Smoking and matrix metalloproteinases,neutrophil elastase and myeloperoxidase in chronic periodontitis

Oral Diseases (2010) 17 , 68–76 Objectives: To investigate possible relationship between smoking and serum concentrations of matrix metalloproteinase‐8,‐9 (MMP‐8, MMP‐9), tissue inhibitor of matrix metalloproteinases‐1 (TIMP‐1), neutrophil elastase (NE), myeloperoxidase (MPO) in chronic periodontitis (CP) patients relative to periodontally healthy subjects. Methods: Serum samples were obtained from 111 subjects before initiation of any periodontal intervention. Fifty‐five CP patients (39 non‐smokers, 16 smokers) and 56 periodontally healthy subjects (39 non‐smokers, 17 smokers) were recruited. Serum concentrations of MMP‐8 were determined by IFMA and MPO, MMP‐9, TIMP‐1, NE concentrations by ELISA. ANCOVA and Pearson correlation analysis was utilized for statistical analysis. Results: Serum MPO, NE concentrations were higher in smoker CP than non‐smoker CP patients (P = 0.002 and P < 0.001, respectively), whereas these were similar in smoker, non‐smoker periodontally healthy groups (P > 0.05). TIMP‐1 concentration was higher in non‐smoker CP than smoker CP group (P < 0.05). MMP‐9/TIMP‐1 ratios were higher in smoker CP than non‐smoker CP group (P = 0.01). MMP‐8 concentrations, MMP‐8/TIMP‐1 and MMP‐9/TIMP‐1 ratios in CP group were not significantly different from those in periodontally healthy group (P > 0.05). Conclusions: Our findings of significantly elevated serum MMP‐9, MPO, NE together with decreased TIMP‐1 in smoker CP patients than non‐smokers support that smoking together with periodontal destruction may expose/predispose to cardiovascular diseases.     

Trends in oral hygiene, gingival status and dental caries experience in 13-14-year-old Jordanian school children between 1993 and 1999

Aims : The aim of this survey was to describe the trends in oral hygiene, gingival condition and dental caries prevalence in 13–14‐year‐old northern Jordanian school children. Method : A dental survey was conducted in 1999, similar to one carried out in 1993, utilising 10 schools (666 pupils) and 20 schools (1,695) with children of 7th grade, respectively. These schools were chosen by a simple random method from the five geographic areas of the city. All participants had dental examinations for oral hygiene, gingival condition and dental caries experience using the Silness and Löe plaque index (PI.I), Löe and Silness gingival index (GI) and decayed (D), missing (M) and filled (F) teeth (DMFT) and surfaces (DMFS) codes, respectively. Results : Boys had higher plaque and gingival scores than girls in both groups. The mean PI.I and Gl scores of males and females were significantly higher in the 1993 survey than in 1999 (P < 0.05). Also, male and female children examined in 1993 had significantly higher caries experience, as measured by DT, DS, DMFT and DMFS scores than in 1999 (P < 0.01). No differences were found between M and F values of both groups. It is concluded that oral hygiene, gingival condition and dental caries has improved since 1993.     

Saliva and Serum Levels of B‐Cell Activating Factors and Tumor Necrosis Factor‐α in Patients With Periodontitis

Background: B‐lymphocytes play a central and critical role in the adaptive immune response against invading pathogens. This study evaluates saliva and serum levels of APRIL (a proliferation‐inducing ligand), B‐cell activating factor (BAFF), tumor necrosis factor‐α (TNF‐α), interleukin (IL)‐6, and IL‐10 in patients with chronic periodontitis (CP) or aggressive periodontitis (AgP) and periodontally healthy individuals. Methods: Twenty‐five patients with AgP, 20 patients with CP, and 20 periodontally healthy individuals were included. Smoking status was recorded, and all individuals were divided into non‐smokers and smokers. Saliva and serum samples were collected before clinical periodontal measurements. APRIL, BAFF, TNF‐α, IL‐6, and IL‐10 levels in serum and saliva samples were determined by enzyme‐linked immunosorbent assay. Statistical analysis was performed using multivariate analysis of variance and bivariate correlation. Results: Serum and saliva levels of TNF‐α, APRIL, BAFF, IL‐6, and IL‐10 were similar in CP and AgP groups. Serum levels of TNF‐α, APRIL, and BAFF and saliva levels of BAFF were significantly higher in periodontitis groups than healthy controls (P <0.05). Non‐smokers with CP or AgP had lower levels of saliva TNF‐α and APRIL and serum APRIL and IL‐6 than smokers with CP or AgP (P <0.05). Saliva APRIL and serum TNF‐α and IL‐6 levels were significantly higher in healthy smokers than healthy non‐smokers (P <0.05). Clinical periodontal parameters correlated positively with TNF‐family cytokines and negatively with IL‐10 (P <0.05). Conclusions: Within the limits of this study, it may be suggested that elevated salivary and serum TNF‐α, APRIL, and BAFF in patients with periodontitis may contribute to the dominance of B cells in periodontitis lesions. Moreover, higher levels in healthy smokers than non‐smoking counterparts may play a role in detrimental effects of smoking on periodontal tissues.     

