Oral hygiene compliance and gingivitis expression in cigarette smokers

Abstract – 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.     

Experimental gingivitis in cigarette smokers: a clinical and microbiological study

Objective: To assess clinical and microbiological changes during experimental gingivitis in cigarette smokers and non‐smokers. Material and Methods: Eleven current smokers (5 years) and 11 (never‐) non‐smokers periodontally healthy or with gingivitis (PPD4 mm) were included. According to the original model ( Löe et al. 1965 ), an experimental 3‐week plaque accumulation period resulting in experimental gingivitis and a subsequent 2‐week period of optimal plaque control were performed. Subgingival plaque samples were collected at Days 0, 21 and 35 from one site per quadrant, pooled and analysed using checkerboard DNA–DNA hybridization. Results: Smokers {mean age: 24.7±2.2 [standard deviation (SD)] years, range 21–28 years} had a mean lifetime cigarette exposure of 6.4±2.8 (SD) pack‐years, while non‐smokers presented with a mean age of 23.1±2.2 (SD) years (range 21–29 years). Between Days 0, 21 and 35, no statistically significant differences in mean Plaque and mean Gingival Index scores were observed between smokers and non‐smokers. In both smokers and non‐smokers, mean total DNA probe counts did not significantly differ nor increase between Days 0 and 21. Also, between Days 21 and 35 they did not significantly differ nor decrease. This was also true for the various proportions of bacterial complexes. Conclusion: Both current smokers and (never‐) non‐smokers reacted to experimental plaque accumulation with gingival inflammation. Periodontal and microbiological parameters assessed in current cigarette smokers did not significantly differ from those in non‐smokers during an identical period of experimental plaque accumulation. Hence, the early host response to the bacterial challenge appears to be of similar magnitude and timing in both groups.     

Oral hygiene, gingivitis and periodontal breakdown in adult Tanzanians

This study describes the cross-sectional findings on dental plaque, calculus, gingivitis, loss of attachment, periodontal pockets and tooth loss in a population of adult Tanzanians aged 30–30 years. In all age groups more than 90% of all tooth surfaces exhibited plaque and 50–50% exhibited calculus deposits. Both plaque and calculus deposits were more extensive in the older age groups whereas gingival bleeding affected 30–30% of the surfaces in all age groups. Less than 35% of all surfaces exhibited a loss of attachment ≥4 mm and less than 10% had a loss of attachment exceeding 6 mm. Loss of attachment was accompanied by recession of the marginal gingiva and pockets deeper than 3 mm were present on less than 10% of all surfaces. The mean number of teeth present ranged from 23.9 in the oldest to 29.5 in the youngest age group. An interesting finding was that relatively few individuals accounted for most of the loss of attachment and periodontal pockets found in the study. Therefore, in future epidemiologic studies more emphasis should be put on the identification of these particularly susceptible subpopulations.     

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.     

Oral hygiene, gingivitis, and periodontitis in persons with Down syndrome

This study was conducted to determine and compare the prevalence, severity, and extent of gingivitis and periodontitis in patients with Down syndrome and patients who did not have Down syndrome. The authors also assessed the relationship of these conditions and compared them to the age, gender, and oral hygiene profiles in both groups. Using a case-control study design, the authors examined 32 individuals with Down syndrome (DS) and matched each with a participant from the control group (CG) according to age and gender. Researchers determined the Simplified Oral Hygiene Index, Gingival Index, and measured the level of gingival attachment for each participant. The authors found that the relationship between the presence of dental plaque and the severity of gingivitis was moderate among participants with DS. While the overall characteristics of the periodontal and gingival health status were not markedly different between the two groups, the extent and severity of gingivitis and the extent of periodontitis were greater in the group with DS than in the CG.     

Oral hygiene, gingivitis and periodontal status of Libyan school children.

There is relatively little information about the dental health of Libyan children, so this study was initiated to assess the level of oral hygiene and the gingival and periodontal status in children living in urban and rural parts of Libya. Two thousands and fifteen children aged 7-16 years were examined during 1987 using World Health Organization criteria. The oral hygiene was found to be good (mean oral hygiene index = 0.12); boys demonstrated significantly worse oral hygiene than girls (P less than 0.001). Overall, gingival inflammation was categorised as mild (mean gingival index = 0.05). Boys had more gingivitis than girls (P less than 0.001). Periodontal pockets of more than 3.5 mm were found in 4.1 per cent of 15-16-year-old children.     

