Dental patient awareness of smoking effects on oral health: Comparison of smokers and non-smokers

OBJECTIVES: The negative effects of cigarette smoking on oral health are well established, yet few studies assessed patient awareness of such effects. The aim of this study was to examine differences in dental patient knowledge and awareness of the effects of smoking on oral health between smokers and non-smokers. METHODS: Adult patients from 12 dental centers in Kuwait were asked to complete a 14-point self-administered structured questionnaire on the effects of smoking on oral health in this cross-sectional survey. Significant associations between oral health knowledge, smoking status, and sociodemographic variables were examined with univariate analysis and logistic regression. RESULTS: A total of 1012 subjects participated (response rate = 84.3%). The prevalence of smoking was 29.3%. Fewer smokers than non-smokers thought that oral health and smoking are related (92.2% vs. 95.8%; P = 0.020), and that smoking affected oral cancer (52.4% vs. 66.8%; P < 0.001), periodontal health (72% vs. 78%; P = 0.040), or tooth staining (86.1% vs. 90.9%; P = 0.018). Logistic regression analysis showed smokers to be significantly less aware of the oral health effects of smoking than non-smoking patients (OR=1.51; 95% CI: 1.05-2.16; P = 0.025). CONCLUSION: Smoking dental patients are significantly less aware of the oral health effects of smoking than non-smokers. Comparative studies in other populations may be warranted to ascertain the validity of these results.     

Smoking, tooth brushing and oral cleanliness among 15-year-olds in Tehran, Iran

PURPOSE: To assess smoking, tooth brushing and oral cleanliness and their relationships among 15-year-olds in Tehran, Iran. MATERIALS AND METHODS: A cross-sectional study based on World Health Organization criteria and the methods of the Second International Collaborative Study was carried out in autumn 2004 among 15-year-olds (n=502) in Tehran. Data were based on a self-administered questionnaire and a clinical dental examination. RESULTS: Smokers comprised 5% of the boys and 2% of the girls (p = 0.02). Smoking was more common among students of less-educated parents (50% vs. 30%, p < 0.05). Of all students, 26% reported twice-daily tooth brushing; those of higher socio-economic backgrounds and girls did so more frequently. Of the smokers, 11% reported no tooth brushing compared to 6% of the non-smokers. Oral cleanliness was good for 13%, moderate for 32%, and poor for 55%; the rates associated positively with female gender (p = 0.002), having higher-educated parents (p = 0.03), and reporting a higher frequency of tooth brushing (p < 0.001). Those students reporting twice-daily tooth brushing had less dental plaque and gingival bleeding (p < or = 0.01) on both anterior and posterior teeth. In multivariable analyses, the best predictors for a good level of oral cleanliness were female gender (OR = 2.0) or twice-daily tooth brushing (OR = 1.7). CONCLUSION: Oral cleanliness and tooth brushing among 15-year-olds were at poor levels, particularly among boys. Such poor levels call for intensive attempts to enhance rates of twice-daily tooth brushing and to improve its quality. For this age group, anti-smoking purposes should be combined into school-based oral health promotion programmes as well.     

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目的了解中日友好医院口腔门诊患者口腔卫生知识的知晓及口腔健康行为情况,为今后该院口腔门诊患者健康教育及诊疗服务提供参考。方法参考全国口腔流行病学调查问卷自行设计问卷,对2011年1—12月来该院口腔门诊就诊、年龄≥7周岁的患者进行调查,调查的内容为:一般人口学信息、口腔卫生知识的知晓情况、口腔健康行为情况及口腔疾病的患病情况。调查结果通过Epidata3.0软件建立数据库,SPSS15.0统计软件进行统计分析。结果 2011年来该医院口腔门诊就诊的8362例患者,患病以牙周疾病和龋齿为主,所占的比例分别为36.0%和28.7%;正确刷牙方法的知晓率为30.2%,牙结石、合理洁牙频次、牙菌斑知晓率分别为22.1%、10.9%、2.4%;日常行为中采取正确刷牙方法的比例占15.1%,曾经洗过牙的占10.2%,睡觉前经常吃甜食的占20.4%,未接受过口腔门诊健康教育的比例占37.8%,最近5年未曾看过口腔门诊者占65.2%,经常吸烟的比例占39.2%,经常饮酒的占36.5%,经常熬夜的占40.6%,不经常锻炼身体的占76.4%;被调查患者获取口腔卫生知识的主要途径是报纸、电视及网络。结论该医院口腔门诊就诊患者口腔卫生知识知晓率较低,口腔健康行为比例较低,应通过口腔门诊进一步加强对患者的健康教育。     

