Oral hygiene compliance and gingivitis expression in cigarette smokers

The compliance with an oral hygiene intervention program and its effect on oral cleanliness and gingivitis was studied in smokers and non-smokers. The study group represented patients with regular dental attendance. It comprised 68 patients 21-60 yr of age, including 28 habitual smokers. The program included toothbrushing with an electric toothbrush for 12 months. Oral cleanliness was evaluated according to a percentage plaque index and gingivitis according to the percentage of bleeding sites. The compliance with the oral hygiene program was very high among smokers and non-smokers. Plaque index at baseline was very similar in smokers and non-smokers and remained so during the course of the investigation. Following the introduction of the oral hygiene program, plaque index decreased in both groups, and there were no statistically significant differences between the two groups. In spite of the similarity in plaque index, gingival bleeding was significantly lower in smokers than non-smokers. The results suggest that smokers and non-smokers do not differ with respect to habitual oral hygiene or compliance with hygiene programs. In smokers, however, the clinical gingivitis expression in response to plaque is suppressed.     

Effect of cigarette smoking on the transition dynamics in experimental gingivitis

This paper reports the findings of an experimental gingivitis study conducted in smokers and non-smokers. 33 volunteers were examined and underwent prophylaxis during a period of 4 weeks. 28 subjects who showed a plaque index less than 0.20 on all prophylaxis occasions were permitted to continue in the study. Subjects then had their gingival status recorded, had their teeth polished and were requested to abstain from all oral hygiene measures for the following 21 days. After 5 days, 10 days and 21 days, plaque and gingival status were recorded using the criteria of the plaque index and gingival index. After the examination on day 21, the teeth were polished and oral hygiene was re-instituted. Following 2 weeks of supervised oral hygiene, recordings of plaque and gingival status were performed. At the initial examination, there was no difference between the clinical assessment of plaque and gingival status in smokers and non-smokers. Similar amounts of plaque accumulated in the 2 groups during the period of no oral hygiene, but smokers exhibited less gingival inflammation assessed clinically than non-smokers. This difference occurred as a result of an apparently lowered incidence rate and a markedly higher recovery rate in smokers compared to non-smokers. These findings may indicate that smokers for reasons yet unknown have a reduced capacity to mount and maintain an effective defense reaction to a given plaque challenge.     

The influence of cigarette smoking on the development of experimental gingivitis

The aim of this investigation was to study the influence of cigarette smoking on the development of gingivitis. Experimental gingivitis was induced in the mandibular anterior region by abstention from oral hygiene for 28 days. The study group consisted of 20 healthy dental students, 10 of whom were regular smokers. The clinical parameters studied were gingival bleeding on probing (60 g), gingival redness and gingival exudate. The results showed that the plaque formation rate was similar in both groups. However, smokers displayed a less pronounced gingival inflammatory reaction as compared with non-smokers. Concerning gingival bleeding and gingival redness, the reaction in smokers was significantly less elevated from d 14 through d 28 and concerning the amount of gingival exudate it was significantly less elevated from d 21 through d 28. The differences between groups tended to increase with time. These results suggest that the inflammatory gingival response to accumulating plaque may be suppressed under the influence of cigarette smoking.     

Bleeding on probing in smokers and non-smokers in a steady state plaque environment

An altered gingival inflammatory response to supragingival plaque in smokers had been claimed by several authors. Relatively limited information exists with regard to the consistency of naturally occurring plaque and bleeding upon probing within the oral cavity under usual oral hygiene measures. The aims of the present study were to describe the distribution of tooth surfaces covered by supragingival plaque and gingival units bleeding upon probing in a steady state environment of no dental intervention. In addition relative consistency of plaque and bleeding was investigated. 65 volunteers, 14 women and 51 men in the age range of 19 to 30 years, participated. 33 volunteers were heavy smokers and 32 non-smokers. Clinical examinations revealed mild, plaque-induced gingivitis with no overt destructive periodontitis. Within a 6-month period. presence and amount of plaque, calculus and gingival bleeding was site-specifically assessed four times, i.e., every 8 weeks. Well-defined, symmetric and consistent patterns of plaque and calculus distribution within the oral cavity were observed, which were rather identical in smokers and non-smokers. Smokers had evenly more plaque in all regions of the oral cavity. In contrast, there was no obvious pattern of bleeding upon probing. Consistency of observations was considerably lower than for plaque scores. This was particularly true for smokers, where the association between bleeding scores was generally smaller than in non-smokers. A large portion of the variation of gingival bleeding may be due to presently unknown factors other than plaque and calculus with considerable consequences for preventive programmes.     

