Periodontal Disease In Smokers Research Articles

Assessing the relationship between Tooth Heavy Metal Deposition and Periodontal Disease in Smokers and Non-Smokers

Objective: Heavy metals threaten life by accumulating in the body via various sources as water,air and foods. Smoking is one of the important factors that causes this problem. Despite there is an abundant number of studies showing the detrimental effects of smoking on periodontal health, the mechanisms that cause these harmful effects is not clearly known yet. The main aim of our study is to discover whether heavy metal deposition on the tooth surface is related to the disease-causing potential of smoking. Materials and Method: Total of 80 individuals consist of 43 women and 37 men were included in this study. The participants were divided into 4 groups of 20 individuals each according to the results from clinical examination and anamnesis. Plaque index, gingival index, pocket depth, bleeding on probing and clinical attachment level were recorded clinically. The teeth indicated for extraction were collected. Cd, Pb, Ni, Cr and Fe depositions on teeth were measured by ICP-OES device. Kolmogorov-Smirnov, Student T, Mann Whitney U, One way ANOVA, Kruskal Wallis, Ki-Kare, Pearson, and Spearman tests were performed for the statistical analysis. Results: Smoking increases the accumulation of heavy metals such as Cd, Ni, Cr, and Pb. The Pb level was higher in both the smoking group and the periodontitis group, compared with the control group. Fe levels were found high in the non-smoking healthy group. Cr and Fe levels were found higher in women while Cd level was higher in men. Positive correlations were found between Pb and plaque index, gingival index, pocket depth and bleeding on probing; and also between Ni and plaque index. ( p=0.000, p=0.009, p=0.025, p=0.011, p=0.019) Conclusion: In conclusion, our study explored the connection between heavy metal deposition on tooth surfaces and the disease-causing potential of smoking. Smoking has been identified as a significant factor in the increased accumulation of heavy metals, including Cd, Ni, Cr, and Pb. The higher Pb levels seen in both the smoking and periodontitis groups, compared to the control group, suggest a potential link between Pb accumulation and periodontal health. Additionally, differences based on gender were observed, with women showing higher Cr and Fe levels, while Cd levels were more elevated in men. The positive correlations between Pb and various periodontal indices, along with the correlation between Ni and plaque index, shed light on the potential influence of heavy metal deposition on periodontal health. While our findings enhance our understanding of the interplay between smoking, heavy metal deposition, and oral health, further research is needed to fully comprehend the underlying mechanisms. Such insights could lead to interventions aimed at minimizing the adverse effects of heavy metal accumulation on oral health.

Assessment and Correlation of Salivary Ca, Mg, and pH in Smokers and Non-Smokers with Generalized Chronic Periodontitis.

Background and Objectives: Diagnostic evaluation with the aid of biomarkers has reached newer heights to assess disease activity. Salivary calcium, magnesium, and pH are one of the biochemical parameters which can be helpful in assessing the progression of periodontal disease. Smokers are at topnotch threat for having oral diseases, predominantly periodontal diseases. The aim of this study was to assess the salivary calcium, magnesium, and pH levels in smokers compared with non-smokers with chronic periodontitis. Materials and Methods: The current study was conducted on 210 individuals affected with generalized chronic periodontitis, with the age group between 25 and 55 years. Based on their smoking habit, an equal number of patients were categorized into two groups; namely, group I consisted of non-smokers and group II consisted of smokers. The clinical parameters that were measured included Plaque Index (PI), Gingival Index (GI), Probing Pocket Depth (PPD), and Clinical Attachment Loss (CAL). The biochemical variables that were evaluated in the current study included salivary calcium, magnesium, and pH using an AVL9180 electrolyte analyzer (Roche, Germany). The gathered data were analyzed with an unpaired t test was using SPSS 20.0. Results: A statistically significant higher PPD (p < 0.01), CAL (p < 0.05), and salivary calcium levels (p < 0.001) were observed in the smokers' compared with their non-smoking counterparts. Among the biochemical parameters, calcium showed a significantly (p < 0.001) higher level in smokers (5.79 ± 1.76) in contrast to non-smokers (3.87 ± 1.03). Additionally, a significant negative correlation (p < 0.05) between calcium and PPD was observed in non-smokers, whereas a non-significant inverse relation (p > 0.05) was seen in smokers. Conclusions: The present study indicates that the salivary calcium level can be a potential biochemical parameter to assess the progression of periodontal disease in smokers and non-smokers. Within the limitations of the current study, the salivary biomarkers appear to have an essential role in the identification and indication of the status of periodontal diseases.