Periodontal awareness and knowledge,and pattern of dental attendance among adults in Jordan

AIMS: To provide baseline data on periodontal awareness and health knowledge, and to assess patterns of dental attendance behaviours among 20 to 60 year-old Jordanian adults. METHODS: A questionnaire incorporating items related to personal and socio-demographic data, periodontal awareness and health knowledge, and self-reported dental attendance behaviours. One-thousand questionnaires were distributed among adults attending dental clinics. RESULTS: 743 questionnaires were completed and statistically analysed. About one-quarter of adults reported 'gum bleeding' on brushing, but more subjects (40.4%) believed that they had periodontal disease. Also, 47% of the participants thought that they had a 'rough tooth surface', 16% had 'gum irritation' and 25% had 'bad breath'. There were no statistically significant differences between genders with regard to responses on periodontal awareness (P >0.05). The majority of adults incorrectly defined the meaning of dental plaque and did not know its role in the aetiology of gingival disease. Conversely, the majority of participants (60.8%) were aware that gingival bleeding upon brushing indicated the presence of periodontal disease that can be prevented by brushing and flossing (63.4%), mainly before going to bed (73.9%). The overwhelming majority of subjects (81.4%) were irregular attenders. 'Treatment not necessary' and 'cost' were found to be the common barriers for regular dental attendance. The most common treatment received by the subjects at their last visit was restorative therapy. CONCLUSION: Knowledge and awareness concerning periodontal disease is still poor in Jordan, therefore, more dental health education is needed to improve oral health.     

Cigar, pipe, and cigarette smoking as risk factors for periodontal disease and tooth loss

BACKGROUND: Our purpose was to test the hypotheses that cigar and pipe smoking have significant associations with periodontal disease and cigar, pipe, and cigarette smoking is associated with tooth loss. We also investigated whether a history of smoking habits cessation may affect the risk of periodontal disease and tooth loss. METHODS: A group of 705 individuals (21 to 92 years-old) who were among volunteer participants in the ongoing Baltimore Longitudinal Study of Aging were examined clinically to assess their periodontal status and tooth loss. A structured interview was used to assess the participants' smoking behaviors with regard to cigarettes, cigar, and pipe smoking status. For a given tobacco product, current smokers were defined as individuals who at the time of examination continued to smoke daily. Former heavy smokers were defined as individuals who have smoked daily for 10 or more years and who had quit smoking. Non-smokers included individuals with a previous history of smoking for less than 10 years or no history of smoking. RESULTS: Cigarette and cigar/pipe smokers had a higher prevalence of moderate and severe periodontitis and higher prevalence and extent of attachment loss and gingival recession than non-smokers, suggesting poorer periodontal health in smokers. In addition, smokers had less gingival bleeding and higher number of missing teeth than non-smokers. Current cigarette smokers had the highest prevalence of moderate and severe periodontitis (25.7%) compared to former cigarette smokers (20.2%), and non-smokers (13.1%). The estimated prevalence of moderate and severe periodontitis in current or former cigar/pipe smokers was 17.6%. A similar pattern was seen for other periodontal measurements including the percentages of teeth with > or = 5 mm attachment loss and probing depth, > or = 3 mm gingival recession, and dental calculus. Current, former, and non- cigarette smokers had 5.1, 3.9, and 2.8 missing teeth, respectively. Cigar/pipe smokers had on average 4 missing teeth. Multiple regression analysis also showed that current tobacco smokers may have increased risks of having moderate and severe periodontitis than former smokers. However, smoking behaviors explained only small percentages (<5%) of the variances in the multivariate models. CONCLUSION: The results suggest that cigar and pipe smoking may have similar adverse effects on periodontal health and tooth loss as cigarette smoking. Smoking cessation efforts should be considered as a means of improving periodontal health and reducing tooth loss in heavy smokers of cigarettes, cigars, and pipes with periodontal disease.     