Evaluation of 2 methods to assess gingival bleeding in smokers and non-smokers in natural and experimental gingivitis

Abstract. The purpose of the present study was to compare the bleeding tendency as elicited by probing the marginal gingiva (BOMP) and probing to the bottom of the pocket (BOPP) in smokers and non-smokers in natural gingivitis and during experimental gingivitis, 11 smokers (sm) and 14 non-smokers (nsm) were recruited. When they had less than 20% approximal bleeding sites, they entered a 14-day trial period of experimental gingivitis'. Subjects returned 30 days later, after resuming normal oral hygiene procedures, for a final gingival assessment. A split-mouth design was chosen using 2 contra-lateral quadrants for each index (being either BOMP or BOPP). A consistently higher bleeding score of approximately 10% was observed by probing to the bottom of the pocket. At day 14 with both indices, a significant difference between smokers and non-smokers was detected (BOMP: sm=15%, nsm = 30%; BOPP: sm = 27%, nsm=44%). The increment between gingival health and experimental gingivitis was significantly higher in non-smokers than in smokers but comparable for both indices (BOMP: sm=8%, nsm = 23%; BOPP: sm=9%, nsm=26%). Probing to the bottom of the pocket results in significantly more bleeding in gingival health and gingivitis as compared to probing of the marginal gingiva. This shows that evaluation of the gingival condition with BOMP, the method of choice with respect to gingivitis, can be used as a parameter for inflammation when comparing smokers and nonsmokers. The suppressed inflammatory response to plaque accumulation, as observed in smokers, indicates that they should be identified as a separate group when they participate as panellists in (experimentally induced) gingivitis     

体验式口腔卫生指导方法在单纯性牙龈炎患者中的应用效果研究

目的　探讨体验式口腔卫生指导方法在单纯性牙龈炎患者中的应用效果。方法　选取2017年1—7月于青岛大学医学院附属青岛市市立医院口腔医学中心就诊的单纯性牙龈炎患者62例，随机均分为试验组（32例）和对照组（30例）。试验组患者采用体验式口腔卫生指导方法教授患者刷牙，对照组患者采用模型教授法，研究两组患者在口腔护理方面的差异，分析两组患者治疗1个月后的菌斑指数、探诊出血（bleeding on probing，BOP）阳性位点数及BOP百分率。结果　治疗前两组患者的菌斑指数、BOP阳性位点数及BOP百分率差异均无统计学意义（P＞0.05）；治疗1个月后，两组患者的上述指标均有改善（P＜0.05），其中试验组的菌斑指数、BOP阳性位点数及BOP百分率均有更加显著的改善（P＜0.01），且两组患者上述指标的差异具有统计学意义（P＜0.05）。结论　对单纯性牙龈炎患者采用体验式口腔卫生指导方法，可显著改善菌斑指数、BOP阳性位点数及BOP百分率，值得在临床上推广。     

Influence of cigarette smoking on vascular reaction during experimental gingivitis

Abstract — The influence of cigarette smoking on the vascular reaction during plaque induced gingivitis was studied in humans for 28 days. Sixteen healthy dental students, 8 smokers and 8 non-smokers, aged 19–42 yr, volunteered for the experiment. A numerical method was used for the evaluation of the vascular reaction. With the aid of stereophotographs changes in the number of gingival vessels were followed during the experiment. It was found that the number of vessels identified increased over time during the experiment in both smokers and non-smokers. However, in spite of the fact that the plaque accumulation rate was equal, the vascular reaction was less pronounced in smokers. At the end of the experiment after 28 days the intensity of the vascular reaction in smokers was only 50% of that observed in non-smokers. The difference was statistically significant at the P -level of 0.05. One week after termination of the experiment and reinstitution of oral hygiene the number of gingival vessels equaled the pre-experimental values in both groups. The results indicate that the vascular reaction associated with plaque induced gingivitis is suppressed in smokers.     

Influence of cigarette smoking on vascular reaction during experimental gingivitis

The influence of cigarette smoking on the vascular reaction during plaque induced gingivitis was studied in humans for 28 days. Sixteen healthy dental students, 8 smokers and 8 non-smokers, aged 19-42 yr, volunteered for the experiment. A numerical method was used for the evaluation of the vascular reaction. With the aid of stereophotographs changes in the number of gingival vessels were followed during the experiment. It was found that the number of vessels identified increased over time during the experiment in both smokers and non-smokers. However, in spite of the fact that the plaque accumulation rate was equal, the vascular reaction was less pronounced in smokers. At the end of the experiment after 28 days the intensity of the vascular reaction in smokers was only 50% of that observed in non-smokers. The difference was statistically significant at the P-level of 0.05. One week after termination of the experiment and reinstitution of oral hygiene the number of gingival vessels equaled the pre-experimental values in both groups. The results indicate that the vascular reaction associated with plaque induced gingivitis is suppressed in smokers.     