The impact of smoking status on antioxidant enzyme activity and malondialdehyde levels in chronic periodontitis

Background: The aim of this study is to investigate the impact of smoking status on the systemic and local superoxide dismutase (SOD), glutathione peroxidase (GSH‐Px), and catalase (CAT) activities and malondialdehyde (MDA) levels in subjects with chronic periodontitis (CP). Methods: Sixty‐five CP patients (23 smokers [CP‐S], 23 former smokers [CP‐FS], and 19 non‐smokers [CP‐NS]) and 20 periodontally healthy non‐smoker controls (PH‐NS) were included in the study. After the clinical measurements, serum and gingival tissue samples were collected. SOD, GSH‐Px, and CAT activities and MDA levels in hemolysates and gingival tissue samples were spectrophotometrically assayed. Results: Blood MDA levels in all the periodontitis groups were higher than in the PH‐NS group but only the difference between CP‐FS and PH‐NS groups was significant (P <0.01). Gingival tissue MDA levels in the periodontitis groups were significantly higher than that in the control group (P <0.01). However, the control group had the highest gingival SOD, GSH‐Px, and CAT activities compared with all the periodontitis groups (P <0.01). The CP‐S group had the highest gingival MDA levels and SOD, GSH‐Px, and CAT activities among the periodontitis groups, whereas the lowest values were observed in the CP‐NS group (P <0.01). The blood and gingival MDA levels in the CP‐FS group were similar in the CP‐NS group, whereas they were lower than in the CP‐S group. Conclusions: Systemic and local MDA levels are increased by smoking in addition to the impact of periodontitis. The decreased local SOD, GSH‐Px, and CAT activities observed in periodontitis patients may increase with smoking.     

Clinical and Microbiologic Effects of Adjunctive Metronidazole Plus Amoxicillin in the Treatment of Generalized Chronic Periodontitis: Smokers Versus Non‐Smokers

Background: The aim of the present study is to evaluate the clinical and microbiologic effects of the adjunctive use of metronidazole (MTZ) and amoxicillin (AMX) in the treatment of smokers and non‐smokers with generalized chronic periodontitis (CP). Methods: Thirty‐two smokers and 32 non‐smokers were selected and received scaling and root planing (SRP) combined with MTZ (400 mg three times daily) and AMX (500 mg three times daily) for 14 days. Clinical and microbiologic examinations were performed at baseline and 3 months after SRP. Nine subgingival plaque samples per patient were analyzed using checkerboard DNA–DNA hybridization. Results: Both groups presented a significant improvement in all clinical parameters at 3 months after therapy (P <0.05). Non‐smokers showed lower mean number of sites with probing depth (PD) ≥5 mm after therapy. Fewer non‐smokers exhibited at least nine of these sites at 3 months after treatment. Non‐smokers also presented the greatest reductions in mean PD and gain in clinical attachment between baseline and 3 months after therapy at initially deep (PD ≥7 mm) sites (P <0.01). The most beneficial changes in the microbial profile were also observed in the non‐smoker group, which showed the lowest proportions of the orange complex at 3 months, as well as a significant increase in the proportions of Actinomyces species after treatment. Conclusion: Smokers with CP benefit less than non‐smokers from treatment by the combination of SRP, MTZ, and AMX.     

