Impact of oral hygiene instructions on cytokines in smokers and vapers with gingivitis
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Abstract
Background: Cigarette smoking (CS) is a periodontal disease risk factor, affecting clinical parameters such as bleeding on probing (BOP), plaque index (PI), gingival index (GI) and proinflammatory cytokines level. This study examines the impact electronic cigarette use on proinflammatory cytokines and periodontal parameters. Methods: In this non-randomized study, ninety participants diagnosed with gingivitis were assigned into three groups. examined the effect of oral hygiene instructions on periodontal parameters and inflammatory biomarkers. Thirty CS (n=30) vaping electronic-cigarettes (e-cig) (n=29), and non-smoker (NS) (n=31) was included. Clinical parameters including PI, BOP, and GI were recorded at baseline and after 3 weeks. Enzyme-linked immunosorbent assay was used to assess levels of matrix metalloproteinases (MMP)-8 and matrix metalloproteinases (MMP)-9 in saliva at baseline and after 3 weeks. Results: CS and vapers exhibited significantly higher PI, GI, MMP-8 and MMP-9 scores compared to NS before and after the oral hygiene instructions, indicating greater periodontal inflammation. CS as well as individuals who use electronic cigarettes exhibited reduced BOP, likely because nicotine-induced vasoconstriction conceals the actual severity of inflammatory periodontal disease. Conclusion: CS and electronic cigarette use adversely affect periodontal health, increasing PI, GI, MMP-8 and MMP-9 levels while altering BOP. These findings stress the importance of tailored maintenance of periodontium smokers and vapers through integrating vaping cessation into treatment protocols to improve oral health outcomes.
Received date: 12-12-2024
Accepted date: 01-02-2025
Published date: 15-09-2025
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References
Sgolastra F, Petrucci A, Severino M, Gatto R, Monaco A. Periodontitis, implant loss and peri-implantitis. A meta-analysis. Clin Oral Implants Res. 2015;26(4):e8–16.
Renvert S, Aghazadeh A, Hallström H, Persson GR. Factors related to peri-implantitis - a retrospective study. Clin Oral Implants Res. 2014;25(4):522–9.
Jemt T, Karouni M, Abitbol J, Zouiten O, Antoun H. A retrospective study on 1592 consecutively performed operations in one private referral clinic. Part II: Peri-implantitis and implant failures. Clin Implant Dent Relat Res. 2017;19(3):413–22.
Heitz-Mayfield LJA. Peri-implant diseases: diagnosis and risk indicators. J Clin Periodontol. 2008;35(8 Suppl):292–304.
Ayers JW, Leas EC, Allem J-P, Benton A, Dredze M, Althouse BM, et al. Why do people use electronic nicotine delivery systems (electronic cigarettes)? A content analysis of Twitter, 2012-2015. PLoS ONE. 2017;12(3):e0170702.
Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4(1):1–6.
Javed F, Al-Askar M, Samaranayake LP, Al-Hezaimi K. Periodontal disease in habitual cigarette smokers and nonsmokers with and without prediabetes. Am J Med Sci. 2013;345(2):94–8.
Fathallh AA, Mahmood MA. The estimation of the viable count of mutans streptococcus in waterpipe smokers and cigarette smokers. J Bagh Coll Dent. 2021;33(3):23–9.
Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontol 2000. 2007;44:178–94.
Nanakaly HT, Ismail AE, Othmn DA. Influence of smoking on salivary interleukin-8 levels in chronic periodontitis. J Bagh Coll Dent. 2020;32(1):28–34.
Katz J, Caudle RM, Bhattacharyya I, Stewart CM, Cohen DM. Receptor for advanced glycation end product (RAGE) upregulation in human gingival fibroblasts incubated with nornicotine. J Periodontol. 2005;76(7):1171–4.
Sundar IK, Javed F, Romanos GE, Rahman I. E-cigarettes and flavorings induce inflammatory and pro-senescence responses in oral epithelial cells and periodontal fibroblasts. Oncotarget. 2016;7(47):77196–204.
Al-Mufti SMT, Saliem SS, Abdulbaqi HR. The association between receptor activator of nuclear factor kappa-β ligand and clinical attachment level among waterpipe smoker. J Indian Soc Periodontol. 2017;21(5):376–9.
Gaur S, Agnihotri R. Health Effects of Trace Metals in Electronic Cigarette Aerosols-a Systematic Review. Biol Trace Elem Res. 2019;188(2):295–315.
Kite AC, Le BQ, Cumpston KL, Hieger MA, Feldman MJ, Pozez AL. Blast Injuries Caused by Vape Devices: 2 Case Reports. Ann Plast Surg. 2016;77(6):620–2.
Mohammed MA, Abbas RF, Akram HM. Salivary IL-17 and IL-10 as Potential Diagnostic Biomarkers of Different Stages of Periodontitis in Smoker and Nonsmoker Patients. Eur J Dent. 2024;18(1):253–64.