Smoking and periodontal disease severity, probing pocket depth and bleeding on probing

Background and Objective: The purpose of the present study was to investigate whether severity of disease process differed between smokers and nonsmokers and to study characteristic differences in pattern of periodontal disease in smokers in a group of known chronic periodontitis patients.Materials and Methods: The study included 150 individuals in an age range of 35–60 years wherein periodontal evaluation including probing pocket depth (PPD) and bleeding on probing (BOP) was performed using Williams's periodontal probe. For both the parameters (PPD and BOP), mean scores were calculated from different quadrants of the oral cavity while the results obtained were subjected to statistical analysis.Results: The mean percentage of sites that presented with BOP was higher for nonsmokers compared with smokers. Furthermore, smokers had more number of pockets and pockets with increased PPD. On analysis of buccal and lingual sides, also, it was observed that smokers had more number of sites with PPD of ≥5 mm than nonsmokers.Conclusion: From the results, it could be concluded that smoking is associated with more severe periodontal attachment and bone loss and deeper periodontal pockets.

Salivary free hemoglobin and lactate dehydrogenase as biomarkers for periodontal disease in smokers.

The purpose of the present study was to compare levels of the biomarkers lactate dehydrogenase (LDH) and free hemoglobin in the saliva of different groups of smokers for early diagnosis of periodontitis and their clinical relevance for use as a screening tool. Eighty cigarette smokers were divided into light (< 10 cigarettes/day) moderate (10 to 19 cigarettes/day) and heavy (≥ 20 cigarettes/day) smokers. Stimulated saliva samples were obtained by the expectoration method and evaluated for LDH and free hemoglobin levels. Clinical parameters were recorded after saliva collection using the modified Community Periodontal Index (CPI). Salivary free hemoglobin level was higher in light smokers compared to heavy smokers (mean 363.89 ± 295 µmol/L in light vs mean 79.55 ± 37.41 µmol/L in heavy, P = .001) and positively correlated with CPI score. There was no control group to prevent bias with free hemoglobin results in healthy individuals. Salivary LDH levels were higher in light smokers (411.24 ± 18.62 IU/L) compared to heavy smokers (313.26 ± 23.98 IU/L). However, a significant correlation between free hemoglobin, LDH, and CPI score (clinical parameters) was seen between the three groups of smokers (P < .01). Within the limitations of this observational study, there was a progressive reduction in free hemoglobin and LDH levels from light smokers to heavy smokers. However, the severity of periodontal disease conditions increased as the severity of smoking habit increased.

Severity of periodontal disease in smokers

ABSTRACT Introduction: The objective of the present study was to evaluate the severity of periodontal disease in a population of adults with gingival or periodontal disease who assist at the periodontics service of the Faculty of Dentistry of the National University of Rosario. Methods: The study evaluated the periodontal conditions in smokers and non smokers. The sample consisted of 400 individuals: 268 non-smokers (NS) and 132 active smokers (S). The classification of gingival and periodontal diseases was based on the criteria of the American Association of Periodontology (2017), recruiting patients with diagnoses of gingivitis, stage II, III and IV of periodontitis. Each one of these pathologies was related to the different age groups to assess the risks of clinical attachment loss. The periodontal variables studied were: probing depth (PD), attachment level (AL), number of teeth present (TP), oral hygiene index (OHI), tooth mobility (M) and bleeding on probing (BOP). A multivariate analysis was also carried out to determine the degree of responsibility of the different risk factors, such as age, gender, being a smoker and the years of that habit duration, in relation to the extent and severity of the periodontal disease. Results: Twenty-nine per cent of women and fourty percent of men were smokers. The periodontal variables in the groups of S and NS behaved in the following way: PD for NS 4.19 (± 0.67), and for S 5.37 (±0.64) ; AL for NS 3.43 (±1.28), and for S 4.30 (±1.43); BOP for NS 41 (±23.76), and for S 43.28 (±23.56); OHI for NS 1.75 (±0.61), and for S 1.82 (±0.53); TP for NS 21.38 (±6.13), and for S 21.20 (±6.60) ; and M for NS 1.65 (±0.74), and for S 2.10 (±0.65). Conclusion: Stage II and III of periodontitis behaved similarly in both groups, but when we analysed stage IV of periodontitis, it was more prevalent in smokers, regardless of their age. When the population was stratified according to the age of the individuals, stage IV of periodontitis was more prevalent in older people who did not smoke and in young individuals under 40 who had the habit. PD, CAL and M periodontal variables were found with more severe values in the S group.

