The effect of cigarette smoking on the severity of periodontal disease among older Thai adults

BACKGROUND: The aim of this study is to determine the effect of cigarette smoking on the severity of periodontitis in a cross-sectional study of older Thai adults. METHODS: The study population consisted of 1,960 subjects (age 50 to 73 years old). All subjects received both medical and dental examinations. Periodontal examinations, including plaque score, probing depth, and clinical attachment level, were done on all teeth present in two diagonal quadrants. Sociodemographic characteristics and smoking status were obtained by questionnaires. Multinomial logistic regression was used to address the association between cigarette consumption and mean clinical attachment level. RESULTS: In this study population, 48.7% were non-smokers, 14.4% were current smokers, and 36.9% were former smokers. Current smokers had higher percentage of sites with plaque, deeper mean probing depth, and greater mean clinical attachment level than former smokers and non-smokers. The odds of having moderate and severe periodontitis for current smokers were 1.7 and 4.8 times greater than non-smokers, respectively. Former smokers were 1.8 times more likely than non-smokers to have severe periodontitis. Quitting smoking reduced the odds of having periodontitis. For light smokers (<15 packyear), the odds for severe periodontitis reverted to the level of non-smokers when they had quit smoking for > or =10 years. For moderate and heavy smokers (> or =15 packyear), the odds of having severe periodontitis did not differ from those of non-smokers when they had quit smoking for > or =20 years. CONCLUSIONS: There was a strong association between cigarette smoking and the risk of periodontitis among older Thai adults. Quitting smoking appears to be beneficial to periodontal health.     

Probing depth, attachment loss and gingival recession

The present investigation describes probing pocket depth, probing attachment level and recession data from 319 randomly selected subjects, aged 20-79 years, from Ushiku, Japan. The findings are reported as mean values, frequency distributions and percentile plots of the 3 parameters at buccal, interproximal and lingual surfaces of single rooted (incisors, canines, premolars) and molar teeth. Inter-as well as intra-examiner errors for probing pocket depth and probing attachment levels were assessed and found to be small. The data reported revealed that practically all subjects studied had one or more sites in the dentition affected by destructive periodontal disease and that the severity of disease increased with age. It was further observed that in each age group, molars had suffered more attachment loss than single rooted teeth and that the interproximal surfaces as a rule had lost more periodontal tissue support than corresponding buccal and lingual surfaces. The attachment loss difference observed between different surfaces of a given tooth or a group of teeth, however, was comparatively small. In the age groups between 20-59 years, advanced destructive periodontal disease was found in a small subgroup of the subject sample, while after the age of 60 years, widespread destructive periodontitis was common. An attempt was made to examine the progression of destructive disease with age by comparing the frequency distributions of sites with attachment loss of greater than or equal to 3 mm in subjects of different age groups. The data suggested that in younger subject groups, progression was confined to a subset of individuals, while in older age groups, more subjects and sites became involved. A major feature of destructive periodontal disease in older individuals was the accompaniment of attachment loss with recession at the gingival margin. Deep pockets were relatively infrequently detected, while advanced loss of attachment (with recession) occurred at many sites.     

The influence of current and former smoking on gingival bleeding: the Hisayama study

BACKGROUND: Previous studies have shown that smoking is a risk factor for periodontitis and that it has a suppressive effect on gingival bleeding. This study examined the relationship between smoking, including past smoking, and periodontal conditions, mainly gingival bleeding, in a community-based health investigation. METHODS: Smoking status was examined in 958 subjects, along with the quantity of tobacco currently or previously smoked (never, former light, former heavy, current light, and current heavy). We analyzed the influence of smoking on probing depth (PD), clinical attachment loss (CAL), and gingival bleeding on probing (BOP). Results: In multivariate logistic regression analyses, current heavy smokers were at a significantly greater risk for having a higher proportion of teeth with PD > or =4 mm and a higher proportion of teeth with CAL > or =5 mm; however, they had a lower risk for having a high BOP than did those who had never smoked. Moreover, both former light and former heavy smokers had significantly lower risks for high BOP. When the analysis was limited to subjects with PD > or =4 mm, former heavy and current heavy smokers showed a significant suppression of high BOP compared to never smokers. CONCLUSION: This study suggests that smoking is significantly associated with PD and CAL and that current and past smoking has a suppressive effect on BOP.     