Al-Aali KA, Alrabiah M, ArRejaie AS, Abduljabbar T, Vohra F, Akram Z. Peri-Implant Parameters, Tumor Necrosis Factor-Alpha, and Interleukin-1 Beta Levels in Vaping Individuals. Clin Implant Dent Relat Res. 2018;20(3)410–415.
Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. J Periodontol. 2018;89(S1):S74–84.
Zhang Y, Kang N, Xue F, Qiao J, Duan J, Chen F, et al. Evaluation of salivary biomarkers for the diagnosis of periodontitis. BMC oral health. 2021;17;21(1):266.
Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol. 1970;41(1):41–3.
Löe H. The Gingival Index, the Plaque Index and the Retention Index Systems. J Periodontol. 1967;38(6):Suppl:610-616.
Mühlemann HR, Son S. Gingival sulcus bleeding--a leading symptom in initial gingivitis. Helvetica odontologica acta. 1971;15(2), 107–113.
Yu V, Rahimy M, Korrapati A, Xuan Y, Zou AE, Krishnan AR, et al. Electronic cigarettes induce DNA strand breaks and cell death independently of nicotine in cell lines. Oral Oncol. 2016;52:58–65.
Baab DA, Oberg PA. The effect of cigarette smoking on gingival blood flow in humans. J Clin Periodontol. 1987;14(7):418–24.
Ardais R, Mário T de G, Boligon J, Kantorski KZ, Moreira CHC. The effect of smoking on bleeding on probing after nonsurgical periodontal therapy: a quasi-experimental study. Braz Oral Res. 2014;28:1–7.
Joss A, Adler R, Lang NP. Bleeding on probing. A parameter for monitoring periodontal conditions in clinical practice. J Clin Periodontol. 1994;21(6):402–8.
Calsina G, Ramón JM, Echeverría JJ. Effects of smoking on periodontal tissues. J Clin Periodontol. 2002;29(8):771–6.
Gupta N, Gupta ND, Goyal L, Moin S, Khan S, Gupta A, et al. The influence of smoking on the levels of matrix metalloproteinase-8 and periodontal parameters in smoker and nonsmoker patients with chronic periodontitis: A clinicobiochemical study. J Oral Biol Craniofacial Res. 2016;6(Suppl 1):S39–43.
ArRejaie AS, Al‐Aali KA, Alrabiah M, Vohra F, Mokeem SA, Basunbul G, et al. Proinflammatory cytokine levels and peri‐implant parameters among cigarette smokers, individuals vaping electronic cigarettes, and non‐smokers. J Periodontol. 2019;90(4):367–74.
Luzzi LIT, Greghi SLA, Passanezi E, Sant’ana ACP, Lauris JRP, Cestari TM. Evaluation of clinical periodontal conditions in smokers and non-smokers. J Appl Oral Sci. 2007;15(6):512–7.
Bergström J. Oral hygiene compliance and gingivitis expression in cigarette smokers. Scand J Dent Res. 1990;98(6):497–503.
Bergström J, Preber H. The influence of cigarette smoking on the development of experimental gingivitis. J Periodontal Res. 1986;21(6):668–76.
Modéer T, Lavstedt S, Ahlund C. Relation between tobacco consumption and oral health in Swedish schoolchildren. Acta Odontol Scand. 1980;38(4):223–7.
Ozçaka O, Biçakci N, Pussinen P, Sorsa T, Köse T, Buduneli N. Smoking and matrix metalloproteinases, neutrophil elastase and myeloperoxidase in chronic periodontitis. Oral Dis. 2011;17(1):68–76.
Trombelli L, Farina R, Silva CO, Tatakis DN. Plaque‐induced gingivitis: Case definition and diagnostic considerations. J Periodontol [Internet]. 2018;89(S1).
Bergström J, Preber H. Tobacco use as a risk factor. J Periodontol. 1994 May;65(5 Suppl):545–50.
Haber J, Wattles J, Crowley M, Mandell R, Joshipura K, Kent RL. Evidence for cigarette smoking as a major risk factor for periodontitis. J Periodontol. 1993;64(1):16–23.
Hakki A, Hallquist N, Friedman H, Pross S. Differential impact of nicotine on cellular proliferation and cytokine production by LPS-stimulated murine splenocytes. Int J Immunopharmacol. 2000;22(6):403–10.
Hill PA, Reynolds JJ, Meikle MC. Osteoblasts mediate insulin-like growth factor-I and -II stimulation of osteoclast formation and function. Endocrinology. 1995;136(1):124–31.
Li W, Zhu Y, Singh P, Ajmera DH, Song J, Ji P. Association of Common Variants in MMPs with Periodontitis Risk. Dis Markers. 2016;2016:1545974.