Oral health knowledge, attitude and behaviour among Saudi school students in Jeddah city

OBJECTIVES: To assess the knowledge, attitude and behaviour in relation to periodontal health status among Saudi intermediate and high school students living in Jeddah, Kingdom of Saudi Arabia. METHODS: A dental health questionnaire was distributed to a random sample of a total of 2586 Saudi students from intermediate and high school, aged 12-18 years residing in Jeddah. RESULTS: While about 87.1% knew that tooth brush helps prevent periodontal disease, only 33.1% knew that using dental floss helps in preventing periodontal disease. Females used brushing and flossing more than males, while males used miswak more than females. Tooth brushing (P<0.001) and dental floss (P<0.015) were used more frequently among private subjects, while miswak was utilized more frequently among governmental school students (P<0.005). Dental pain was found to be the main reason for visiting the dentist among the target group. CONCLUSIONS: It appears that knowledge, attitude, and behaviour concerning periodontal health among young Saudi school students living in Jeddah city are in need of improvement.     

Epidemiology and preventive direction of periodontology in China

OBJECTIVE: The aim of this work was to estimate the present periodontal problems of people in China, based on an epidemiological investigation of adults. MATERIAL AND METHODS: The data were collected from the northwest, southwest, northeast and east regions (400 subjects from each region) of China. All subjects were over 25 years of age. About half of the subjects were farmers and about half were urban professionals. Everyone was asked to fill out a questionnaire and to undergo a professional oral examination. Periodontal health status was evaluated by a simplified oral hygiene index (OHI-S), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PD), clinical attachment loss (CAL), and tooth mobility. RESULTS: Of the 1590 subjects enrolled in this investigation, 45.7% were male, 45.5% were farmers, and the remaining were urban professionals, and 27.7% of the subjects were smokers. There was a significant difference in the educational background but not smoking between the rural and urban groups. While 34.9% of the subjects in the urban group brushed only once per day, 56.1% of the subjects in the rural group did so. The prevalence of bleeding during brushing was 71.1%, while about 61.4% of the subjects know nothing about scaling. All periodontal indices were significantly higher in males than in females and higher in the rural group than in the urban group. PD, CAL and tooth mobility increased with age. The percentage of sites with CAL>3 mm in the rural group (49.5%) was significantly higher than that in the urban group (37.5%). Both current and former smokers showed increased CAL than non-smokers. CONCLUSION: Gingivitis and periodontitis are common findings in China. Most Chinese have no knowledge of common periodontal prevention and treatment and very few have regular dental care. The data of this study suggest that age, smoking, and limited education are significantly associated with Chinese adult periodontal attachment loss. Preventive periodontal care and education should be reinforced in the future by establishing relevant oral health projects.     

Determinants of oral health behaviour among Iranian dentists

AIM: To study the oral health behaviour of Iranian dentists. DESIGN: A cross-sectional study. Setting: Two annual dental meetings in Tehran, Iran. PARTICIPANTS: 1,033 dentists responded, 980 were eligible for this study. METHOD: Data were collected using a self-administered questionnaire which covered dentists' oral self-care, dental attendance, and smoking. Recommended oral self-care (ROSC) included tooth brushing > 1/day, eating sugary snacks < daily, and regularly using fluoride toothpaste. Knowledge of preventive dental care was assessed by nine Likert-scale statements. Dentist's gender, age, and professional reading were recorded. Statistical evaluation was by the Chi-square test and logistic regression. RESULTS: In total, 59% of respondents reported brushing their teeth at least 2/day, 59% consumed sugary snacks < daily, 74% used fluoride toothpaste regularly, and 76% were non-smokers. Of all, 27% followed ROSC. Women reported desirable behaviours more frequently than did the men (p < 0.01). Female gender (OR 1.4-2.3), being a non-smoker (OR 1.3-1.5), and wider professional reading (OR = 1.2) were the major factors that contributed to dentists' desirable oral health behaviour. CONCLUSIONS: That only a small number of Iranian dentists follow the ROSC calls for more attention to behavioural contributions to oral diseases and its consequences with general and oral health, regarding both dental curriculum and continuing education.     

