|ORIGINAL RESEARCH REPORT
|Year : 2020 | Volume
| Issue : 4 | Page : 127-130
Relating oral hygiene, gingival, and periodontal status with nicotine dependence among smokers - A cross-sectional study
Chibuzor Osediye Boi-Ukeme1, Clement Chinedu Azodo2
1 Department of Periodontics, School of Dentistry, University of Benin, Benin City, Edo State, Nigeria
2 Department of Periodontics, University of Benin, Benin City, Edo State, Nigeria
|Date of Submission||22-Apr-2019|
|Date of Acceptance||31-Jul-2020|
|Date of Web Publication||19-Oct-2020|
Dr. Clement Chinedu Azodo
Room 21, 2nd Floor, Department of Periodontics, Prof Ejide Dental Complex, University of Benin Teaching Hospital, PMB 1111, Ugbowo, Benin City, Edo State
Source of Support: None, Conflict of Interest: None
Background: The objective was to examine the oral hygiene, gingival, and periodontal status among smokers and to relate them with nicotine dependence. Methods: The cross-sectional study was carried out among smokers and nonsmokers in Benin-City, Edo State. Data collection was done through questionnaire and oral examination. The indices applied were Fagerstrom test, Simplified Oral Hygiene Index (OHI-S), Gingival Index (GI), Community Periodontal Index, and tooth mobility index. Results: A total of 40 (20 smokers and 20 nonsmokers) persons participated in the study. The mean OHI-S for smokers was 2.87 ± 0.92 while that of nonsmoker was 2.20 ± 0.73 and this was statistically significant (P = 0.015). The mean GI for smokers was 1.04 ± 0.36 while that of nonsmoker was 0.80 ± 0.22 and this was statistically significant (P = 0.018). The mean number of mobile teeth for smokers was 0.15 ± 0.49 while that of nonsmoker was. 00 ± 0.00 and this was not statistically significant (P = 0.178). One-quarter (25%) of smokers had score 3 and 4 while only 5% of nonsmokers had were found Shallow and deep pockets were found score 3 and 4. About half (45.0%) of the smokers had low-moderate nicotine dependency among the smokers revealed that. Participants with higher nicotine dependence had nonsignificantly poorer oral hygiene, gingival, and periodontal status than their counterparts. Conclusion: Smokers generally had poorer oral hygiene, gingival, and periodontal status as compared to the nonsmokers. Smokers with higher nicotine dependence did not have poorer oral hygiene, gingival, and periodontal status than their counterparts.
Keywords: Nonsmokers, oral health, periodontal disease, smokers
|How to cite this article:|
Boi-Ukeme CO, Azodo CC. Relating oral hygiene, gingival, and periodontal status with nicotine dependence among smokers - A cross-sectional study. J Clin Sci 2020;17:127-30
|How to cite this URL:|
Boi-Ukeme CO, Azodo CC. Relating oral hygiene, gingival, and periodontal status with nicotine dependence among smokers - A cross-sectional study. J Clin Sci [serial online] 2020 [cited 2021 Jan 25];17:127-30. Available from: https://www.jcsjournal.org/text.asp?2020/17/4/127/298452
| Introduction|| |
Tobacco in varied forms (smoked or smokeless) is harmful to almost every organ in the body and is associated with multiple diseases thereby reducing quality of life and longevity. Many chemicals generated when cigarette burns are poisonous and potentially carcinogenic and the morbidities from cigarette smoking documented in the literature are skewed toward general health despite the fact that the oral manifestations are glaring and starts early.