Effect of tobacco- smoking on periodontal tissue of 15-year-old schoolchildren

193 schoolchildren 15 years of age were grouped as non-smokers and smokers on the basis of their smoking habits. In all cases an X-ray examination was made of the lower incisors, and a record was made of plaque and gingival index. The resulting values were compared between non-smokers and smokers. The following conclusions could be drawn. Oral hygiene and gingival inflammation are directly correlated. Oral hygiene is worse in smokers than in non-smokers. The gingival status is worse in smokers than in non-smokers. When investigating gingival status on the same level of oral hygiene, no significant difference is found between the groups.     

Oral microbiota in smokers and non-smokers in natural and experimentally-induced gingivitis

Abstract. The present study primarily aimed at investigating the oral microbiota in smokers and non-smokers with established gingivitis and monitoring its composition during experimental gingivitis. Secondly, it aimed at examining whether the composition of the microbiota is associated with different levels of gingival inflammation during this experimental gingivitis trial. For this purpose, 25 non-dental university students with gingivitis were recruited. 11 subjects were smokers and 14 were non-smokers. After achieving gingival health, they entered a 14-day experimental gingivitis trial. Plaque and bleeding were assessed before entering into the study (intake), at day 0. day 5 and at day 14 of the experiment. Microbiological samples from mucosal sites and dental plaque (taken at intake, day 0, and day 14) were analysed for the presence of Actinomyces species. Actinobacillus actinomycetemcomitans, Bacteroides forsythus, Campylobacter rectus, Fusobacterium nucleatum, Peptostreptococcus micros. Porphyromonas gingivalis, Prevotella intermedia and Streptococcus species. At day 14 of the experimental period, the level of plaque formation was not different between smokers and nonsmokers, but bleeding scores were lower in smokers than in non-smokers (15% and 30%) respectively, p= 0.01). The change from natural gingivitis to a state of gingival health and a subsequent change from gingival health to experimentally induced gingivitis was accompanied by quantitative alterations in the cultivable microbiota in both groups. Changes were most prominent in the transition from gingival health to experimental gingivitis and were found in dental plaque for Actinomyces species, C. rectus, F. nucleatum, and P. intermedia. Within the group of non-smokers, a distinction was made between subjects with a‘weak’or 'strong’inflammatory response. No relationship with a single bacterial species could be established which would likely explain the differences in levels of inflammation. It is concluded that differences in response to experimental gingivitis are not caused by major differences in the composition of the oral microbiota.     

实验性龈炎的细菌成分变化的分析

目的:观察实验性龈炎发展过程中细菌成分的变化,分析细菌成分与临床指标间的关系。方法:选取11名受试者,在其停止口腔卫生措施后21d内(第0、2、4、7、14、21天)和恢复口腔卫生措施1周后(第28天)取龈下菌斑作刚果红涂片,分析细菌成分;同时记录临床指标的变化。结果:在实验性龈炎发展过程中,螺旋体的百分含量在基线时最低,随着停止刷牙的时间的延长而逐渐增加,并达到峰值,与基线存在显著性差异(P<0.05),恢复刷牙后迅速降低。其百分含量与各临床指标(菌斑指数、出血指数、牙龈指数)有显著性正相关(P<0.01),杆菌和球菌所占比例在试验过程中无明显变化(P>0.05)。结论:螺旋体的百分含量在基线、停止刷牙和恢复刷牙1周后存在显著差异,并与各临床指标有显著性正相关,其变化与牙龈炎症的形成和发展过程一致。     

Effect of smoking on gingival crevicular fluid cytokine profile during experimental gingivitis