Investigating the relationship between self-reported oral health status, oral health-related behaviours and self-consciousness in Romania

PURPOSE: The aim of the present study was to investigate whether self-consciousness, self-reported oral health status and oral-health-related behaviours were associated. MATERIAL AND METHODS: The present study sample consisted of 253 first year medical students in Romania. The questionnaire included information about socio-demographic factors, behavioural variables, self-reported oral health status and three self-consciousness subscales (Private Self-Consciousness, Public Self-Consciousness, and Social Anxiety). RESULTS: Significant differences were found in Public Self-Consciousness and Social Anxiety according to several variables: anxiety, stress, depression and current non-treated caries. There were significant differences in Social Anxiety for the variables of gender, smoking, perceived dental health, self-reported gum bleeding and reason for dental visit (p < 0.05). A significant difference was found in Public Self-Consciousness for the reason for dental visits (p < 0.05). Total Self-Consciousness is correlated with anxiety, stress, depression, current non-treated caries, gingival bleeding and reason for dental visit. Oral health behaviours such as tooth brushing, flossing, mouth washing and last dental visit were not influenced by each of the self-consciousness subscales. CONCLUSIONS: The results suggest that self-consciousness might be a psychosocial risk marker that influences self-reported oral health status.     

Oral health status of male prisoners in Italy

OBJECTIVES: To determine the prevalence of dental and root caries, periodontal conditions, and prosthetic status of prison inmates. DESIGN: Cross-sectional survey. SETTING: Penal institutions in the Calabria region (Italy). PARTICIPANTS: A random sample of 544 prisoners. METHODS: Participants underwent a structured interview by trained interviewers and a dental examination. RESULTS: Only 2% had no history of caries. Mean DMFT and DMFS were 9.8 and 37.6 and missing teeth was the most prevalent component of the DMFT. Higher DMFT was found among older prisoners, having regular dental attendance, higher plaque index, and in those with a lower frequency of a tooth brushing habit. Conservative care and extractions were required by 61.9% and 33.3%. The mean plaque and gingival indices were 0.74 and 0.75; 10.5% had healthy periodontal tissues. The highest number of individuals was classified as having a CPI of 2, whereas 5% had at least one sextant with a CPI score of 4. Deep pockets were more likely in older subjects and in those with a lower frequency of a tooth brushing habit. A minimum of oral hygiene instruction was needed by 89.6%. Seven subjects were edentulous and 85.1% had a prosthetic treatment need. CONCLUSIONS: This survey emphasises the need for programmes to improve the oral health of prisoners.     

Noxious effect of cigarette smoking on periodontal health

Periodontal probing depth, furcation involvement and tooth mobility were compared in smokers and non-smokers. The study covered 242 subjects aged 21–60 yr, 76 of whom were smokers. Oral hygiene status and dental care habits were above average and of similar standard in both groups (Pll = 0.9). Probing depth was measured at 6 sites around all teeth and sites with a depth of 4 mm or more were regarded as diseased. Both number and probing depth of pockets were significantly greater in smokers than in non-smokers. On average, smokers exhibited 36.0 sites with a probing depth of 4 mm or more, in contrast to 21.8 sites in non-smokers. Probing depth was 2.59 ± 0.06 (mean ± SEM) and 2.36 ± 0.03 in smokers and non-smokers, respectively. The relatively greater occurrence of pockets in smokers remained even when allowance was made for age and oral hygiene. There were also significantly increased numbers of teeth with furcation involvement, pocket involvement and hypermobility in smokers. It is concluded that smoking is associated with a deterioration in periodontal health and that the influence of smoking may be independent of plaque exposure.     

Oral health attitudes, knowledge, and behavior among school children in North Jordan

The aim of this study was to assess the knowledge, attitude, and behavior of school children towards oral health and dental care as well as to evaluate the factors that determine these variables. School children (n=557) of an average age of 13.5 years attending public schools in North Jordan were recruited into this study. The subjects completed a questionnaire that aimed to evaluate young school children's behavior, knowledge, and perception of their oral health and dental treatment. The participants' oral hygiene habits (such as tooth brushing) were found to be irregular, and parents' role in the oral hygiene habits of their children was limited. The study population showed higher awareness of caries than periodontal conditions. Irregular visits to the dentist were found to be common, and toothache was the major driving factor for dental visits. Children had positive attitudes toward their dentists; nevertheless, they indicated that they feared dental treatment. The children in this study also recognized the importance of oral health to the well-being of the rest of the body. Parents were not proactive in making sure that their children received regular dental care. Parents' knowledge and attitudes about the importance of oral health care and their fears about dental treatment influenced their children's dental care. The results of this study indicate that children's and parents' attitudes toward oral health and dental care need to be improved. Comprehensive oral health educational programs for both children and their parents are required to achieve this goal.     