Gingivitis susceptibility and its relation to periodontitis in men

The objective of this cross-sectional study was to evaluate whether gingivitis susceptibility is associated with periodontitis. We analyzed data of 462 men in the VA Dental Longitudinal Study aged 47 to 92 years who had never smoked or had quit smoking 5+ years previously. Multiple logistic regression models, with tooth-level bleeding on probing at sites with attachment loss相似文献   

Clinical and other risk indicators for early periodontitis in adults

BACKGROUND: Periodontal diseases affect over half the adults in the U.S., disproportionately affecting minority populations. Periodontitis can be treated in early stages, but it is not clear what features indicate, or could be risk factors for, early stages of periodontal attachment loss. This study aimed to evaluate associations between clinical and other risk indicators of early periodontitis. METHODS: A cross-sectional evaluation of 225 healthy and early periodontitis adults aged 20 to 40 years was performed. Clinical measurements, demographic information, and smoking histories were recorded. Analyses evaluated demographic and clinical associations with health and early periodontitis disease categories and periodontal attachment loss. Patterns of attachment loss at interproximal and buccal/lingual sites were evaluated. RESULTS: Subject age, plaque, and measures of gingivitis exhibited associations with attachment loss and probing depth. More periodontal attachment loss was detected in African-American and Hispanic subjects compared to Asian and Caucasian subjects. Smoking history was associated with attachment loss. At interproximal sites, lower molars most frequently had attachment loss, whereas at buccal/lingual sites, higher proportions of lower bicuspid teeth demonstrated attachment loss compared with other sites. CONCLUSIONS: In this study of subjects with minimal attachment loss, gingival inflammation was associated with early periodontitis. Lower molar interproximal sites were frequently associated with interproximal attachment loss, whereas lower bicuspid teeth were at risk for gingival recession on buccal surfaces.     

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.     

Smoking-attributable periodontal disease in the Australian adult population

Background: The extent to which periodontitis is attributable to smoking in Australia has not been examined. Objectives: To investigate the smoking–periodontitis relationship and to estimate the public health impact of smoking on periodontitis in Australia. Material and Methods: The National Survey of Adult Oral Health 2004–2006 collected nationally representative oral epidemiologic data for the Australian adult population. Examiners measured probing pocket depth (PPD) and gingival recession at three sites per tooth to compute clinical attachment level (CAL). Moderate‐severe cases were defined as having: 2 interproximal sites (not on same tooth) with 4 mm CAL or with 5 mm PPD. Smoking status was defined as never‐, former‐ or current‐smoker. Current‐smokers were further classified into light‐, moderate‐ or heavy‐smoker using calculated pack‐years. Age, sex and socioeconomic position were examined as potential confounders. Results: Twenty‐three per cent were former‐smokers and 15% were current‐smokers. Prevalence of periodontitis was 23%. In unadjusted analyses, former‐ and current‐smokers had significantly higher periodontitis prevalence than never‐smokers. Relative to non‐smokers, adjusted prevalence ratios (95% confidence interval) for periodontitis were as follows: former‐smokers: 1.22 (1.03–1.46), moderate‐smokers: 1.63 (1.16–2.30); and heavy‐smokers: 1.64 (1.27–2.12). The population attributable fraction of smoking for moderate‐severe periodontitis was 32% (equivalent to 700,000 adults). Conclusion: Smoking has a significant impact on periodontal health of the Australian adults.     

