The Effect Of Smoking On Initial Therapy Of Patients With Chronic Periodontitis

Objective: To compare the impact of smoking on initial therapy effect onpatients with chronic periodontitis by comparing the levels of PD and CALand the concentration of TNF-α and IL-10in GCF among smoking andnon-smoking male patients with chronic periodontitis before and after theirinitial therapy.Methods:1Selection of patients: Twenty-seven male patients withchronic periodontitis and treated in Stomatology Hospital of Hebei MedicalUniversity between July-December in2012were selected. They are aged29-58years with an average age of47.5years. Inclusion criteria:(1) Male ofHan nationality.(2) Have no less than20teeth remaining in the mouth.(3)Without diabetes,cardiovascular disease, blood coagulation dysfunctiondisease,nervous system disease, rheumatoid disease and other systematicdiseases.(4) Took no antibiotics,nonsteroidal anti-inflammatory drugs,immunemodulators etc6months prior to the experiment; had no acute or chronicinflammation in3months.(5) Had no periodontal treatment in one year andwith no malocclusion.(6) All subjects included in the study were informedand signed consent.2Group of the experiment: a total of12cases were choose from casesmeet the above criteria that with male chronic periodontitis patients that withan average daily smoking number of more than10cigarettes as smokingPeriodontitis (SP) group and the situation lasted for more than3years; a totalof15patients with no history of smoking were selected as Non-smokingPeriodontitis (NP) group.3Experimental methods:(1) Records of general information include:name, nationality, date of birth, place of birth, marital status, occupation,education, state of health, medical history, smoking habits, oral hygiene habits, history of periodontal treatment, other inflammatory lesions, contactinformation and their inspection dates etc.(2) Oral health education: they shallbrush their teeth once in the morning and once in the evening brush with noless than3minutes and use clear water to rinse mouth after a meal. Properbrushing method, guidance of the usage of dental floss and interdental brushwere demonstrated.(3) Shoots of panoramic radiographs were taken as thebasics of the determination of the scope and severity of the patients.(4)Full-mouth teeth examination were conducted and the use of Floridaperiodontal probe system was used to record the clinical index of the patientsto detemine the baseline values.(5) GCF collection of observed teeth: selectedthe second premolar or molar which the teeth has no caries and filling body,and the PD>3mm, AL≥1mm, the X-ray films also showed that the alveolarbone have absorption and damage. GCF collection was done by Collectingfrom4sites with the usage of filter strips, after the completion, the filter stripswere put into the Eppendorf (Ep) tube and sealed, weighing and recorded andsaved in the-70℃refrigerator to frozen for stand-by usage.(6) Supragingivalscaling, subgingival scaling and root planting.(7) Postoperative review onemonth after the surgery: Shoots of panoramic radiographs were taken again,gingival crevicular fluid samples were collected from the same observedteeth，the PD and CAL were record. The occlusal adjustment and stabilizationof loosen teeth would be taken when necessary.Enzyme-linked immunosorbent assay (ELISA) test was taken to test theconcentration of TNF-and IL-10in the collected gingival crevicular fluidsamples and used the SPSS13.0software for statistical analysis.Results：1Clinical index1.1Probing depthBefore initial therapy, the baseline value of probing depth in SP groupwas5.38±0.85mm, and that of NP group was5.03±0.67mm. There was nostatistically distinguished significant between SP group and NP group in thebaseline value of probing depth (P0.05). After initial therapy, the probing depth of SP group was4.41±0.62mmand that of NP group was3.34±0.51mm. SP group was higher than NP group,there was statistically distinguished significant (P<0.05). There wasstatistically distinguished significant between the SP group and NP groupsince the decreased of probing depth than prior to the initial therapy (P<0.05).The decreased of probing depth was more significantly lower in the SPgroup (0.97±0.62) than the decreased of NP group (1.69±0.47), there wasstatistically distinguished significant in the difference of SP and NP group(P0.05).1.2Clinical attachment lossBefore initial therapy, the baseline value of clinical attachment loss in SPgroup was5.86±0.82mm and that of NP group was5.78±0.95mm. There wasno statistically distinguished significant between SP group and NP group inthe baseline value of clinical attachment loss (P0.05).After initial therapy, the clinical attachment loss in SP group was4.96±0.76mm and that of NP group was4.42±0.86mm, there was nostatistically significant difference between SP group and NP group (P<0.05).There was statistically distinguished significant between the SP group and NPgroup since the decreased of clinical attachment loss than prior to the initialtherapy (P<0.05).There was no statistically distinguished significant between the decreaseof clinical attachment loss in SP group (0.89±0.30) and in NP group(1.35±0.49) before and after initial therapy (P<0.05).2The levels of TNF-α and IL-10in GCF2.1The level of TNF-α in GCFBefore initial therapy, the baseline value of concentration of TNF-α inGCF of the SP group was6.12±1.33ng/ml and that of NP group was5.29±0.79ng/ml. The baseline concentration of TNF-in GCF of smokinggroup was higher than that of the non-smoking group; thus the difference wasstatistically distinguished significant (P<0.05).After initial therapy, the concentration of TNF-α in GCF of the SP group was5.01±1.55ng/ml and that of NP group was3.46±1.05ng/ml. SP group washigher than NP group, there was statistically distinguished significant (P<0.05).There was statistically distinguished significant between the SP group and NPgroup since the decreased of TNF-α concentration in GCF than prior to theinitial therapy (P<0.05).The decreased of concentration of TNF-α in GCF was more significantlylower in the SP group (1.11±0.67) than the decreased of NP group (1.82±0.74),there was statistically distinguished significant in the difference of SP and NPgroup (P0.05).2.2The level of IL-10in GCFBefore the initial therapy, the baseline value of concentration of IL-10inGCF of SP group was4.08±0.95ng/ml and that of NP group was4.81±1.95ng/ml. The baseline concentration of IL-10in GCF of SP was lowerthan the baseline in NP; the difference was statistically distinguishedsignificant (P<0.05).After initial therapy, the concentration of IL-10in GCF of SP group was16.17±2.53ng/ml and that of NP group was18.53±1.19ng/ml. Theconcentration of IL-10in GCF was significantly lower in SP group than thatof NP group, the difference was statistically distinguished significant (P<0.05). There was statistically distinguished significant between the SP groupand NP group since the increased of IL-10concentration in GCF than prior tothe initial therapy (P<0.05).The increased of concentration of IL-10in GCF was more significantlylower in the SP group (12.09±1.56) than the increase of NP group (13.72±1.29)before and after the initial therapy; there was statistically distinguishedsignificant in the difference of SP and NP group (P0.05).Conclusion：1The concentration of TNF-α in SP were higher than that of NP before andafter initial therapy, which indicates that smoking causes the increase ofTNF-α concentration of chronic periodontitis patients.2The concentration of IL-10in SP were lower than that of NP before and after initial therapy, which indicates that smoking causes the decrease of the IL-10concentration of chronic periodontitis patients.3Initial therapy could effectively reduce periodontal probing depth andTNF-α concentration, and increase IL-10concentration of both Smokers andnon-smokers periodontitis patients.4The change of probing depth, decrease of TNF-α concentration and increaseof IL-10concentration of SP group were all lower than that of NP group,which indicates that smoking has negative effect on the initial therapy ofperiodontitis patients.