Dental health behaviours among early adolescents in Hong Kong

To cite this article:
Int J Dent Hygiene 9 , 2011; 122–126
DOI: 10.1111/j.1601‐5037.2010.00452.x
Mak KK, Day JR. Dental health behaviours among early adolescents in Hong Kong. Abstract: Objectives: This study aimed to investigate the prevalence and socioeconomic differences in dental health behaviours among Hong Kong early adolescents. Methods: A cross‐sectional survey was conducted among 4927 students (44.7% boys) aged 14–15 from 36 secondary schools in 2000–2001. Students reported their socioeconomic information and dental health behaviours using the Health Related Behaviour General Questionnaire (HRBGQ). Logistic regression models were used to determine the adjusted odds ratios of regular tooth brushing (at least twice daily), weekly use of dental floss (in the past 7 days) and annual dental visit (in the past 12 months) for different socioeconomic characteristics. Results: Of the subjects, 77.8% reported to have brushed regularly, but only 22.3% used dental floss weekly and 37.9% had annual dental visit. Male gender and Chinese ethnicity were significantly associated with lower odds of regular brushing, use of dental floss and annual dental visit. Two or more siblings and not living with both parents were also significantly associated with lower odds of regular brushing and annual dental visit. Furthermore, students living in non‐private housing were significantly less likely to have annual dental visit than those in private housing. Conclusions: Regular brushing was common, but not use of dental floss and annual dental visits among Hong Kong early adolescents. In general, socioeconomic disparity in dental health behaviours was observed. Extending the existing government‐run dental health programmes to secondary school students in Hong Kong is warranted.     

Smoking behaviour and knowledge in high school students in Riyadh and Belfast.

Smoking is one of the risk factor associated with onset, severity and progression of periodontal disease. AIM: The aim of the study was to examine the smoking behaviour and dental health knowledge of high school students in Riyadh and Belfast. MATERIALS AND METHODS: Eight schools from Riyadh and 6 from Belfast were randomly selected by cluster distribution sampling method. Two hundred and ninety students from Riyadh and 144 from Belfast were included giving an overall response rate of 85%. The age range was between 16-17 years. A questionnaire was used to assess demography, smoking habits, dental health knowledge and oral hygiene practices. RESULTS: The results showed that 18% of students were smokers; 24% in Belfast and 15% in Riyadh (x2 (1) = 4.29: P = 0.04). 24% of students in Belfast and 56% in Riyadh smoked at least 1 cigarette per day. 61% of students had bleeding gums although 85% stated that they brushed their teeth at least daily. Bleeding on brushing was common with 53% of Belfast students compared with 65% from Riyadh. Students in Belfast (2.51 +/- 1.15) had significantly higher mean scores for their knowledge about gum health compared with Riyadh students (2.21 +/- 1.44) (t = 2.29: P = 0.02). There was no differences in knowledge about oral health and smoking between the students. However, non-smokers from Belfast and Riyadh (3.32 +/- 1.60) had greater knowledge about oral health and smoking than those who smoked (2.81 +/- 1.45) (t = 2.73: P = 0.007). There was no difference in knowledge about gum health between smokers and non-smokers. CONCLUSIONS/RECOMMENDATIONS: Smoking is more prevalent in Belfast but more cigarettes are smoked in Riyadh. As non-smokers had greater knowledge of the ill-effects of smoking upon their oral health, there is a need to develop location specific interventions to control smoking habits in late adolescence.     

