The Influence of Smoking in Periodontitis Patients, Before and After Nonsurgical Treatment

Study Overview
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Brief Summary
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Objective: The aim of this study was to evaluate and compare the oral neutrophil numbers (ONN) in saliva, the level of matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid (GCF) and the periodontal parameters in smokers and non-smokers with periodontitis, before and after nonsurgical periodontal treatment (NSPT). Materials and method: 40 periodontitis patients including 20 smokers and 20 non-smokers were enrolled in this study. All patients were received the NSPT included instructing oral hygiene, scaling and root planning. Clinical parameters (plaque index (PlI), gingival index (GI), bleeding on probing (BOP), probing pocket depth (PPD) and clinical attachment loss (CAL)), ONN and GCF MMP-8 level were assessed before (baseline) and after NSPT 1 month and 3 months.

Detailed Description
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After periodontal examination and medical history evaluation, all patients received oral hygiene instructions. The modified-Bass tooth brushing technique, as well as the use of dental floss and interproximal brushes (if needed) were showed to the patients. They were educated to brush their teeth at least twice a day. All patients were given a dentifrice and toothbrush. Patient motivation to quit smoking was also provided. At the first visit, supragingival scaling with ultrasonic scalers (Cavitron Jet Plus (Densply Sirona, Mississauga, Canada) were provided to all patients. Occlusion adjustments were also performed in the case of indications. After one week, the baseline (T0) parameters were recorded. The following samples were collected: (1) saliva, (2) gingival cervical fluid (GCF), and (3) clinical periodontal parameters. A doctor who collected the samples was blinded about the smoking status. Subsequently, scaling and root planning (SRP) by ultrasonic scalers (Cavitron Jet Plus (Densply Sirona, Mississauga, Canada) and Gracey curettes (Hu-Friedy, Chicago, USA), under local anesthesia, were performed by a periodontist, who was also blinded about the smoking status. The number of SRP visits was determined by patient disease conditions. Following the completion of NSPT, all subjects were recalled after one month and three months for re-evaluation. The collection of (1) saliva, (2) gingival cervical fluid (GCF), and (3) clinical periodontal parameters were performed. Based on the patients' periodontal status, supragingival scaling and polishing were given.

Official Title
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The Influence of Smoking on Oral Neutrophils and Matrix Metalloproteinase-8 in Periodontitis Patients, Before and After Nonsurgical Treatment

Conditions
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Periodontitis

Intervention / Treatment
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* Procedure: Nonsurgical periodontal treatment


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Male patients Aged from 30 to 60 years old Systemically healthy Having at least 20 teeth Diagnosed with moderate to severe periodontitis according to american academy of periodontology 2015: gingival bleeding at examination, ≥5mm periodontal pocket depth (PPD), bone resorption on x-ray film ≥16% or >3mm root length Having at least two sites at anterior teeth with PPD from 5 to 7 mm For group 1, subjects who never smoke For group 2, subjects who had smoked more than 10 cigarettes per day for at least the past 10 years Exclusion Criteria: Patients with acute or chronic medical disorders Patients under any medication for the past 3 months Patients who had undergone periodontal therapy in the last 12 months Patients with oral lesions such as ulcers, aphthous ulcers, glossitis or multi tooth decays

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 60 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Non-smoker group<br> | Procedure: Nonsurgical periodontal treatment<br>* Oral hygiene instructions, scaling and root planning.<br>|
| Experimental: Smoker group<br> | Procedure: Nonsurgical periodontal treatment<br>* Oral hygiene instructions, scaling and root planning.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oral neutrophils | The number of neutrophils in saliva | At baseline (T0) | 
| Oral neutrophils | The number of neutrophils in saliva | After Nonsurgical periodontal treatment one month (T1) | 
| Oral neutrophils | The number of neutrophils in saliva | After Nonsurgical periodontal treatment three months (T3) | 
| Matrix metalloproteinase-8 (MMP-8) | The level of matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid | At baseline (T0). | 
| Matrix metalloproteinase-8 (MMP-8) | The level of matrix metalloproteinase-8 (MMP-8) in gingival crevicular fluid | After Nonsurgical periodontal treatment three months (T3) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Plaque Index (PlI) | Plaque Index (Silness and Loe, 1967) | At baseline (T0). | 
| Plaque Index (PlI) | Plaque Index (Silness and Loe, 1967) | After Nonsurgical periodontal treatment one month (T1) | 
| Plaque Index (PlI) | Plaque Index (Silness and Loe, 1967) | After Nonsurgical periodontal treatment three months (T3) | 
| Gingival Index (GI) | Gingival Index (Silness and Loe, 1967) | At baseline (T0). | 
| Gingival Index (GI) | Gingival Index (Silness and Loe, 1967) | After Nonsurgical periodontal treatment one month (T1) | 
| Gingival Index (GI) | Gingival Index (Silness and Loe, 1967) | After Nonsurgical periodontal treatment three months (T3) | 
| Probing pocket depth (PPD) | The distance from the gingival margin to pocket base | At baseline (T0). | 
| Probing pocket depth (PPD) | The distance from the gingival margin to pocket base | After Nonsurgical periodontal treatment one month (T1) | 
| Probing pocket depth (PPD) | The distance from the gingival margin to pocket base | After Nonsurgical periodontal treatment three months (T3) | 
| Clinical attachment loss (CAL) | The distance from the cementoenamel junction (CEJ) to the gingival margin | At baseline (T0). | 
| Clinical attachment loss (CAL) | The distance from the cementoenamel junction (CEJ) to the gingival margin | After Nonsurgical periodontal treatment three months (T3) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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periodontitis, smoking, neutrophil, matrix metalloproteinase-8, nonsurgical treatment