The Role of Smoking and Gingival Crevicular Fluid Markers on Coronally Advanced Flap Outcomes

Background: This study evaluates possible effects of smoking on the following: 1) biochemical content in gingival crevicular fluid (GCF) samples from sites of gingival recession and saliva; and 2) clinical outcomes of coronally advanced flap (CAF) for root coverage. Methods: Eighteen defects in 15 patients were included in each of the smoker and non‐smoker groups. Baseline cotinine, basic fibroblast growth factor, vascular endothelial growth factor, platelet‐derived growth factor, interleukin (IL)‐8, IL‐10, IL‐12, tumor necrosis factor‐α, matrix metalloproteinase (MMP)‐8, MMP‐9, and plasminogen activator inhibitor‐1 levels were determined in GCF and saliva samples. CAF with microsurgery technique was applied. Plaque index, papilla bleeding index, recession depth (RD), recession width (RW), and root surface area were evaluated at baseline and postoperative months 1, 3, and 6. Probing depth, clinical attachment level (CAL), and keratinized gingival width (KGW) was recorded at baseline and month 6. Percentage of root coverage and complete root coverage were calculated at postoperative months 1, 3, and 6. Results: All biochemical parameters were similar in the two groups apart from the definite difference in salivary cotinine concentrations (P = 0.000). Compared with the baseline values, RD, RW, CAL, and root surface area decreased, and KGW increased, with no significant difference between the study groups. CAL gain, percentage of root coverage, and complete root‐coverage rates were similar in the study groups. Conclusion: Similar baseline biochemical data and comparably high success rates of root coverage with CAF in systemically and periodontally healthy smokers versus non‐smokers suggest lack of adverse effects of smoking on clinical outcomes.     

Supervised toothbrushing and oral health education program in Kuwait for children and young adults with Down syndrome

The authors report on the effectiveness of a school-based, supervised toothbrushing program among a group of 112 children with Down syndrome in Kuwait. The study involved 45 boys and 67 girls, who ranged in age from 11–22 years (mean, 14.8 years). The participants had moderate mental retardation and attended one of two special needs schools. Plaque was scored according to the Silness and Loe plaque index and gingivitis according to the Loe and Silness gingival index. Supervised toothbrushing and dental health education sessions were conducted twice a week. The program was evaluated at the end of three months. The mean plaque score decreased from 1.93 to 0.95 (p < 0.001), and the mean gingival score from 2.00 to 0.83 (p < 0.001). This three-month supervised toothbrushing program was effective in reducing plaque and gingivitis scores, but the key to long-term success of the program is sustaining the children's motivation to make oral hygiene a part of their daily life.     

Flow-cytometric analysis of T-lymphocyte subsets after different treatment methods in smokers and non-smokers with chronic periodontitis

Aim : To determine any change in T‐lymphocyte subsets after applying different treatment methods in smokers and non‐smokers with chronic periodontitis. Participants : 50 adults with chronic periodontitis. Method : The subjects were divided into smokers and non‐smokers. Biopsy samples were taken from the gingival pocket wall tissues at sites with chronic periodontitis before treatment, after initial treatment, after curettage and after flap operation and tested for CD4⁺, CD8⁺ lymphocyte and CD4/CD8 ratio values. Gingival pocket depth, gingival index (Gl‐Löe‐Silness) and plaque index (Pl‐Silness‐Löe) scores were also recorded. Analysis aimed at determining the relation between the clinical measurements and the laboratory results. Results : Flow cytometry findings in both groups showed that CD4⁺ and CD8⁺ lymphocyte values before treatment were under the normal value while the CD4⁺/CD8⁺ ratio was within normal distribution interval. The lymphocyte values observed in the smokers were found to be lower than those in the non‐smokers. After treatment the difference between the lymphocyte values in smokers and non‐smokers was found to be statistically significant. However, the difference between the CD4/CD8 rate obtained in smokers and non‐smokers was not found to be statistically significant. Conclusions : The lymphocyte values observed in smokers were found to be lower than those in non‐smokers after applying different treatment methods and the local immune response was poor in the smokers.     