Studies have established an etiological link between smoking and periodontal disease,,,, which is one of the main oral diseases and a major cause of tooth loss in Nigeria. Smoking increases the severity and progression of periodontal disease and exerts adverse effects on periodontal treatment outcome. It has also been reported that cigarette smoking exerts a strong and chronic effect on the periodontium resulting in lesser gingival bleeding and deeper periodontal pockets., Tobacco smoking is an important environmental risk factor for periodontitis as smokers are five times more likely to develop severe periodontitis than nonsmokers., The other periodontal manifestations of tobacco smoking include stained teeth, bad breadth, gingival recession, attachment loss, dental implant failure, increase in number of deep pockets, furcation involvement in molar teeth, bone loss, and tooth loss.,,
Cigarette smoking results in periodontal manifestations through local and systemic mechanisms. Cigarette stains favor plaque retention while nicotine causes vasoconstriction of gingival blood vessel and decreases oxygen tension, which may create a favorable subgingival environment for colonization by anaerobic bacteria., Heat from cigarette smoke increases calculus formation. Other mechanisms include reduced mobilization and movement of host defence to the gingiva, decreased healing capacities in collagen synthesis, inhibition of fibroblast growth and damage to cell membrane.,,,, It has also been shown that both cellular and humoral immune systems are adversely affected through its effect on the cytokine network and suppression of both chemotactic and phagocytic functions of polymorphonuclear leukocytes in saliva and tissues. Smokers have been shown to respond poorly to periodontal therapy than nonsmokers because smoking impairs healing by decreasing the reparative and regenerative potential of the periodontium and calcium deposition in the alveolar bone., Few oral health studies on smokers in Nigeria that evaluated their response to periodontal treatment or were conducted in a risk group (inmates of prison), included arrays of periodontal indices but none assessed nicotine addiction among the smokers.,, Even when neglect of oral hygiene exists in drug addicts. Hence, the objective of this study was to examine the oral hygiene, gingival and periodontal status among smokers and to relate them with nicotine dependence.
| Materials and Methods|| |
This cross-sectional study was conducted among smokers in Benin City between December, 2016 and February, 2017. The smokers aged 18–60 years were approached at varied locations in Benin City and invited to University of Benin Teaching Hospital Outpatient Dental Clinic for the research. Smokers who came to hospital and gave consent were included while those who had any known systemic conditions that could influence oral health and did not give informed consent were excluded from the study. Age- and sex-matched nonsmokers were recruited from the same population. Data collection was done through interviewer-administered questionnaire and clinical examination. The questionnaire elicited information on demographic characteristics and nicotine dependence of the smokers. Clinical examination was done to determine oral hygiene, gingival health, periodontal status, and tooth mobility. Nicotine dependence of the smokers was assessed using Fagerstroms test which is a standard instrument for assessing the intensity of physical addiction to nicotine. The test provides an ordinal measure of nicotine dependence related to cigarette smoking. It contains 6 items that evaluate the quantity of cigarette consumption, the compulsion to use, and dependence. Fagerstrom Test for Nicotine Dependence is scored as follows; yes/no items are scored from 0 to 1 and multiple-choice items are scored from 0 to 3. The items are summed to yield a total score of 0–10. The higher the total Fagerström score, the more intense is the patient's physical dependence on nicotine. Nicotine dependency among the smokers were categorized as low dependence (1–2), low-moderate dependence (3–4), moderate dependence (5–7), and (High dependence) 8–10. Oral hygiene status was assessed using Oral Hygiene Index-Simplified (OHI-S) Index, gingival status with Gingival Index (GI), periodontal status with Community Periodontal Index (CPI), and tooth mobility with Millers index. Tooth mobility of Grade 0 which means absence of tooth mobility was scored as 0 per tooth while Grade 1–3 was scored as 1 per tooth.
Informed consent was obtained from the participants. Participation was voluntary. Scaling and root planing were done for the participants after the questionnaire administration and clinical examination as incentive for participation. The obtained data were subjected to Chi-square or Fisher's exact statistics and independent t-test and using IBM SPSS version 21.0 (IBM Corp. Armonk, New York, United States of America). The statistically significant association was set at P < 0.05.