The Human Salivary Antimicrobial Peptide Profile according to the Oral Microbiota in Health, Periodontitis and Smoking

Antimicrobial peptides (AMPs) are a diverse family of peptides that defend the mucosal surfaces of the oral cavity and other locations. Many AMPs have multiple functions and properties that influence aspects of innate defense and colonization by microorganisms. The human oral cavity is home to the second-most diverse microbiome, and the health of the mouth is influenced by the presence of these bacteria as well as by extrinsic factors such as periodontitis and smoking. This study hypothesized that the AMP profile is different in the presence of extrinsic factors and that this would also be reflected in the bacteria present. The AMP profile was analyzed by quantitative selected-reaction-monitoring mass spectrometry analysis and 40 bacterial species were quantified by DNA-DNA hybridization in saliva donated by 41 individuals. Periodontal status was assessed through dental examination and smoking status through medical charting. Periodontal health (in nonsmokers) was associated with a higher abundance of ribonuclease 7, protachykinin 1, β-defensin 128, lipocalin 1, bactericidal permeability-increasing protein fold-containing family B member 3, and bone-marrow proteoglycan. Nonsmoking periodontal disease was associated with an abundance of neutrophil defensin 1 and cathelicidin. However, 7 AMPs were overabundant in periodontal disease in smokers: adrenomedullin, eosinophil peroxidase, 3 different histones, myeloperoxidase, and neutrophil defensin 1. There were no differentially abundant AMPs in smokers versus nonsmokers with periodontal health. Correlation network inference of healthy nonsmokers, healthy smokers, nonsmoking periodontitis, or smoking periodontitis donors demonstrated very different networks growing in complexity with increasing numbers of stressors. The study highlights the importance of the interaction between the oral cavity and its resident microbiota and how this may be influenced by periodontal disease and smoking.

Influence of Smoking on Interleukin-34 Levels in Gingival Crevicular Fluid and Plasma in Periodontal Health and Disease: A Clinico-biochemical Study.

Interleukin-34 (IL-34), an alternative ligand for macrophage colony-stimulating factor receptor, plays an important role in osteoclastogenesis. The aim of this study was to analyze the effect of smoking on IL-34 levels in gingival crevicular fluid (GCF) and plasma in individuals with healthy periodontium and chronic generalized periodontitis (CP). A total of 60 individuals ranging in age from 25 to 55 years were enrolled in the study. The participants were divided into 4 groups: Group A, 30 samples (15 GCF and 15 plasma) obtained from 15 non-smokers with healthy periodontium; Group B, 30 samples (15 GCF and 15 plasma) from 15 smokers with healthy periodontium; Group C, 30 samples (15 GCF and 15 plasma) from 15 non-smokers with CP; and Group D, 30 samples (15 GCF and 15 plasma) from 15 smokers with CP. The Gingival Index and probing depth scores, together with the Clinical Attachment Level, were assessed in each group as clinical periodontal parameters. Levels of IL-34 in GCF and plasma were quantified using enzyme linked immunosorbent assay. The results showed that the mean IL-34 concentrations in GCF and plasma were highest in Group D, followed by Group C, Group B, and Group A, and the difference among them was statistically significant (p<0.05). The relatively elevated IL-34 levels observed here in smokers with CP suggest that this cytokine offers a potential inflammatory marker of periodontal disease in smokers.

Commentary: Targeting Underlying Biologic Mechanisms in Selecting Adjunctive Therapies to Improve Periodontal Treatment in Smokers: A Commentary.