Evaluation of Salivary Procalcitonin Levels in Different Periodontal Diseases

Background: The present study aims to investigate the levels of salivary procalcitonin (ProCT) in patients with different periodontal diseases. Methods: Seventy‐two non‐smokers are included in this study: 21 individuals with chronic periodontitis (CP), 14 individuals with generalized aggressive periodontitis (GAgP), 18 individuals with gingivitis (G), and 19 periodontally healthy (H) participants. Clinical periodontal parameters, including probing depth (PD), clinical attachment level (CAL), plaque index, and gingival index (GI), were assessed in all participants. Saliva samples were collected and examined for evaluating ProCT levels. Results: It was found that the median (interquartile range) salivary ProCT level was lowest in the H group: 0.00 (0.09) ng/mL; followed by the G group: 0.09 (0.11) ng/mL; the CP group: 0.15 (0.29) ng/mL; and highest in the GAgP group 0.28 (0.68) ng/mL. These differences were statistically significant between the H group and the other groups (P <0.05). There were positive correlations between the mean salivary ProCT level and GI, CAL, and PD. Conclusion: According to the present results, ProCT might play a role during periodontal inflammation, and an elevated salivary ProCT level is suggested as a potential biomarker for periodontal diseases.     

Effects of treatment on soluble tumour necrosis factor receptor type 1 and 2 in chronic periodontitis

Aim: We reported that soluble tumour necrosis factor receptor type 2 (sTNFR2)/type 1 (sTNFR1) ratios in gingival crevicular fluid (GCF) decreased as the severity of chronic periodontitis (CP) increased. This study investigated the effects of the periodontal treatment on TNF‐α, sTNFR1 and R2 in GCF and serum of CP patients. Material and Methods: Thirty‐five serum and 90 GCF samples were obtained from 35 CP patients (23 non‐smokers and 12 smokers) at baseline and after treatment. The levels of TNF‐α, sTNFR1 and R2 in serum and GCF were quantified by enzyme‐linked immunosorbant assay. Results: No significant differences were found in the serum levels of TNF‐α, sTNFR1 and R2 and the ratio of sTNFR2/R1 between baseline and after treatment. After treatment, sTNFR1 and R2 levels in GCF of non‐smokers and smokers were significantly decreased compared with baseline. However, the sTNFR2/R1 ratio was significantly increased (non‐smoker: 0.56±0.03–0.84±0.03, p<0.0001; smoker: 0.59±0.06–0.85±0.04, p=0.0019). There were no significant differences between non‐smoking and smoking CP groups in serum and GCF. Conclusion: The ratio of sTNFR2/R1 in GCF significantly increased after treatment, and could be related to the clinical state of CP.     

Prevalence of periodontitis and DMFT index in patients with Crohn's disease and ulcerative colitis

Aim: To compare the prevalence of periodontal disease and the decayed, missing and filled teeth (DMFT) index in patients with Crohn's disease (CD) and ulcerative colitis (UC) with those without these diseases. Material and Methods: Ninety‐nine CD (39.0 SD±12.9 years), 80 UC (43.3 SD±13.2) and 74 healthy controls (40.3 SD±12.9) were compared for DMFT index and presence of periodontitis. Probing pocket depth (PPD), clinical attachment loss (CAL), bleeding on probing (BOP), plaque and DMFT index were measured on all subjects. The presence of periodontitis was defined as having CAL 3 mm in at least four sites in different teeth. Results: Significantly more patients with UC (90.0%; p<0.001) and CD (81.8%; p=0.03) had periodontitis than controls (67.6%). Among smokers, UC patients had significantly more periodontitis. CD had a greater mean DMFT score (18.7 versus 13.9; p=0.031) compared with controls and UC had greater median PPD (2.2 versus 1.7 mm; p<0.0001) than controls. Among non‐smokers, CD (2.4 mm; p<0.0001) and UC showed deeper pockets (2.3 mm; p<0.0001) compared with controls (1.5 mm). UC had a greater mean DMFT score (15.3 versus 12.1; p=0.037) compared with controls. Conclusions: CD and UC patients had higher DMFT and prevalence of periodontitis than controls, but smoking was an effect modifier.     

Efficacy of Local and Systemic Antimicrobials in the Non‐Surgical Treatment of Smokers With Chronic Periodontitis: A Systematic Review