Periodontal conditions of adult regular dental care attendants

Abstract The purpose of the present study was to examine longitudinal alterations in the periodontal conditions of regular dental care attendants, 225 randomly selected patients (age 18–65 years) at 12 community dental clinics in the county of Värmland, Sweden, were subjected to a baseline clinical and radiographic examination in 1978 and to a re-examination in 1990. During the study period, all participants received preventive and therapeutic measures according to decisions made by the dentist on duty in the clinics. The examinations involved assessments of number of remaining teeth, plaque, gingivitis, probing pocket depth, loss of probing attachment and periodontal bone height. The results showed that during the 12 years of monitoring, an average of 0.4 teeth were lost, The % of tooth sites with gingivitis was lower in 1990 (4%) than in 1978 (15%), but no major changes were found for the mean probing pocket depth. The mean probing attachment loss during the 12 years amounted to 0.5 mm. The tooth site analysis revealed that buccal sites had experienced more loss of attachment than lingual and approximal surfaces. Whereas no differences were observed between age groups with respect to longitudinal loss of attachment at lingual and approximal tooth sites, the youngest age group demonstrated more pronounced loss at buccal surfaces than older subjects. The radiographic assessments of the alveolar bone height revealed a mean longitudinal loss amounting to 0.2–0.4 mm in the various age groups. The time-lag comparison revealed less tooth mortality, lower gingivitis scores, less probing attachment loss and less periodontal bone loss in 1990 than in 1978 for subjects of the age 30–53 years, whereas the data were similar for older subjects. The improvement was the result of less breakdown at lingual and approximal sites, whereas no difference was evident for buccal surfaces.     

Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status. A 10-year longitudinal study

BACKGROUND, AIMS: The primary purpose of this study was to determine the association of salivary and gingival crevicular fluid (GCF) cotinine levels with periodontal disease status in smokers and non-smokers. METHODS: 147 male smokers and 30 male non-smokers were included in the current longitudinal study. The 177 individuals were part of a group of 200 subjects (89%) seen 10 years previously for a baseline survey. Oral hygiene indices, probing depth and attachment loss were recorded. Salivary and GCF cotinine levels of 58 smokers were determined by means of ELISA. RESULTS: Results indicated that no significant difference was found in subjects who smoked, when compared to subjects who did not smoke with respect to plaque accumulation and calculus deposits. Smokers, however, had fewer gingival bleeding sites. Cigarette smoking was associated with a greater increase in probing depth and attachment loss, as well as greater tooth loss at an earlier age. There was greater tooth loss in smokers than non-smokers (p < 0.001). 11 smokers became edentulous, while only 1 non-smoker lost all his teeth within 10 years. The degree of periodontal tissue breakdown was different in each age group with greater periodontal deterioration as age increased. All smokers had detectable salivary and GCF cotinine. Mean GCF cotinine was about 4x higher than mean salivary cotinine levels. Individuals who smoked > or = 20 pack years when compared to <20 pack years, had significantly higher saliva and GCF cotinine levels (p < or = 0.05). CONCLUSION: Neither salivary cotinine nor GCF cotinine was significantly correlated with probing depth, attachment loss and tooth loss (p > 0.05).     

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.     