BACKGROUND: Cigarette smoking is a significant risk factor in the pathogenesis of periodontal disease, able to influence both the subgingival microbiota and host responses. AIM: The aim of the present study was to determine the influence of smoking on the amount of IL-1beta, IL-4 and IL-8 in gingival crevicular fluid (GCF) during experimental gingivitis in humans. MATERIAL AND METHODS: Twenty-two healthy subjects, 10 smokers and 12 non-smokers, participated in the study. After professional cleaning, they performed optimal hygiene to reach perfect clinical gingival health. Oral hygiene measures were ceased for a period of 10 days. Clinical indices, including plaque index (PI), gingival index (GI), probing pocket depth (PPD) and bleeding on probing (BOP), were assessed 2 days before (day -2), at the beginning (day 0) and at the end of the experimental gingivitis period (day 10). At the same time, GCF was collected from 12 sites in each patient, by means of durapore filter membranes. Total amounts of IL-1beta, IL-4 and IL-8 were determined by enzyme-linked immunoadsorbent assay. RESULTS: Clinical data revealed that both smokers and non-smokers showed an increase in PI, GI and BOP scores during the experiment. Although no differences were noted with regard to PI at day 10, the GI and BOP were significantly less pronounced in smokers than non-smokers (p < 0.005). Non-smokers showed higher total amounts of IL-4 but lower amounts of IL-8 than smokers, throughout the experiment. Total amounts of IL-1beta and IL-8 increased significantly during plaque accumulation in both groups. IL-4 remained stable for the smoker group and decreased for the non-smoker group. CONCLUSIONS: The present results indicate that smoking interferes with cytokine production. When performing studies regarding the pathogenesis of periodontitis, the smoking status of the participants needs to be taken into consideration.     

Oral cleanliness,gingivitis, dental caries and oral health behaviours in Jordanian children

The aims of the study were to investigate the association between oral cleanliness, gingivitis and sociodemographic factors, dental caries and oral health behaviours amongst 4-5-year-old Jordanian children. A two stage random sampling procedure was used to select children enrolled in kindergartens in Amman. Clinical examinations were carried out by one examiner. Mothers completed questionnaires relating to sociodemographic factors and oral health behaviours. Presence of gingivitis and of four or more sites with dental plaque were seen in 66% and 83% of the children, respectively. No differences in these outcomes were seen between ages and genders. Social class and oral hygiene behaviours were important risk indicators for the level of oral cleanliness and presence of gingivitis. Higher percentages of children with four or more sites with plaque and with gingivitis had a dmft score equal or greater than four. Due to the high level of dental plaque accumulation, presence of gingivitis and their association with social class, dental caries and oral hygiene behaviours, attention should be given to the oral health of these children. In particular to the oral health of children attending kindergartens in areas of lower social class in Amman.     

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

BACKGROUND/AIMS: Whereas accumulation of dentogingival plaque inevitably leads to inflammatory reactions in the adjacent gingival tissue, there is limited information with regard to factors influencing naturally occurring fluctuation between gingival health and disease. The major aims of the present study were to investigate site-specific associations between plaque and gingivitis as well as transition dynamics of naturally occurring gingivitis in smoking and non-smoking young adults. METHODS: 65 systemically healthy young adults, 19 to 30 years old, participated. 33 volunteers smoked at least 20 cigarettes per day, whereas 32 subjects were non-smokers. Clinical periodontal conditions were assessed four times within a time period of 6 months. An ecological approach in data analysis as well as site-specific analyses considering the correlated structure of data were performed. RESULTS: At the outset and after 6 months, smokers had significantly more supragingival plaque than non-smokers. At the final examination, bleeding upon probing as well as calculus were more prevalent in smokers. A site-by-site analysis revealed that smokers tended to have a weaker association between supragingival plaque and bleeding on probing than non-smokers (median Mantel-Haenszel's common odds ratio 1.91 vs. 2.89, p=0.07). Multiple logistic regression analyses adjusted for periodontal probing depth, plaque and calculus identified smoking status to significantly increase the risk for the first transition of non-bleeding to bleeding upon probing by 86% (p<0.01). In contrast, recovery of bleeding sites was positively influenced by female gender, but not smoking. CONCLUSIONS: In multivariate analyses adjusted for probing depth, plaque and calculus, smokers appeared to be at higher risk for the transition from non-bleeding to bleeding on probing. Weaker associations between plaque and naturally occurring gingivitis in smokers may have important consequences for preventive strategies for gingivitis.     