Background: The aim of this systematic review is to evaluate whether use of local or systemic antimicrobials would improve clinical results of non‐surgical periodontal therapy for smokers with chronic periodontitis (CP). Methods: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, and The Cochrane Central Register of Controlled Trials were searched up to and including March 2016. Randomized clinical trials of duration of at least 6 months were included if they reported on treatment of smokers (≥10 cigarettes per day for minimum 12 months) with CP with non‐surgical periodontal therapy either alone or associated with local or systemic antimicrobials. Random‐effects meta‐analyses were undertaken to evaluate mean differences in probing depth (PD) and clinical attachment level (CAL). Results: Of 108 potentially eligible articles, seven were included. Most individual studies (75%) testing locally delivered antibiotics reported that smokers benefited from this treatment approach. Pooled estimates found additional PD reduction of 0.81 mm (P = 0.01) and CAL gain of 0.91 mm (P = 0.01) at sites with baseline PD ≥5 mm. Conversely, meta‐analysis on systemic use of antimicrobials failed to detect significant differences in mean changes from baseline, and only one trial supported their use. Conclusions: In smokers with CP, adjunctive use of local antimicrobials improved efficacy of non‐surgical periodontal therapy in reducing PD and improving CAL at sites presenting PD ≥5 mm before treatment. Current evidence does not demonstrate similar gains when scaling and root planing plus systemic antimicrobial/antibiotics were associated with therapy.     

Saliva and Serum Levels of Pentraxin‐3 and Interleukin‐1β in Generalized Aggressive or Chronic Periodontitis

Background: Pentraxin‐3 (PTX3) is a multifactorial protein involved in immunity and inflammation, which is rapidly produced and released by several cell types in response to inflammatory signals. The aim of the present study is to evaluate saliva, serum levels of PTX3, interleukin (IL)‐1β in patients with generalized chronic periodontitis (CP) or aggressive periodontitis (AgP), and periodontally healthy individuals. Methods: A total of 94 participants (25 patients with AgP, 25 patients with CP, and 44 periodontally healthy individuals matched with AgP and CP groups) were recruited. Saliva and serum samples were collected. Clinical periodontal measurements were recorded. PTX3, IL‐1β levels in serum, and saliva samples were determined by enzyme‐linked immunosorbent assay. Data were tested statistically using Kruskal‐Wallis, Mann‐Whitney U, and Spearman ρ rank test. Results: Serum and saliva data were similar in CP and AgP groups. Saliva levels of IL‐1β were significantly higher in the AgP and CP groups than controls (P <0.05). Salivary PTX3 levels were similar in the CP and control groups. Significantly higher salivary concentrations of PTX3 were detected in the AgP group than the control group (P <0.05). Saliva PTX3 levels correlated with plaque index and bleeding on probing in the CP group (P <0.05). Serum and saliva PTX3 levels correlated with those of IL‐1β in the AgP group (P <0.05). Conclusions: It may be suggested that PTX3 is related with periodontal tissue inflammation. Its salivary concentrations may have a diagnostic potential. Additional intervention and follow‐up studies coupling PTX3 concentrations with microbiologic analysis would better clarify its role in periodontal diseases.     

Healing response of gingival recession defects following guided tissue regeneration procedures in smokers and non-smokers

Abstract This retrospective study evaluated healing response in gingival recession defects following guided tissue regeneration (GTR) in smokers. 22 systemically healthy patients who had been treated for deep (4 mm), buccal. Miller's class I or II gingival recession defects with ePTFE membranes were included. Patients were regarded as smokers if they smoked more than 10 cigarettes/day at the time of surgical procedure. Occasional and former smokers were excluded. 9 patients (6 male, mean age 29 years) were smokers, while 13 patients (4 male, mean age 35 years) were non smokers. Clinical parameters, recorded pre surgery and at 6 months post surgery. included defect-specific plaque (DPI) and bleeding on probing (BoP) scores, recession depth (RD). probing depth (PD). clinical attachment level (CAL). and keratinized tissue width (KG). Extent of membrane exposure (ME) and newly formed tissue (NFT) gain were assessed at membrane removal. Statistical analysis revealed no significant differences between smokers and non-smokers in demographic and pre surgery defect characteristics. DPI and BoP scores were similar pre surgery and remained almost unchanged thorough out the observation interval in both groups. ME was significantly greater in smokers (2.6±1.4 mm) than in non smokers (1.3±0.6 mm). NFT gain was 2.8±1.0 mm in smokers and 3.6±1.4 mm in non-smokers, the difference being not statistically significant. Smokers showed significantly less RD reduction and root coverage (2.5±1.2 mm and 57%, respectively) compared to non-smokers (3.6±1.1 mm and 78%, respectively). In conclusion, the results indicate that treatment outcome following GTR in gingival recession defects is impaired in cigarette smokers.     