| Results|| |
A total of 97 (62 tobacco users and 35 nontobacco users) persons were approached to take part in the study but only 20 male smokers gave their consent and 20 age-matched nonsmokers were consequently selected giving a total of 40 participants. The mean age of smokers was 39.20 ± 7.26 years while that of the nonsmokers was 39.10 ± 7.75 years [Table 1]. Nicotine dependency among the smokers revealed that 9 (45.0%) had low dependence (1–2), 9 (45.0%) had low-moderate dependence (3–4), 2 (10.0%) had moderate dependence (5–7), and 0 (0.0%) had high dependence) (8–10). The mean OHI-S for smokers was 2.87 ± 0.92 while that of nonsmoker was 2.20 ± 0.73 and this was statistically significant (P = 0.015). The mean GI for smokers was 1.04 ± 0.36 while that of nonsmoker was 0.80 ± 0.22 and this was statistically significant (P = 0.018). The mean number of mobile teeth for smokers was 0.15 ± 0.49 while that of nonsmoker was 0.00 ± 0.00 and this was not statistically significant (P = 0.178). One-quarter (25.0%) of the smokers had poor oral hygiene while one-tenth (10.0%) of the nonsmokers had poor oral hygiene. There was no statistically significant association between oral hygiene status and smoking status (P = 0.246). Four-tenth (40%) of the smokers had moderate-to-severe gingival inflammation while all (100.0%) nonsmokers had mild gingivitis. There was statistically significant association between gingival status and smoking status (P = 0.003). One-quarter (25%) of the smokers had CPI scores 3 and 4 while only 5% of the nonsmokers had CPI scores 3 and 4. There was no statistically significant association between periodontal status and smoking status (P = 0.257) [Table 2]. Half (50.0%) of the moderate nicotine-dependent smokers had poor oral hygiene status while 22.2% of the low and low-moderate dependent smokers had poor oral hygiene status but this was not statistically significant (P = 1.000). Half (50%) of moderate nicotine-dependent smokers and 44.4% of the low-moderate dependent smokers had moderate and severe gingival inflammation but this was not statistically significant (P = 0.762). All (100.0%) of the moderate nicotine-dependent smokers had shallow pockets while 22.2%% of the low-moderate-dependent smokers had shallow pockets (11.1%) and deep pockets (11.1%) but this was not statistically significant (P = 0.063) [Table 3].
|Table 2: Oral hygiene, gingival, and periodontal status among the participants|
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|Table 3: Relating nicotine dependence with oral hygiene, gingival, and periodontal status among smokers|
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| Discussion|| |
Findings from this study, using the Fagerstrom test showed that the smokers generally had low to low-moderate nicotine dependence which contrasted with findings among Indian health and nonhealth-care professional college students where the participants had moderate nicotine dependence. In this study, more smokers (25.0%) had poorer oral hygiene status than nonsmokers (10.0%). This was not statistically significant with the categorization of oral hygiene into good, fair, and poor status but became statistically significant when the mean values were compared. This finding was similar to that of studies conducted in Lagos, and Ibadan, Nigeria among smokers. The worse oral hygiene status seen among the smokers may be due to increased calculus formation and plaque accumulation due to cigarette tar stains in smokers.
Smokers had significantly more severe (moderate-to-severe) form of gingival inflammation than nonsmokers which is in keeping with findings of a study by Arowojolu et al. finding in a study among smokers and nonsmokers in Ibadan, Nigeria. Smokers had poorer periodontal status in terms of shallow pockets (score 3) and Deep pockets (score 4) than nonsmokers. Poorer periodontal status in terms of shallow pockets and Deep pockets with reports in sextants patterns in smokers in comparison with nonsmokers has been similarly reported by Nwhator et al. The mean number of mobile teeth for smokers was higher than that recorded among nonsmoker which is indicative of severe periodontal status and in keeping with the deleterious effect of smoking on periodontal health. The poorer gingival and periodontal status among smokers in this study may be explained by the decrease in the salivary level of immunoglobin A (IgA) and serum IgG that protect periodontium against periodontopathogenic organisms, such as Porphyromonas gingivalis, Aggregactibacter actinomycetecomitans, Provotella intermedia, and Fusobacterium nucleatum.
Smokers with higher nicotine dependence had worse oral hygiene, gingival inflammation, and periodontal status. This lent credence to a dose-dependent relationship between cigarette consumption and periodontal tissue destruction., The resultant effect may emanate from detrimental effects of nicotine and some other tobacco compounds on fibroblast function, including fibroblast proliferation, adhesion to root surfaces, and cytotoxicity.
| Conclusion|| |
Smokers generally had poorer oral hygiene, gingival, periodontal status as compared to the nonsmokers. Smokers with higher nicotine dependence had worse oral hygiene, gingival, and periodontal status than their counterparts.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Malhotra R, Kapoor A, Grover V, Kaushal S. Nicotine and periodontal tissues. J Indian Soc Periodontol 2010;14:72-9.
] [Full text]
Gautam DK, Jindal V, Gupta SC, Tuli A, Kotwal B, Thakur T. Effect of cigarette smoking on periodontal health status: Comparative cross-sectional study. J Indian Soc Periodontol 2011; 15:383-7.