Despite well-established evidence that cigarette smoking is the largest modifiable risk factor for periodontal disease and has many deleterious health effects, treatment of periodontal disease in smokers remains a challenge of periodontal therapy. A recent meta-analysis revealed that adjunctive use of local delivery of antimicrobials, but not systemic antibiotic usage, with non-surgical periodontal therapy resulted in improvement in clinical periodontal parameters. Further evaluation of the current literature reveals that host modulation therapy may also result in clinical benefit in smokers. These findings may be tied to the underlying pathophysiology of periodontal disease progression in smokers and suggest that focused therapies that target known mechanisms of action are critical to the success of proposed treatments.

The influence of KIR gene presence/absence polymorphisms on the development of periodontal disease in smokers and non-smokers.

IntroductionPeriodontal diseases are highly prevalent inflammatory, multifactorial diseases. Smoking is one of the most important environmental risk factors for the development and severity of periodontal disease. Killer cell immunoglobulin-like receptors (KIRs) are members of the immunoglobulin (Ig) superfamily and play an essential role in the regulation of NK cell activity, allowing natural killer (NK) cells to sense and respond to human leukocyte antigen (HLA) class I. The aim of this study was to evaluate the influence of KIR gene presence/absence polymorphisms on the development of periodontal disease in smokers and non-smokers.Material and methodsThis study enrolled 400 Caucasian subjects (age range 25-69 years) from the West Pomeranian region of Poland. The subjects were categorized into four subgroups (smoking and non-smoking patients with periodontal disease; smoking and non-smoking subjects without periodontal disease – control subjects).ResultsThe differences of KIR gene frequencies between non-smoking patients and non-smoking control subjects as well as smoking patients and control subjects were not statistically significant. In multivariate regression analysis advanced age of patients and smoking were independent factors associated with increased frequency of periodontal disease.ConclusionsThe results of this study suggest that the main factor associated with increased risk of periodontal disease is smoking, whereas KIR presence/absence polymorphism is not a significant factor involved in the pathogenesis of periodontal disease.

Association between anxiety, obesity and periodontal disease in smokers and non-smokers: A cross-sectional study.

Background. Psychological stress is known to be a relevant risk factor for many inflammatory conditions, including periodontal disease. A few studies have probed the relationship between obesity and periodontal disease. Therefore this cross-sectional study was aimed to examine the relationship between psychological stress and obesity and periodontal disease in smokers and non-smokers.Methods. The participants included 90 patients, equally divided into three groups of non-smokers and periodontally healthy, non-smokers and smokers with untreated moderate-to-severe chronic periodontitis. Socioeconomic data, psychosocial measurements, physical parameters and clinical findings of PPD, CAL, PI and GI were recorded.Results. The clinical parameters were assessed for three groups in three different anxiety levels of mild, moderate and severe. Intra-group comparison of PPD and CAL in the three anxiety levels showed increased periodontal destruction with an increase in anxiety levels, the results being statistically highly significant for PPD differences in smokers (P < 0.0001). The mean differences in PPD and CAL in severe anxiety levels between smokers and non-smokers were 0.68 mm and 0.70 mm and both the findings were statistically significant. The mean PPD and CAL in smoker and non-smoker groups in obese patients was higher as compared to non-obese patients and the differences were highly significant (P < 0.001).Conclusion. The results of our study indicated a positive and strong correlation between anxiety, obesity and periodontal disease in smokers and non-smokers. Smoking appears to further attenuate this association.

Influence of interventional nonsurgical periodontal treatment on levels of salivary and serum nitric oxide in smokers and nonsmokers with chronic periodontitis.