Clinical and Immunoinflammatory Evaluation of One‐Stage Full‐Mouth Ultrasonic Debridement as a Therapeutic Approach for Smokers With Generalized Aggressive Periodontitis: A Short‐Term Follow‐Up Study

Background: This study aims to evaluate the effect of one‐stage full‐mouth ultrasonic debridement (OSFMUD) on clinical and immunoinflammatory parameters in smokers with generalized aggressive periodontitis (GAgP). Methods: Fourteen smoking and 14 non‐smoking patients with GAgP were selected. After initial supragingival therapy, patients were treated by OSFMUD. Full‐mouth parameters evaluated were: 1) plaque index (PI); 2) bleeding scores (BS); 3) probing depth (PD); and 4) clinical attachment level (CAL). Clinical evaluation was performed, and gingival crevicular fluid (GCF) was collected for selected sites (ss) at baseline and 1, 3, and 6 months. GCF was analyzed via enzyme‐linked immunosorbent assay for: 1) receptor activator of nuclear factor‐κ B ligand (RANKL); 2) osteoprotegerin (OPG); 3) interleukin (IL)‐6; and 4) tumor necrosis factor (TNF)‐α, whereas secreted osteoclastogenic factor of activated T‐cells (SOFAT) was evaluated by Western blotting. Results: Significant reduction (P <0.05) was observed between baseline and 6 months for: 1) PI; 2) BS; and 3) PD, with no difference between smoking and non‐smoking patients (P >0.05). Regarding CAL, only non‐smoking patients showed a significant decrease (P <0.05). Significant reduction (P <0.05) was observed in both groups for: 1) PIss; 2) PDss; 3) bleeding on probing; and 4) relative CAL. Smoking and non‐smoking patients presented significantly decreased levels of IL‐6 and TNF‐α over time (P <0.05); however, no difference was observed between groups (P >0.05). RANKL was significantly different (P <0.05) only for non‐smokers at 6 months, whereas OPG was not significant (P >0.05). SOFAT expression was significantly lower (P <0.05) after OSFMUD for non‐smokers only. Conclusion: Considering the clinical and immunoinflammatory parameters evaluated in this short‐term follow‐up study, it can be concluded that OSFMUD can be used as an alternative treatment for smokers with GAgP.     

The Cardiff Dental Survey: oral hygiene, gingival and periodontal health in relation to smoking in young adults

Abstract: Objective: To examine the relationship between tobacco smoking, oral hygiene, gingival and periodontal health in young adults. Study design: Cross‐sectional (conducted in the course of a cohort study). Setting: Cardiff, UK, 1989 and 2000. Methods: Plaque was recorded, as was presence or absence of bleeding on probing and loss of attachment (LA). Information concerning tobacco smoking was obtained from questionnaire data. Results: At age 19–20 years, smokers had statistically significantly (P < 0.01) higher whole mouth mean plaque scores than non‐smokers. Whole mouth mean bleeding scores, however, were similar in smokers and non‐smokers. The relationship of plaque to smoking was very similar at age 30–31, yet bleeding scores were approximately 25% lower in smokers than in non‐smokers (P < 0.01). Whole mouth LA scores showed small, statistically non‐significant differences between smokers and non‐smokers. At the age of 30–31 years, gender and social class had a negligible confounding effect on oral hygiene, gingival and periodontal health in smokers and non‐smokers. Conclusions: Smokers consistently demonstrated poorer oral hygiene than non‐smokers. The effect of smoking in reducing gingival bleeding was already apparent at age 19–20 years despite the fact that, at this time, subjects might be assumed to have been exposed to a relatively small dose of tobacco over a short period of time. In the follow‐up study conducted at the age of 30–31 years, the impact of smoking on the periodontal tissues was, as expected, more pronounced.     