] [Full text]
Smejkalova J, Jacob V, Hodacova L, Fiala Z, Slezak R, Vellappally S. The Influence of Smoking on Dental and Periodontal Status, Oral Health Care-Paediatric, Research, Epidemiology and Clinical Practices, Prof. Mandeep Virdi (Ed.); 2012.
Shah AH, ElHaddad SA. Oral hygiene behavior, smoking, and perceived oral health problems among university students. J Int Soc Prev Community Dent 2015;5:327-33.
Singh S, Dagrus K, Bkariya P, Bargale S, Shah S. Knowledge and attitude regarding ill effects of smoking among College students. EJDTR 2015;4:259-65.
Danielson OE, Chinedu AC, Oluyemisi EA, Bashiru BO, Ndubuisi OO. Frequency, causes and pattern of adult tooth extraction in a Nigerian rural health facility. Odontostomatol Trop 2011;34:5-10.
Jain H, Mulay S. Detrimental effects of smoking on periodontium in health and disease. Int J Sci Stud 2014;2:76-81.
Palmer RM, Wilson RF, Hasan AS, Scott DA. Mechanisms of action of environmental factors--tobacco smoking. J Clin Periodontol 2005;32 Suppl 6:180-95.
Olayanju OA, Rahamon SK, Joseph IO, Arinola OG. Salivary immunoglobulin classes in Nigerian smokers with periodontitis. World J Biol Chem 2012;3:180-3.
Ah MK, Johnson GK, Kaldahl WB, Patil KD, Kalkwarf KL. The effect of smoking on the response to periodontal therapy. J Clin Periodontol 1994;21:91-7.
Nwhator SO, Ayanbadejo P, Savage KO, Jeboda SO. Oral hygiene status and periodontal treatment needs of Nigerian male smokers. TAF Prev Med Bull 2010;9:107-12.
Reddy S. Essentials of Clinical Periodontology and Periodontics. New Delhi, India: Jaypee Brothers; 2006.
Nwhator SO, Olagundoye O. Do smokers benefit from dental hygiene oral prophylaxis? A Nigerian pilot study. East Mediterr Health J 2009;15:976-82.
Dosunmu EB, Lawal FB, Akinyemi OA. Smokers and non smokers: A comparison of oral health practices and effect of non surgical periodontal therapy on their periodontium. Niger Postgrad Med J 2015;22:110-6.
Akaji EA, Folaranmi N. Tobacco use and oral health of inmates in a Nigerian prison. Niger J Clin Pract 2013;16:473-7.
] [Full text]
Greene JC, Vermillion JR. The Simplified Oral Hygiene Index. J Am Dent Assoc 1964;68:7-13.
Loe H, Silness J. Periodontal disease in pregnancy. I. Prevalence and severity. Acta Odontol Scand 1963;21:533-51.
Ainamo J, Barmes D, Beagrie G, Cutress T, Martin J, Sardo-Infirri J. Development of the World Health Organization (WHO) Community Periodontal Index of treatment needs (CPITN). Int Dent J 1982;32:281-91.
Miller SC. Texbook of Periodontia. Philadelphia: Blakiston Company; 1938. p. 92.
Chopra A, Lakhanpal M, Gupta N, Suri V, Kaur G, Bhudhiraja S. The influence of occupational stress factors on nicotine dependence among students of health and nonhealth care professional colleges. Niger Med J 2015;56:349-52.
] [Full text]
Savage KO, Afolabi BM, John MO. Assessment of periodontal status of Nigerian factory workers in relation to cigarette smoking in Lagos. Nig Q J Hosp Med 1999;9:198-201.
Arowojolu MO, Fawole OI, Dosumu EB, Opeodu OI. A comparative study of the oral hygiene status of smokers and non-smokers in Ibadan, Oyo State. Niger Med J 2013;54:240-3.
] [Full text]
Calsina G, Ramón JM, Echeverría JJ. Effects of smoking on periodontal tissues. J Clin Periodontol 2002;29:771-6.
Shereef M, Sanara PP, Karuppanan S, Noorudeen AM, Joseph K. The effect of cigarette smoking on the severity of periodontal diseases among adults of Kothamangalam Town, Kerala. J Pharm Bioallied Sci 2015;7:S648-51.
[Table 1], [Table 2], [Table 3]