Background and Objective:Nitric oxide (NO) is a widespread signaling molecule which is known to influence varied biological processes. However, an uncontrolled high level of NO accelerates tissue destruction. The pathogenesis of periodontal disease is also affected by smoking which alters the inflammatory response. The present study was thus performed to assess the effect of nonsurgical periodontal treatment on salivary and serum NO levels in smokers and nonsmokers with chronic periodontitis.Materials and Methods:Forty patients with chronic periodontitis, including 20 nonsmokers and equal number of smokers participated in the present study. Probing depth, clinical attachment level, plaque index, gingival index were assessed, serum and saliva samples were obtained from the patients at baseline and after Phase I therapy at 6 weeks to estimate NO by Griess colorimetric reaction.Results:Smokers showed higher serum and saliva NO levels 30.3 ± 3.28 and 50.4 ± 4.07 μM as compared to nonsmokers 20.05 ± 2.42 μM and 37.5 ± 2.95 μM, respectively, at baseline. After Phase I therapy, both the groups exhibited significant improvement in clinical parameters and reduction in serum and saliva NO levels; however, reduction was higher in nonsmokers.Conclusion:More destructive expression of periodontal disease in smokers causes an increase in the concentrations of NO and less reduction after Phase I therapy as compared to nonsmokers with chronic periodontitis. Hence, NO levels in saliva and serum could be used as indicators of periodontal inflammatory condition.

Smoking effect on chemokines of the human chronic periodontitis

AimEvaluate the effects of smoking on chemokines of the human chronic periodontitis (CP). Materials and methodsGingival samples were obtained from 23 smokers (S) and 20 non-smokers (NS) diagnosed with CP. Periodontal examination was performed. The CCL2, CCL3, CCL5, CCL19, CCL20, and CXCL8 chemokine levels were measured in gingival tissues using enzyme-linked immunosorbent assay. Chemokines were compared between S and NS, and were correlated with the number of cigarettes per day (C/day) and time of the smoking habit in years (SH/years). ResultsCCL3 and CXCL8 of S were significantly smaller than that found in NS subjects, whereas the CCL5 levels increased in the S group. Negative correlations could be observed between CCL19 levels and SH/year. ConclusionSmoking suppresses the immune response which may contribute to an increased susceptibility to periodontal disease in smokers.

보육교사에서 구강건강행동 및 구강자각증상과 BMI의 연관성

Objectives : The aim of this study was to analyze relationship between body mass index(BMI), oral health behavior, and perceived oral symptoms among child care teachers. Methods : The subjects were 310 child care teachers who worked in child care centers in Jeollabukdo Province, Korea. A cross tab analysis and a multiple regression analysis were conducted to find a possible relationship between oral health behavior, oral symptoms and BMI. Results : BMI in child care teachers was 35.1% and male and married teachers had higher BMI. Higher BMI revealed perceived periodontal disease in smokers. Higher BMI was closely related to perceived xerostomia and halitosis. Conclusions : BMI is a very important index to develop health improvement and obesity control.

Comparative Evaluation of Prevalence of Periodontal Disease in Smokers and Non-smokers in Factory Workers of Jodhpur, Rajasthan

Need For The Study: Increasing evidence points to smoking as a major risk factor for periodontitis, affecting the prevalence, extent and severity of the disease, Although gingival inflammation seems to be reduced in response to plaque accumulation compared with non smokers, an overwhelming body of data points to smoking as a major risk factor for increasing the prevalence and destruction. Hence, this paper focuses on prevalence of periodontal disease in smokers compared to non-smokers of factory workers. Aims & Objectives: 1) To detect the prevalence of periodontal disease in smokers and non smokers. 2) To compare the prevalence of periodontal disease in smokers and non smokers. Methodology: A total number of 626 subjects were examined out of which 449 (71.7%) were non smokers and 177 (28.2%) smokers. The WHO (1997) Oral Health Performa3 was used to record the demographic information viz; age in years, education, life style and smoking habits. All fully erupted permanent teeth were scored. The Periodontal status was assessed by recording the Community Periodontal Index (CPI) using a specially designed light weight CPI probe and the Clinical Attachment Level (CAL) values were scored The data thus collected was statistically analyzed for Two-Way ANOVA test for CPI and CAL scores. Results: Clinical attachment loss was significantly higher in smokers for all scores from 1 to 4. 107 smokers showed clinical attachment loss in comparison to 173 non smokers. Conclusion: The results of the present study showed that smokers had higher attachment loss as compared to non smokers.

