studies of the potential mechanisms whereby smoking tobacco may predispose to periodontal disease have been conducted, and it appears that smoking may affect the vasculature, the humoral immune system, and the cellular immune and inflammatory systems, and have effects throughout the cytokine and adhesion molecule network. The aim of this review is to consider the evidence for the association between smoking and periodontal diseases and to highlight the biological mechanisms whereby smoking may affect the periodontium.

The prevalence of pathogenic periodontal microflora in healthy young adult smokers

BACKGROUND

Smoking is a major risk factor in periodontitis, although the mechanisms of its effects are not well understood. The overall goal of this clinical study was to determine if smoking enhances the colonization of the oral cavity by pathogenic bacteria in a periodontitis-free population. The prevalence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum, Campylobacter rectus, Eikenella corrodens, Bacteroides forsythus, and Treponema denticola was investigated in 25 smokers and 25 non-smokers by using DNA probes.

METHODS

The subjects were 21 to 35 years of age with a healthy periodontium or slight gingivitis and were systemically healthy. The test group included subjects who had a minimum of a 1.5 pack-year history of smoking, while the control subjects never smoked. Subgingival plaque samples were taken by paper point following the assessment of multiple clinical parameters.

RESULTS

This investigation showed: 1) no statistically significant differences were noted in any clinical parameter measured between the groups; 2) of the 8 subjects who were infected by at least 1 tested pathogen, seven were smokers (P= 0.02); 3) infected smokers had a 15.7+/-3.5 pack-year history and smoked a mean of 27+/-5 cigarettes/day versus 4.4+/-0.8 pack years and 15+/-1 cigarettes/day for the non-infected smokers (P = 0.0001 and P = 0.004); and 4) smokers were 18 times more likely to exhibit the presence of pathogens than non-smokers.

CONCLUSIONS

These data indicate that the prevalence of colonization of the sulcus by pathogenic bacterial species in periodontitis-free individuals is related to the quantity and duration of cigarette smoking.