Marta Liliana Musskopf

Is There a Positive Effect of Smoking Cessation on Periodontal Health? A Systematic Review

BACKGROUND Although the detrimental effects of tobacco on the periodontal tissues have been reported extensively, little is known about the potential beneficial effect of smoking cessation on periodontal health. The aim of this systematic review is to evaluate the effect of smoking cessation on periodontitis progression and response to periodontal therapy. METHODS Two independent reviewers completed the review process through title (n = 118), abstract (n = 24), and whole-paper selection (n = 5). Sources include Medline and EMBASE databases (up to December 2012) and a reference list of selected studies. Prospective studies comparing progression rates of periodontitis between smokers and quitters and clinical trials evaluating the effect of smoking-cessation programs, alone or in combination with periodontal treatment, were included. At least 1 year of follow-up was required for inclusion. RESULTS Of 331 potentially relevant publications, five studies fulfilled the inclusion criteria. Because of heterogeneity of the studies, a meta-analysis could not be performed. One study reported that the progression of clinical attachment loss (AL) ≥3 mm during a 6-year period was approximately three times higher among smokers than quitters (P <0.001). Two studies (10 and 20 years of follow-up) observed a decrease in radiographic bone loss of ≈30% among quitters when compared with smokers. Among individuals receiving non-surgical periodontal treatment, quitters were more likely to have periodontal probing depth reductions (P <0.05) than non-quitters/oscillators. No differences in AL were observed. CONCLUSION Based on the limited available evidence, smoking cessation seems to have a positive influence on periodontitis occurrence and periodontal healing.

Periodontal disease and systemic complications.

Periodontal diseases comprise a number of infectious and inflammatory conditions brought about by the interaction between supragingival and subgingival biofilms and the host inflammatory response. Periodontal diseases should be considered systemic conditions. This means that they are both modulated by the bodys systems and play a role as a risk factor for systemic derangements. The current evidence supports some of these interactions, such as smoking as a risk factor for periodontal disease and diabetes mellitus, as both influenced by and influencing inflammatory changes in the periodontal tissue. Other potential associations are still being researched, such as obesity, hormonal changes, cardiovascular disease, and adverse outcomes in pregnancy. These, and others, still require further investigation before the repercussions of periodontal disease can be fully elucidated. Nevertheless, at the present time, the treatment of periodontal diseases-and, most importantly, their prevention-enables adequate intervention as a means of ensuring periodontal health.

Relationship between cytokine levels in serum and gingival crevicular fluid (GCF) in pregnant women

BACKGROUND Periodontal disease has been linked to systemic diseases/disorders and a low-grade systemic inflammatory status originated from periodontitis has been proposed as a possible explanation for this association. This study evaluates the relationship, early in pregnancy, between gingival crevicular fluid (GCF) and serum levels of a panel of cytokines that have been implicated in PTB and periodontal disease. METHODS One hundred pregnant women aged 18-35 years old with a gestational age up to 20 weeks were included (mean±SD gestational age:16.1±3.5 weeks). Four periodontal sites per subject were randomly selected for GCF collection. Serum and GCF levels of IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNF-α were analyzed using a cytometric bead array. Regression and correlation analyses were used to assess the relationship between serum and GCF cytokine levels. RESULTS Participants had widespread periodontal inflammation but limited periodontal destruction. Cytokine levels were significantly higher in GCF than serum for all cytokines but IL-10. GCF levels had small but significant effect on serum levels for IL-10 (β=0.34±0.09, p<0.01), IL-12p70 (β=0.48±0.08, p<0.01) and TNF-α (β=0.29±0.09, p<0.01). Periodontal probing depth and bleeding on probing were significantly associated with GCF levels for IL-1β, IL-6 and IL-8; however, they had negligible effect on serum cytokine levels. Correlation between GCF and serum levels was non-significant, except for IL-12p70, which showed a significant but small correlation between the two sources (r=0.32, p=0.001). CONCLUSIONS GCF cytokine levels were not strongly associated with serum cytokine levels in pregnant women with widespread periodontal inflammation but limited periodontal destruction.

Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

Tobacco use and smoking cessation among third‐year dental students in southern Brazil

The aim of the present cross-sectional study was to assess tobacco use and smoking cessation among third-year dental students in southern Brazil. The Global Health Professions Student Survey questionnaire was used in eight dental schools in Rio Grande do Sul state, Brazil. Of the 663 eligible students, 576 (87%) participated. The prevalence of current smoking was 19.1% [95% confidence interval (CI): 12.9-25.3%], and 61.6% (95% CI: 54.9-68.3%) of students reported having smoked at least once in their lifetime. The prevalence of dental students who had smoked ≥ 100 cigarettes in their lifetime was 17.1% (95% CI: 12.5-21.7%). Being frequently exposed to other smokers at home or in other places (second-hand smoke) increased the likelihood of current smoking by two- to threefold. Approximately 6.1% (95% CI: 3.5-8.7%) of the students reported that they currently wanted to stop smoking and 7.5% (95% CI: 5.3-9.6%) had tried to stop smoking in the last year. Friends and family were the most frequent sources of help or counselling, and only a limited proportion of students received help from health professionals. Tobacco use and exposure to second-hand smoking is widespread among dental students in southern Brazil. Smoking-cessation initiatives targeting health care students are urgently needed.

Response to a letter to the editor addressing the publication "Effect of nonsurgical periodontal therapy and strict plaque control on preterm/low birth weight: a randomized controlled clinical trial".

1. The traditional classification based on a distinction between “spontaneous” and “medically indicated” preterm birth proposed by Dr. Lopez has long been debated in obstetrics due to its inherent ambiguity and it is no longer in use. To properly address this issue, the Global Alliance to Prevent Prematurity and Stillbirth task force established a new classification system for the preterm birth syndrome intended for clinical and research use [1]. The 2009 classification was based on the following five components: (1) maternal conditions prior to presentation for birth, (2) fetal conditions prior to presentation for birth, (3) placental pathologies, (4) signs of early labor, and (5) route (pathway) of birth (started spontaneously or by the doctor). Notably, risk factors or the route of delivery (vaginal or cesarean) are explicitly omitted in this new classification [2]. Whereas our original publication did not report results according to the above-mentioned classification, data collected during the study were retrieved and the results are presented below for the reader’s sake. As reported previously, 14 and 17 preterm births occurred in the control and test groups, respectively. Four out of the 14 preterm births in the control group had significant maternal conditions as defined by the new classification, namely one case of chronic hypertension, one case of preeclampsia, and two cases of urinary tract infection. The remaining ten women had no maternal, fetal, or placental factors for preterm birth that could be identified. In the test group, 6 out of the 17 preterm births showed significant pathological conditions: one case of preeclampsia, one case of depressed mood, two cases of gestational diabetes, and two cases of urinary tract infection. Eleven cases of preterm birth in the test group did not have any maternal, fetal, or placental factors that could be identified. No cases of fetal or placental pathological conditions were identified in any of the participants. Spontaneous delivery occurred in 10 out of 14 women in the control group and in 11 out of 17 women in the intervention group (71.4 vs. 64.7 %, p=0.70). Thus, no significant differences could be observed between groups when the most current classification system is used, corroborating our initial findings and conclusions. P. Weidlich (*) : T. Fiorini :M. L. Musskopf : J. M. da Rocha : M. L. R. Oppermann : C. K. Rösing : R. V. Oppermann Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil e-mail: patricia.weidlich@ufrgs.br

Oral health related quality of life among pregnant women: a randomized controlled trial.

The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.