The effect of different types of smoking habits on periodontal attachment

The association between different types of smoking (cigarette, Shesha and Argela) and periodontal attachment loss was investigated in the Riyadh area. The study group included 150 subject 20-60 years of age. Of this, 27.5% were cigarette smokers, 20.3% were Shesha smokers, 20.3% were Argela smokers, and 32% were non-smokers (females 24.2%: 74% males). The study was based on clinical examination, periodontal parameters recorded by one examiner (AS) and included measurement of pocket depth (PD 1) followed by measurement of recession from the CEJ to gingival margin (GR 2). Attachment loss (AL) was calculated by adding recession or by subtracting gingival overgrowth to measurements of probing depth. The readings were taken from buccal and lingual surfaces of all teeth except third molars. The influence of age, sex and different types of smoking consumption on these periodontal parameters was statistically evaluated using an analysis of variance (ANOVA). The effect of smoking on periodontitis showed no association with sex, but it was associated with age. By performing both univariate and multivariate tests. P-value for smoking and periodontitis were GR (p = 0.0001), PD (p = 0.0001), and AL (p = 0.0001). The result showed that there is increased loss of attachment in smokers than non-smokers. However, when comparing Shesha smokers to cigarette smokers it was found that Shesha smokers had a greater attachment loss (p = 0.0001), recession (p= 0.0001) and deeper pocket depth (p = 0.001) than cigarette and Argela smokers. These findings suggest that all types of tobacco consumption increase periodontal disease severity and Shesha smoking had a greater effect than cigarette and Argela smoking on disease severity. This study confirms that tobacco is an important risk factor for periodontal disease. Since Shesha smoking is widely used among Saudi subjects of both sexes, additional studies should be conducted to study the effect of Shesha smoking on the periodontium.     

Smoking, a weak predictor of periodontitis in older adults

BACKGROUND: The impact of smoking habits on periodontal conditions in older subjects is poorly studied. AIMS: To assess if a history of smoking is associated with chronic periodontitis and medical history in older subjects. MATERIAL AND METHODS: The medical and dental history was collected from 1084 subjects 60-75 years of age. Smoking history information was obtained from self-reports. Periodontal variables [clinical probing depth (PD)>/=5.0 mm, clinical attachment levels (CALs) >/=4.0 mm], and radiographic evidence of alveolar bone loss were assessed. RESULTS: 60.5% had never smoked (NS), 32.0% were former smokers (FS) (mean smoke years: 26.1 years, SD+/-13.1), and 7.5% were current smokers (CS) (mean smoke years 38.0 years, (SD+/-12.1). The proportional distribution of CAL >/=4.0 mm differed significantly by smoking status (NS and CS groups) (mean difference: 12.1%, 95% confidence interval (CI): 1.5-22.6, p<0.02). The Mantel-Haenszel common odds ratio between smoking status (CS+FS) and periodontitis (>20% bone loss) was 1.3 (p<0.09, 95% CI: 0.9-2.0) and changed to 1.8 (p<0.02, 95% CI: 1.3-2.7) with 30 years of smoking as cutoff. A weak correlation between number of years of smoking and CAL>/=4.0 mm was demonstrated (r(2) values 0.05 and 0.07) for FS and CS, respectively. Binary logistic forward (Wald) regression analysis demonstrated that the evidence of carotid calcification, current smoking status, gender (male), and the number of remaining teeth were explanatory to alveolar bone loss. CONCLUSIONS: A clinically significant impact on periodontal conditions may require 30 years of smoking or more. Tooth loss, radiographic evidence of carotid calcification, current smoking status, and male gender can predictably be associated with alveolar bone loss in older subjects.     