Folic acid: A positive influence on periodontal tissues during health and disease

Periodontal disease is a multifactorial disease, the origin of which remains obscure. However, the manifestation and progression of periodontitis is influenced by a wide variety of determinants including social and behavioral factors, systemic factors, environmental and genetic factors. Periodontal tissue integrity is dependent on the adequate intake of proteins, carbohydrates, fats, vitamins, and mineral salts. Chronic deficiencies in the availability of one or more of these nutrients are expected to produce pathological alterations in the expression and progression of periodontal disease. Folic acid, also known as vitamin B 9 or folacin, is one such vitamin that is essential for numerous bodily functions ranging from nucleotide biosynthesis to the remethylation of homocysteine. Folic acid deficiency causes absence of keratinization of gingival surface, decreased resistance to infection, necrosis of gingiva, periodontal ligament, and alveolar bone destruction in animals and humans. This may be accompanied by ulcerative glossitis and cheilitis. Repair and maintenance of periodontal tissues generates a high turnover rate of squamous epithelium and without folic acid, epithelial cells do not divide properly. Folic acid deficiency is the most common nutrient deficiency in the world. Organic nitrites, nitrous oxide, cyanates, and isocyanates found in cigarette smoke have been shown to interact with folic acid, transforming them into biologically inactive compounds and thereby leading to lower folic acid levels in serum, red blood cells, and respiratory tract. Folic acid supplementation as an adjunct in the management of periodontal disease in smokers will prove to have beneficial effect on the periodontal tissues during repair and turnover.

Locally Delivered Doxycycline as an Adjunctive Therapy to Scaling and Root Planing in the Treatment of Smokers: A 2‐Year Follow‐Up

The aim of this clinical study was to evaluate the association of locally delivered doxycycline 10% with scaling and root planing in the periodontal treatment of smokers during a 2-year period. Forty-eight chronic periodontitis patients, presenting a minimum of four pockets (>or=5 mm) that bled on probing on anterior teeth were included. Patients were randomly assigned to receive one of the following treatments: scaling and root planing (SRP) and scaling and root planing followed by local application of doxycycline (SRP-D). Assigned treatments were performed at baseline and at 12 months. Clinical parameters, including probing depth (PD) and relative attachment level (RAL), were recorded at baseline; 45 days; 3, 6, and 12 months (retreatment); 45 days following retreatment; and at 15, 18, and 24 months. In initially deep pockets (>or=7 mm), SRP-D showed greater PD reduction than SRP at 6 and 18 months (mean difference between groups of 1.18 and 1.73 mm, respectively; P <0.05) and greater RAL gain in all periods after 3 months (mean difference between groups of 1.16, 1.99, and 1.78 mm, at 6, 18, and 24 months, respectively; P <0.05). Also, the proportion of sites showing >or=2 mm PD reduction was greater for SRP-D at 6 months (81.2% x 50.8%; P <0.001) and at 24 months (65.5% x 46.5%; P = 0.01). As for RAL gain, this proportion was 34.4% and 18.1% for SRP-D and SRP at 24 months, respectively (P = 0.008). The use of locally delivered doxycycline may constitute an important adjunct for the active and supportive treatments of severe periodontal disease in smokers.

Local Oxygen Therapy for Treating Acute Necrotizing Periodontal Disease in Smokers

The main aim of treatment for acute necrotizing periodontal disease is fast and effective reduction of anaerobic destructive microorganisms to avoid periodontal damage. The effect of adjunctive local oxygen therapy in the treatment of necrotizing periodontal disease was examined in this study. Thirty patients with acute necrotizing periodontal disease were treated with the systemic antibiotics amoxicillin, clavulanic acid, and metronidazole. In 15 out of 30 patients, adjunctive local oxygen therapy was administered. The patients were followed from the first to 10th day of treatment with clinical and bacteriological examinations. The clinical examination registered gingival bleeding, periodontal probing depth, and attachment loss; to follow up microbiological colonization of the periodontal sulcus, five representative bacteria were registered by a semiquantitative DNA polymerase chain reaction test. In both groups of patients, colonization with Prevotella intermedia, Tannerella forsythensis, and Treponema denticola was initially positive. None of these three microorganisms were completely eradicated in any of the patients in the group without oxygen therapy within the first 10 days of treatment. In the group with adjunctive oxygen therapy, all patients either showed a reduction in or complete eradication of the microorganisms, resulting in more rapid clinical restitution with less periodontal destruction. Adjunctive oxygen therapy results in early eradication of pathogenic anaerobic microorganisms in cases of acute necrotizing periodontal disease. The damage to periodontal tissue is reduced.