Effect of cigarette smoking on periodontal status of healthy young adults

BACKGROUND: It has been shown that tobacco is a significant risk factor for periodontal disease; however, there have been few studies on young populations where problems of general health can be discounted. The purpose of this study was to examine the influence of tobacco consumption on the periodontal condition of a young, healthy population. METHODS: The study population consisted of 304 young Caucasian males (average age 19.38 +/- 0.72 years) entering the Armed Forces. All the subjects completed a self-administered questionnaire on age, oral hygiene habits, previous dental examinations, and quantity and length of tobacco use. The periodontal examination consisted of the plaque index (PI); periodontal bleeding index (PBI); probing depth (PD); and clinical attachment level (CAL). One- and 2-way ANOVA was used to compare data recorded between smokers and non-smokers. RESULTS: Forty-six percent of subjects reported that they brushed their teeth at least once a day, but only 13% visited a dentist at least once a year. Over half (53%) were habitual smokers, 43% smoking between 5 and 20 cigarettes per day; 39% of the smokers had been smoking for less than 5 years. Mean PI was 31.24 +/- 14.88 (27.19 +/- 15.93 for smokers and 35.78 +/- 12.17 for non-smokers), with significant differences between non-smokers and those who smoked 5 to 20 cigarettes per day (26.85 +/- 16.11, P<0.0001). Mean PBI was 42.29 +/- 8.43 (non-smokers 44.67 +/- 6.53 and smokers 40.17 +/- 9.46). Significant differences were found between the PBI of the non-smokers and of those who smoked 5 to 20 cigarettes per day (39.90 +/- 9.64, P <0.0001). There were also differences in the PBI between those who brushed their teeth once (40.53 +/- 9.61) and twice (44.86 +/- 5.9) a day (P<0.0001). Mean PD was 1.62 +/- 0.43 mm (non-smokers 1.56 +/- 0.36 and smokers 1.68 +/- 0.49). Deeper probing depths were recorded among smokers than among non-smokers, with statistically significant differences (P<0.049); statistically significant differences were also found between those who attended (1.49 +/- 0.50) and those who did not attend (1.65 +/- 0.42) regular dental check-ups (P<0.031). Mean CAL 1.75 +/- 0.41 (non-smokers 1.64 +/- 0.32 and smokers 1.82 +/- 0.44). CONCLUSIONS: It may be concluded that, even at such an early age, tobacco consumption affects the periodontal health. It is necessary to inform young smokers of the risk of tobacco use regarding periodontal health.     

Experiences from a school-based oral health promotion programme in Wuhan City, PR China

Objectives. To evaluate the effect of a six-year oral health promotion programme for school children of Wuhan City, PR China.
Methods. The programme group (P-group) comprised 233 children who had just entered grade 1 (1989). The programme provided an oral health promotion programme, and 215 12-year-old children from three schools participated as a control group (C-group). After the 6-year period of the programme (1995), all of the children had a clinical examination according to the criteria of the WHO and responded to a structured questionnaire on dental health behaviour.
Results. The results showed that attitudes to dental care, regular tooth brushing habits, use of fluoridated toothpaste, gingival health and dental visits, frequencies of consuming sugary drinks/foods were improved in the p-group when compared with the C-group.
Conclusion. The school-based oral health promotion programme should be expanded.     

Oral health in rural and remote Western Australian indigenous communities: a two-year retrospective analysis of 999 people

AIM: Remoteness is a significant factor determining the level of basic health, education and infrastructure services to which Aboriginal people have access. This study examines the oral health status and oral health behaviours of Aboriginal people attending rural and remote dental clinics. METHODS: Data were collected as part of routine delivery of dental services in five rural and remote dental clinics. RESULTS: The average DMFT score of patients in all the clinics was 8.5 (sd 6.6). Advanced periodontal disease (a CPI score of 3 and/or 4) was present in 60.8% of all patients. Almost 88% of patients had experienced toothache in the previous six months. Almost a third (31.4%) of people could not remember the last time they went to the dentist. Less than half of the people reported brushing their teeth daily (40.4%) with 37.9% cleaning occasionally. A total of 52.4% of patients identified themselves as a 'smoker' of tobacco products. Past smokers accounted for 10.5% of the participants. The most common self-reported reason for visiting the clinic was for 'hole in tooth/fillings required' (37.4%), followed by 'pain/urgent problem' (24.8%). CONCLUSIONS: This study emphasises the urgent need for the development of strategies targeting Aboriginal oral health, both as stand alone, and as part of a multifactorial risk factor approach where oral health is integral to general health activities.     