吸烟对慢性牙周炎患者牙槽骨缺损影响研究

目的 探讨吸烟对慢性牙周炎患者牙槽骨缺损的影响。方法 从2012年10月至2014年3月中国医科大学附属口腔医院牙周科确诊为慢性牙周炎的患者中选择吸烟与非吸烟患者各30例,分别作为吸烟组与非吸烟组。采用Florida探针检查其全口牙齿近中、远中、唇（颊）侧及舌（腭）侧4个位点的牙周探诊深度（PD）及附着丧失水平（AL）。采用锥形束CT（CBCT）对入选对象进行扫描,并应用其自带的NNT软件测量切牙区、尖牙区、前磨牙区及磨牙区牙齿近中、远中、唇（颊）侧及舌（腭）侧4个位点的牙槽骨缺损程度。结果 吸烟组与非吸烟组的PD和AL差异无统计学意义（P > 0.05）,吸烟组的平均牙槽骨缺损程度较非吸烟组重,差异有统计学意义（P < 0.05）。吸烟组与非吸烟组相比,相同牙位的各个位点牙槽骨缺损都较重,差异有统计学意义（P < 0.05）。两组中各牙位牙槽骨缺损程度最轻的部位位于尖牙区,缺损程度最重的部位位于磨牙区（P < 0.05）。吸烟组中相同牙位的不同位点之间牙槽骨缺损程度差异有统计学意义（P < 0.05）,其中缺损程度最重的位于上颌磨牙区腭侧;除下颌磨牙区远中位点和下颌切牙区颊舌侧位点外,上颌各牙位牙槽骨缺损程度较下颌相应牙位重,差异有统计学意义（P < 0.05）。非吸烟组中不同牙位相同位点的牙槽骨缺损程度自磨牙区向尖牙区呈逐渐减小的趋势;但下颌切牙区各位点牙槽骨缺损程度明显高于上颌切牙区,差异有统计学意义（P < 0.05）。结论 慢性牙周炎患者中,吸烟者较非吸烟者牙槽骨缺损重。吸烟对于慢性牙周炎患者牙槽骨缺损的影响存在牙位和位点特异性表现,最严重的部位位于上颌磨牙区腭侧。CBCT的应用有利于临床医生更好地了解牙槽骨缺损的形式,会对牙周病诊断及治疗提供更大的帮助。     

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??Abstract??Objective To study the effect of smoking on alveolar bone defect in patients with chronic peridontitis. Methods Select thirty patients respectively in smoking and non-smoking patients with chronic periodontitis??who are scanned by cone beam CT??CBCT??. Florida probe is applied to measure the PD and AL of all the teeth??including teeth's mesial??distal??buccal??lingual??. NNT software is applied to measure the average degree of alveolar bone defects in different regions??incisor area??canine area??premolar area and molar area??including teeth's mesial??distal??buccal??lingual??. Results The periodontal probing depth and attachment loss level had no significant difference??P > 0.05??in smoking group and non-smoking group??smoking group's alveolar bone defect degree was more serious than non-smoking group??the difference being statistically significant??P < 0.05??. Compared with the non-smoking group??alveolar bone defects in smoking group in each site of the same teeth were more serious??the difference being statistically significant??P < 0.05??. In two groups??the alveolar bone defect of canine area was the mildest??the most serious part of the alveolar bone defect in molar area??P < 0.05??. The alveolar bone defect had significant differences in smoking group among different sites of the same teeth??P < 0.05????while the most serious part in maxillary molars palatal. In smoking group??except for the distal sites of mandibular molar area and buccal and lingual sites of mandibular incisor area??the alveolar bone defect of maxillary teeth was more serious than mandibular teeth??the difference being statistically significant??P < 0.05??. In non-smoking group??the alveolar bone defect of the same site in different teeth showed a decreasing trend from the molar area to the canine area. But the alveolar bone defect of each point in mandibullar incisor area was significantly higher than maxillary incisor area??the difference being statistically significant??P < 0.05??. Conclusion In chronic periodontitis patients??the alveolar bone defect of smokers is more serious than non-smokers. The alveolar bone defects of smokers with chronic periodontitis present teeth and site-specific effects and the most serious area is located in maxillary molars palatal. The application of CBCT is conducive for the clinicians to have a better understanding of the alveolar bone defect forms??and provides more help to the diagnosis and treatment of periodontal disease.     

Periodontitis in smokers and non-smokers: intra-oral distribution of pockets

AIM: The purpose of the present study was to establish retrospectively whether the disease severity differs between smokers and non-smokers. METHODS: The study population consisted of 183 periodontitis patients, 79 smokers and 104 non-smokers. These subjects had been referred by general dentists to the Clinic for Periodontology, Utrecht, because of periodontal problems and were selected on the basis of the clinical diagnosis: adult periodontitis. The proportion of bleeding sites and the intra-oral distribution of probing pocket depth was evaluated. RESULTS: No statistically-significant differences between smokers (SM) and non-smokers (NSM) were found regarding the mean % of sites that bled upon probing (SM=76%, NSM=72%). Overall differences in the prevalence of probing depths > or =5 mm between smokers and non-smokers were found (SM=44%, NSM=34%). The proportion of sites with a probing pocket depth of > or =5 mm was consistently higher in smokers in the anterior, premolar and molar regions. The data also show that in the upper jaw at the anterior and premolar teeth, the largest differences are found between smokers and non-smokers. Smokers have more sites with a pocket depth > or =5 mm, especially on the lingual surfaces of these teeth. CONCLUSIONS: The present study indicates that cigarette smoking is a factor associated with deeper periodontal pockets and an intra-oral distribution that is suggestive of a local effect.     