Effect of amine fluoride-stannous fluoride containing toothpaste (Meridol) on plaque and gingivitis in adults: a six-month clinical study

Treatments that aim to reduce the accumulation of bacteria on dental surfaces are considered today as the most efficient way of treating gingivitis and the resultant destruction of periodontal tissues. Mechanical plaque removal was found to be very effective in the control of gingival inflammation for most patients, but the supplement of toothpastes and mouthwashes with anti-plaque properties may benefit individuals with unperfected plaque control. The aim of the present study was to investigate the long-term effect of amine fluoride/stannous fluoride (AmF/SnF2) toothpaste on plaque levels and gingivitis in adults, as an additional measure to standard oral hygiene. One hundred and three adult subjects with gingivitis were divided into two randomised groups. One group used NaF toothpaste (control) and the second group AmF/SnF2 (Meridol) toothpaste. The subjects were examined every two months under double-blind conditions. The recorded parameters were plaque index (PlI), gingival index (GI) and bleeding on probing. The differences in PlI between baseline and the end of the study were statistically significant for both treatments, and no significant differences were found between the two treatment groups. There was a significant drop in GI between baseline and the concluding examination only for the AmF/SnF2 group, but the differences between the two treatment groups were not significant. A significant reduction in the percentage of bleeding sites during the six-month study period was found in the AmF/SnF2 group, but not in the control group. The results of the present study suggest that the long-term use of AmF/SnF2 toothpaste in adults may be of benefit to gingival health.     

Assessment criteria for compliance with oral hygiene: application of ROC analysis

PURPOSE: Diabetes is an established risk factor for periodontal disease. Management of periodontal disease is highly dependent upon effective oral hygiene. Assessment of plaque and gingivitis has been commonly used and arbitrarily set in clinical practice to evaluate patients' adherence with oral hygiene recommendations. This study aims to determine an objective cut-off criterion for assessing oral hygiene compliance utilising a combination of plaque and bleeding scores. MATERIALS AND METHODS: 161 patients with diabetes, from a prospective clinical trial, provided the clinical periodontal parameters at baseline to be used to determine the oral hygiene compliance criterion in relation to a composite score of pocket depth, subgingival calculus and supragingival calculus. A sequence of different combinations of plaque and gingival bleeding scores were used. Receiver operator characteristic (ROC) curve assessment, sensitivity, specificity, and predictive values were utilised for the determination of the criterion. RESULTS: The combination of 25% plaque scores and 15% gingival bleeding scores obtained the highest ROC value (using a probability cut-off of 0.5) of 0.868 with sensitivity 98.6%, specificity 75.0%, positive predictive value (PPV) 97.3% and negative predictive value (NPV) 85.7%. According to this criterion, amongst the cohort of subjects examined, 145 (90.1%) were categorised as non-compliant, and only 16 (9.9%) were considered compliant with oral hygiene at baseline. CONCLUSIONS: Based upon the clinical periodontal parameters of subjects from this study, a combination of 25% plaque score and 15% bleeding score appears to be a valid target for determining compliance with oral hygiene in oral health programmes.     

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.     

Toothbrushing efficiency in smokers and non-smokers

The present study was conducted to determine whether smokers have more plaque than non-smokers, and whether higher plaque scores subsequently found in smokers could be explained by differences in toothbrushing time, efficiency and frequency. Plaque was scored from photographs, before and after toothbrushing, in 64 smokers and 64 non-smokers, aged 20-40 years, matched for age and sex. The results showed that in both sexes smokers had more plaque than non-smokers. Male smokers brushed for a shorter time, and had more plaque after toothbrushing, than male non-smokers. A similar, though non-significant trend was found in females. There was no association between tobacco consumption and frequency of toothbrushing. It was concluded that the poorer oral cleanliness found in smokers both before and after toothbrushing may be explained, in part at least, by their shorter toothbrushing time.     

Levels of parotid and submandibular/sublingual salivary immunoglobulin A in response to experimental gingivitis in humans

Salivary secretory IgA (s-IgA) is considered to act as an important first line of defense mechanism in the oral cavity. It has therefore been suggested that an increased antigenic load would induce an increase in salivary IgA production. This study investigated the pure glandular levels of salivary IgA in parotid and submandibular/sublingual (SM/SL) saliva during plaque accumulation leading to experimental gingivitis. Starting from regular oral hygiene, 14 healthy, nonsmoking men refrained from all oral hygiene measures for 12 days. On days –2, 0, 3, 6, and 12 a plaque index, a bleeding index, and unstimulated and stimulated saliva from the parotid and the SM/SL glands were measured. Salivary IgA was quantified using a sandwich ELISA. All subjects developed gingivitis as measured by a bleeding index. Compared to baseline the salivary flow rate was increased on day 12. Regarding the secretion rate of IgA there was a statistically significant increase in stimulated parotid saliva but not SM/SL saliva compared to baseline after 6 and 12 days without oral hygiene. No significant changes were observed for the concentration of IgA during the trial. Thus, in healthy subjects with regular oral hygiene the development of plaque induced gingivitis is associated with increased salivary gland output and increased total IgA output levels in stimulated parotid saliva but not in SM/SL saliva.