Anxiety, gingival inflammation and periodontal disease in non‐smokers and smokers – an epidemiological study

The aim of the present study was to investigate the influence of anxiety, measured by one single question, on gingival inflammation and periodontal disease in non-smokers and smokers. The participants were 144 subjects with untreated periodontal disease 30-40 years of age, and 26 healthy controls, 30-40 years of age. All subjects were clinically examined and answered an uncomplicated question regarding anxiety in every day life, as well as smoking habits. The periodontitis subjects were divided into; an aggressive periodontitis (AP)-group and a chronic periodontitis (CP)-group. Fisher's exact probability t-test, analysis of variance (anova), Mann-Whitney U-test and analysis of covariance (ancova) were used as statistical methods. Anxious subjects had a significantly higher gingival index than non-anxious subjects, when controlling for smoking (p<0.01). The healthy anxious non-smokers had an average score of GI 1.6 (+/-0.4 SD) compared with 1.2 (+/-0.4 SD), p<0.05 for the non-anxious non-smokers. Anxious smokers with periodontits (AP-/CP-group) had significantly more sites with pockets >/=5 mm, compared with non-anxious smokers, (p<0.05). The results of the present study, suggest that self-reported anxiety was associated with an adverse affect on the gingiva. Anxiety seemed to be associated with increased severity of periodontal disease in smokers.

Periodontal disease in smokers

Tobacco contains about 4000 different toxic substances from which almost 40 are proven to be cancerogenic. Nicotine, toxic alkaloid, is the most active substance in tobacco causing major number of harmful consequences for human organism as a whole, and for periodontal tissues as well. The aim of the paper was to show harmful effects of smoking on periodontal disease development, and to point out the problems caused by smoking during and after the periodontal treatment. Periodontal disease occurs in smokers more frequently as opposed to non-smokers. Typically, smokers have lower level of gingival inflammation, more excessive and accelerated loss of alveolar bone and epithelial insertion, deeper periodontal pockets and numerous gingival recessions. Along with that, smokers are carrying a decreased immune response that is expressed through various defense mechanisms. Smoking has negative impact on the outcome of conservative and surgical periodontal therapy. Effects of smoking on periodontal therapy success rate are requiring administration of antiseptic solutions and antibiotics throughout the treatment course. Every periodontologist must influence patients to stop smoking and thus act preventively on occurrence and progress of periodontal disease.

Use of water ‘softening and conditioning systems’ significantly increases the risk of periodontitis: smoking considerations

The role of water in the etiology of periodontal disease is poorly understood. The objective of this study was to examine the association amongst water softness, risk for periodontitis, and smoking status. We examined the association between use of water 'softening and conditioning systems' and the risk for periodontal disease in smokers and non-smokers, using adult participants (18+ years), from the third National Health and Nutrition Examination Survey (NHANES III) data. Zero to 33 per cent (0-33%) of sites with periodontal attachment loss > or = 3 mm was considered a healthy periodontium, and > 33% of sites with periodontal attachment loss > or = 3 mm was defined as periodontitis. Soft water users were divided into 'yes' or 'no' using the question, 'Does your home have a "softening or conditioning system?".' Smoking subjects were divided into groups as follows: current smokers (had smoked > or = 100 cigarettes in their lifetime and currently smoked), former smokers (had smoked > or = 100 cigarettes in their lifetime, not currently smoking), or never smokers (had not smoked > or = 100 cigarettes in their lifetime). Data was analyzed by univariate analyses using SPSS. The 5% level of statistical significance was adopted throughout. Subjects that answered the question 'yes' to soft water use had a significantly higher risk of periodontitis (p < 0.05), adjusting for confounders. When mineral intake from foods was added to the model, the significance of periodontitis risk remained the same for the non-smoking, soft water-using subjects, whereas for the smoking, soft water-using subjects the risk for periodontitis increased significantly (p < 0.05) in most cases. Thus, use of water 'softening and conditioning systems' significantly increased the risk for periodontitis, and smoking increased this risk.