Risk indicators for future clinical attachment loss in adult periodontitis. Tooth and site variables.

In an earlier report, we examined the relationship of patient-derived clinical and epidemiological variables to the risk for future clinical attachment loss (CAL) in chronic adult periodontitis. We determined that the extent of the patient's existing periodontal disease as measured by mean attachment loss (MAL) and the patient's age were the most important patient-derived risk indicators for CAL among those factors evaluated. In this study, we examined the tooth and site variables that were associated with CAL. Seventy-five patients with chronic adult periodontitis were followed for 6 months. Clinical data at baseline, including attachment level and probing depth, were obtained from six sites per tooth. The hazard rate for CAL at all sites was 2.0%, and 4.1% of teeth displayed at least one site with CAL. Mandibular and maxillary molars and maxillary premolars displayed the highest incidence of CAL (6.1%, 5.6%, 5.5%, respectively), while maxillary anterior teeth (1.8%) and mandibular premolar teeth (2.1%) demonstrated the lowest incidence. The greatest number of sites demonstrating CAL had an existing attachment level of 4 to 7 mm and a probing depth of less than or equal to 5 mm. When the data were converted to hazard rates, however, an increase in hazard rate was seen with increasing existing attachment loss or probing depth. When MAL was considered, patients with mild and moderate periodontitis demonstrated a relatively low incidence of CAL at sites with less than or equal to 7 mm of existing attachment loss. Patients with severe periodontitis exhibited greater hazard rates for sites with 0 to 3, 4 to 5 and 6 to 7 mm of existing attachment loss.(ABSTRACT TRUNCATED AT 250 WORDS)     

The effects of cigarette smoking on the periodontal condition of young Jordanian adults

BACKGROUND: Several studies have reported an association between smoking and periodontal destruction in young adults. AIMS: To investigate the effects of cigarette smoking on the periodontal condition of young Jordanian adults. METHODS: A case-control study of young adults between the ages of 20 and 35 years who were attending a dental hospital in Jordan for routine dental treatment. A group of 100 subjects who had smoked for at least 2 years were compared with 100 age- and sex-matched never smokers. Clinical measurements of plaque, bleeding on probing and probing depth were recorded and interproximal bone levels related to molar teeth were assessed from bitewing radiographs. RESULTS: The smokers had higher levels of plaque, more sites which bled in response to probing and a greater mean probing depth than never smokers. The unadjusted odds ratio for smoking to be associated with the presence of more than 10 pockets which were > or =4 mm was 3.08 (95% confidence interval 1.58-6.03). The proportion of measurable surfaces in smokers (22.7%) which had bone levels > or =3 mm below the cementoenamel junction was significantly higher (P<0.0001) than in never smokers (7.4%). Independent predictors of reduced bone levels in multivariate analysis were infrequent interdental cleaning (P=0.03), age of 30 or older (P=0.03) and smoking (P<0.0001). Within the multivariate analysis the adjusted odds ratio for smoking to be associated with reduced molar bone levels was 4.95 (confidence interval 2.48-9.88). CONCLUSIONS: It is concluded that cigarette smoking was a major environmental factor associated with accelerated periodontal destruction in the young adult Jordanians investigated.     