Tobacco smoking and periodontal health in a Saudi Arabian population

BACKGROUND & AIM: Tobacco smoking exerts a harmful effect on the periodontal tissues manifested by periodontal pockets, attachment loss and periodontal bone loss. Current evidences on the effects of tobacco on periodontal health mainly concern cigarette smoking. In view of the increasing popularity of water pipe smoking in Arabian countries and reports confirming that water pipe smoking has health effects similar to those of cigarette smoking, there is a need for a better understanding of the potential harm of this smoking habit. The present thesis was carried out in order to explore whether water pipe smoking is associated with periodontal health in a manner similar to cigarette smoking. MATERIAL & METHODS: Residents in Jeddah City, Saudi Arabia, were invited to participate in the study by means of announcements in two daily newspapers. 355 individuals, 100 women and 255 men (17-60 years) responded to a standardized questionnaire and digital panoramic dental radiographs were taken. The questionnaire included information about oral hygiene practices, dental care and smoking habits. Of these subjects, 262 (73%) also volunteered for clinical examination, including assessments of oral hygiene, gingival inflammation and probing depth. Subgingival microbial test was carried out in 198 individuals for the detection of 12 different bacterial species most commonly associated with periodontal disease using the checkerboard DNA-DNA hybridization technique. Participants were stratified into water pipe smokers 33%, cigarette smokers 20%, smokers of both water pipe and cigarettes (mixed smokers 19%) and non-smokers 28%. RESULTS: Tobacco smoking is associated with a suppression of the gingival bleeding response to plaque accumulation. A suppressive effect was observed in both cigarette and water pipe smokers compared to non-smokers (Study I). Both cigarette and water pipe smoking were associated with the presence of more than 10 pockets of > or = 5 mm probing depth. The relative risk for periodontal disease was 5.1-fold and 3.8-fold increased in water pipe and cigarette smokers, respectively, compared to non-smokers (p < 0.01). The relative risk associated with heavy smoking was about 8-fold elevated in water pipe smokers and 5-fold elevated in cigarette smokers, suggesting an exposure-response effect (Study II). Tobacco smoking was associated with a reduction of the periodontal bone height. The reduction was of similar magnitude in water pipe smokers and cigarette smokers. The relative risk of periodontal bone loss of more than 30% of the root length was 3.5-fold and 4.3-fold elevated in water pipe and cigarette smokers, respectively, compared to non-smokers (p < 0.01). The relative risk associated with heavy smoking was 7.5-fold elevated in water pipe smokers and 6.3-fold elevated cigarette smokers (Study III). Further more, cigarette smokers, water pipe smokers and non-smokers exhibited similar periodontal microflora (Study IV). CONCLUSION: Tobacco smoking is associated with inferior periodontal health. The impact of water pipe smoking is of largely the same magnitude as that of cigarette smoking. The association between tobacco smoking and an inferior periodontal health seems to be independent of the subgingival microflora. Water pipe smoking habit should be considered in periodontal health.     

The theory of reasoned action in describing tooth brushing,dental caries and diabetes adherence among diabetic patients

OBJECTIVES: Preventive oral health behaviour is important among diabetic patients, as it has been found that dental diseases and insulin-dependent diabetes mellitus (IDDM) have some psychological and biological factors in common. The aim here was to analyze the variables of Ajzen and Fishbein's theory of reasoned action to explain the reported frequency of tooth brushing, dental caries, HbA1c level and diabetes adherence. MATERIAL AND METHODS: Cross-sectional data were gathered from 149 IDDM patients by means of a quantitative questionnaire, clinical examination and patient records. RESULTS: The results showed that a firmer intention to brush the teeth was related to a higher reported frequency of tooth brushing (p < 0.001). The attitude to and the subjective norm of tooth brushing were related to the intention to brush(p < 0.001) and to the reported frequency of tooth brushing. A better dental attitude was related to better diabetes adherence (p = 0.002) and fewer decayed surfaces (p = 0.01), and a firmer intention to brush the teeth was related to a lower HbA1c level (p = 0.015). CONCLUSIONS: Our results suggest that in oral health promotion among diabetic patients, both subjective norm and attitude are important and that diabetes adherence may be influenced by promoting dental attitude.