Oral hygiene and gingivitis in a Swedish adult population 1973, 1983 and 1993

Abstract. The periodontal condition of the inhabitants of Jönköping County, Sweden was followed for 20 years by means of 3 cross-sectional investigations performed in 1973, 1983, and 1993. The study comprised individuals in the age groups 20, 30, 40, 50, 60, and 70 years. The number of dentate individuals was 537 in 1973, 550 in 1983, and 552 in 1993. All individuals participating in the studies were examined clinically and radiographically. They also filled out a questionnaire about dental care habits, socio-economic status, and general health. A clear reduction in the plaque score was seen between 1973 and 1983 in all age groups. With one exception, no further significant change in plaque levels was found between 1983 and 1993: the increase in plaque among the 20-year-olds was significant. In 1993 the mean % of surfaces with plaque was between 30% and 40% in all age groups. Gingivitis values corresponded well with the values of dental plaque: the same pattern with a clear reduction in gingivitis score was seen in all age groups between 1973 and 1983, and an increase in the mean frequency of gingival inflammation between 1983 and 1993 was seen in the 20-year age group. 30% of the individuals in this age group had more than 50% gingivitis in 1993 compared with 9% of the individuals in 1983. The 20-year-olds were further analyzed in a linear regression model using gingivitis as a dependent variable against some socio-economic, general health, and dental care variables associated with poor oral hygiene and gingivitis. In 1993, the most important explanatory variable was gender: significantly more males than females had higher gingivitis scores. The second most important explanatory variable was toothbrushing habits. Together they explained 10.9% of the variance. The multivariate analysis did not reveal approximal cleaning habits to be significant, probably due to their strong connection to gender and toothbrushing habits. In the 1983 sample, no significant explanatory variables were found. It was concluded from this data that it is important not only to renew but also to direct preventive guidelines more towards young adults who have no previous extensive experience of oral disease so that they will not be excluded from dental care and their dental health thereby jeopardised. In addition to preventive programmes aimed at the population as a whole, individual programmes based on risk targeting are also necessary to reduce the number of people developing dental disease and to increase the quality of dental care.     

Oral odors in early experimental gingivitis

Volatile chemicals were isolated from mouth air and from incubated whole saliva of 5-matched pairs of male subjects who participated in a 30-day experimental gingivitis protocol. Endogenous oral chemicals were monitored by GC/MS and GC/FPD during the test period. Malodorous sulfur compounds of mouth air were found to increase quantitatively in subjects with gingivitis as compared to control subjects. Salivary volatile production increased with deterioration in gingival health and, conversely, decreased with maintenance of optimal periodontal condition.     

Oral leukocytes and gingivitis in the primary dentition

A survey was performed to evaluate the relationships among orogranulocytic migratory rale, gingival index and plaque index in a group of systematically healthy preschool children.
The fifty children selected for study had only primary teeth, no pharyngeal or extragingival inflammation and were taking no medication. Each child was subjectively scored for the amount of bacterial plaque and gingival inflammation present. The rate of migration of leukocytes into the oral cavity per 30 second period was determined from the last three of ten 30 second consecutive oral saliva rinses as an objective measure of gingival inflammation.
A minimal amount of localized mild marginal gingivitis was observed in the presence of a rather large plaque accumulation. No significant correlation was observed between rates of oral leukocyte migration and the degree of gingival inflammation. However, the leukocyte migratory rates in this group were quite low as compared to those found in adults by other investigators.     

Oral hygiene aids

Different dental hygiene aids are discussed, such as floss, tape, superfloss, gauze, flat shoelace, toothpick, interproximal brush, single-tufted brush, electric toothbrush, manual toothbrush and oral irrigation. Research shows that not one specific aid is superior to another if effectiveness is taken into consideration. Other factors which can influence oral hygiene efficacy are discussed as well.     

Parotid salivary S-IgA antibodies during experimental gingivitis in smokers and non-smokers

Persons who smoke display a less pronounced increase of gingival bleeding in the experimental gingivitis model as compared with non-smokers. The aim of the present study was to investigate whether this could partly be explained by differences in levels of parotid total secretory IgA (S-IgA) or parotid S-IgA reactive with selected oral microorganisms. Parotid saliva samples were obtained from 11 smoking and 14 non-smoking volunteers, at baseline, after 5 and 14 days of full mouth experimental gingivitis. Output levels of total S-IgA and of specific S-IgA reactive with cell extracts from Actinobacillus actinomycetemcomitans, Actinomyces naeslundii, Campylobacter rectus, Fusobacterium nucleatum, Porphyromonas gingivalis, Prevotella intermedia, Prevotella nigrescens, Peptostreptococcus micros, Streptococcus gordonii and Streptococcus mutans were determined in the samples by means of ELISA. Smokers and non-smokers were found to have similar output levels (microg/min) of total S-IgA, and the values did not significantly change during the experimental gingivitis trial. Parotid salivary outputs (units/min) of the bacteria-specific S-IgA at baseline and at days 5 and 14, were not different between smokers and non-smokers; no changes were observed during the experimental gingivitis trial. The present observations indicate that total S-IgA and bacteria-specific S-IgA in saliva are not main factors that can explain the less pronounced increase of gingival bleeding in the experimental gingivitis model in smokers as compared with non-smokers.