Altered Antigenic Profiling and Infectivity of Porphyromonas gingivalis in Smokers and Non‐Smokers With Periodontitis

Background: Cigarette smokers are more susceptible to periodontal diseases and are more likely to be infected with Porphyromonas gingivalis than non‐smokers. Furthermore, smoking is known to alter the expression of P. gingivalis surface components and compromise immunoglobulin (Ig)G generation. The aim of this study is to evaluate whether the overall IgG response to P. gingivalis is suppressed in smokers in vivo and whether previously established in vitro tobacco‐induced phenotypic P. gingivalis changes would be reflected in vivo. Methods: The authors examined the humoral response to several P. gingivalis strains as well as specific tobacco‐regulated outer membrane proteins (FimA and RagB) by enzyme‐linked immunosorbent assay in biochemically validated (salivary cotinine) smokers and non‐smokers with chronic periodontitis (CP: n = 13) or aggressive periodontitis (AgP: n = 20). The local and systemic presence of P. gingivalis DNA was also monitored by polymerase chain reaction. Results: Smoking was associated with decreased total IgG responses against clinical (10512, 5607, and 10208C; all P <0.05) but not laboratory (ATCC 33277, W83) P. gingivalis strains. Smoking did not influence IgG produced against specific cell‐surface proteins, although a non‐significant pattern toward increased total FimA‐specific IgG in patients with CP, but not AgP, was observed. Seropositive smokers were more likely to be infected orally and systemically with P. gingivalis (P <0.001), as determined by 16S RNA analysis. Conclusion: Smoking alters the humoral response against P. gingivalis and may increase P. gingivalis infectivity, strengthening the evidence that mechanisms of periodontal disease progression in smokers may differ from those of non‐smokers with the same disease classification.     

Elevated Levels of a Disintegrin and Metalloproteinase 8 in Gingival Crevicular Fluid of Patients With Periodontal Diseases

Background: A disintegrin and metalloproteinase 8 (ADAM8) is involved in inflammation and is essential for osteoclastogenesis. Elevated ADAM8 levels are detected in human serum and other body fluids in several inflammatory conditions. Therefore, we hypothesized that ADAM8 levels are also raised in gingival crevicular fluid (GCF) of patients with periodontal diseases. Methods: Forty‐five patients with periodontal diseases (n = 15 for each group: the group of patients with gingivitis, the group with aggressive periodontitis [AgP], and the group with chronic periodontitis [CP]) and 15 volunteers who exhibited healthy gingiva were recruited. Four periodontal parameters, gingival index, plaque index, probing depth, and clinical attachment level, were recorded before GCF collection. The presence of ADAM8 in GCF was shown by immunoblotting using anti‐human ADAM8 polyclonal antibody against its prodomain, and the ADAM8 levels were measured by an enzyme‐linked immunosorbent assay. Results: Four immunoreactive bands at 120, 70, 50, and <30 kDa were detected in the groups of patients with periodontitis, whose intensities were stronger than those in the group of patients with gingivitis, consistent with significantly greater ADAM8 levels in both groups of patients, with either CP or AgP, than those in the group of patients with gingivitis and in the group that was healthy (P <0.001). Moreover, the ADAM8 levels correlated significantly with the four periodontal parameters (P <0.001), indicating that ADAM8 levels are positively associated with the degree of periodontal tissue inflammation and destruction. Conclusions: The ADAM8 levels are elevated in the GCF of patients with periodontal diseases, including gingivitis, CP, and AgP, in comparison to control participants who are healthy, and they correlate with four clinical parameters that reflect the degree of disease severity.     

Locally Delivered 1% Metformin Gel in the Treatment of Smokers with Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Metformin (MF) (1,1‐dimethylbiguanide HCl) is one of the most commonly used oral antihyperglycemic agents for the treatment of type 2 diabetes mellitus. Recently, MF has been shown to have bone‐sparing properties. The present study is designed to investigate the effectiveness of MF 1% in an indigenously prepared, biodegradable, controlled‐release gel, as an adjunct to scaling and root planing (SRP) in treatment of vertical defects in smokers with generalized chronic periodontitis (CP). Methods: Fifty patients were categorized into two treatment groups: SRP plus 1% MF and SRP plus placebo. Clinical parameters were recorded at baseline and at 3 and 6 months; they included plaque index (PI), modified sulcus bleeding index (mSBI), probing depth (PD), and clinical attachment level (CAL). At baseline and after 6 months, intrabony defect (IBD) fill was radiologically assessed using computer software. Results: Mean PD reduction and mean CAL gain were found to be greater in the MF group than the placebo group at all visits. Furthermore, a significantly greater mean percentage of bone fill was found in the MF group (26.17% ± 6.66%) than the placebo sites (3.75% ± 8.06%) (P <0.001). Conclusion: There was greater decrease in mSBI and PD and more CAL gain with significant IBD fill at vertical defect sites treated with SRP plus locally delivered MF, versus SRP plus placebo, in smokers with generalized CP.