Baseline adjustment and change revisited: effect of smoking on change in periodontal status following periodontal therapy

Smokers have frequently been reported to have more severe periodontitis, to respond less favorably to periodontal therapy, and to show elevated rate of recurrence compared with non‐smokers. The aims of this study was to compare the results of baseline‐adjusted and ‐unadjusted analyses when assessing the effect of smoking on change in periodontal status following therapy and to discuss the methodological issues involved. This is a secondary analysis of data from 180 periodontitis patients enrolled in a randomized controlled clinical intervention trial. Information on smoking habits was elicited from the participants before, and 12 months after, therapy. The clinical parameters analyzed were probing pocket depth and clinical attachment level, using both simple analysis of change (SAC) and analysis of covariance (ancova ), adjusting for age, gender, and treatment group. The current smokers presented with more severe periodontitis at baseline than did former and never smokers. Results of the SAC indicated that the current smokers benefitted more from treatment than did former or never smokers, whereas the results of the baseline‐adjusted ancova indicated no such differences. Both sets of results are likely to be biased with respect to valid conclusions regarding the ‘causal’ effect of smoking. Possible sources of bias are discussed.     

Progression of periodontal disease in a maintenance population of smokers and non-smokers: a 3-year longitudinal study

BACKGROUND: Cigarette smoking is accepted as an important factor that increases the risk for the initiation and progress of chronic periodontitis. However, the effect of cigarette smoking on the recurrence of disease in patients undergoing regular maintenance therapy is less understood. Therefore, we set out to assess disease progression longitudinally in smoking and non-smoking subjects with chronic periodontitis undergoing periodontal maintenance therapy every 3 to 4 months. METHODS: A total of 108 subjects undergoing regular maintenance therapy for chronic periodontitis were followed over a 3-year period. Self-reports of smoking status were confirmed by analysis of exhaled carbon monoxide concentrations. Clinical parameters (plaque index [PI], bleeding on probing [BOP], clinical attachment loss [CAL], probing depth [PD], and tooth loss) were recorded at yearly reevaluation visits. The study was carried out in a university hospital setting. RESULTS: Longitudinal measurements were obtained from 81 (75%) subjects. There were no differences in inflammatory indices at baseline or over time (PI and BOP; both P >0.05) between smokers (N = 16; age: 54 +/- 6 years) and non-smokers (N = 65; age: 59 +/- 14 years). Likewise, there was no difference between the smoking groups with respect to disease progression (measured as changes in prevalence [number] and proportion [percentage] of progressing sites and as mean CAL, PD, and tooth loss; all P >0.05). CONCLUSION: In this small population, regular maintenance treatment in a cross-section of highly motivated subjects with chronic periodontitis seemed to be equally successful in preventing progressive periodontal tissue destruction in current smokers and current non-smokers.     

A retrospective study of periodontal disease severity in smokers and non-smokers

BACKGROUND: Smoking has been associated with increased risk of periodontitis. The aim of the present study was to compare the periodontal disease severity of adult heavy smokers and never-smokers referred for assessment and treatment of chronic periodontitis. METHODS: A random sample of patients with at least 20 teeth, stratified for smoking and age (5-year blocks, 35 to 55 years), was selected from an original referral population of 1,221 subjects with chronic adult periodontitis. Adequate records for 59 never-smokers and 44 subjects who smoked at least 20 cigarettes per day were retrieved. The percentage of alveolar bone support was measured from dental panoramic radiographs with a Schei ruler at x3 magnification with the examiner unaware of the smoking status. Probing depths at six sites per tooth were obtained from the initial consultation. RESULTS: There was no significant difference in age between groups. Smokers had fewer teeth (p<0.001), fewer shallow pockets (p<0.001) and more deep probing depths (p<0.001). The differences were greater in subjects 45 years of age and over. In this age group, smokers had approximately 13% more bone loss, 15% more pockets in the 4-6 mm category and 7% more pockets in the >/= 7 mm category than the never-smokers. CONCLUSIONS: This study confirmed that smokers had evidence of more severe periodontal disease than never-smokers. The differences increased with age confirming an exposure-related response.