Association between shammah use with periodontal disease and shammah-induced leukoplakia-like lesion among adult males in dawn valley, Yemen

Background: The traditional type of smokeless tobacco (SLT) used in the Arabian Peninsula, especially common in Yemen is called shammah. Shammah and other risk factors play an important role in development of oral diseases. Objectives: The present study has been undertaken to determine the prevalence of shammah use and to determine the association between shammah use with periodontal disease and oral leukoplakia-like lesions. Other associated factors with periodontal disease as well as with oral leukoplakia-like lesions were also determined. Materials and Methods: A cross sectional study was conducted on 346 randomly selected adult males. Multistage random sampling was used to select the study location. After completing the structured questionnaire interviews, all the participants underwent clinical exanimation for periodontal health status and oral leukoplakia-like lesions. Periodontal status was recorded using the Community Periodontal Index (CPI). Clinical features of oral leukoplakia- like lesions were characterized based on the grades of Axéll et al. (1976). Chi-square test was used for assessing significant differences in shammah status in respect to periodontal disease and oral leukoplakialike lesions. Univariable logistic regression and multivariable logistic regression were selected for assessing potential associated factors. Results: Out of 346 male participants aged 18 years and older, 68 reported being current shammah users. The prevalence of current shammah use was 19.7% (95% CI: 15.6%, 24.2%). Chi-square test detected that significant differences exists between the study groups (i.e., never, former, and current shammah users) in respect to the presence of periodontal disease (P= 0.001) as well as to the presence of oral leukoplakia-like lesion (P=0.001). Multivariable logistic regression analysis revealed that age, family income, former shammah user, current shammah user, and annual duration of shammah use were statistically associated with the presence of periodontal disease [Adjusted odds ratio (AOR)= 1.05; 95% CI: 1.03, 1.07; P= 0.001], (AOR= 2.01; 95% CI: 1.16, 3.47; P= 0.012), (AOR= 2.92; 95% CI: 1.20, 7.10; P= 0.018), (AOR= 7.25; 95% CI: 3.84, 13.70; P= 0.001), and (AOR= 2.19; 95% CI: 1.47, 3.24; P= 0.001), respectively. The multivariable analysis also revealed that age, no formal or primary level of education, former shammah user, current shammah user, and frequency of shammah use per day were statistically associated with the presence of oral leukoplakia-like lesion ( AOR= 1.03; 95% CI: 1.01, 1.06; P= 0.006), (AOR= 8.65; 95% CI: 2.81, 26.57; P= 0.001), (AOR= 3.65; 95% CI: 1.40, 9.50; P= 0.008), (AOR= 12.99; 95% CI: 6.34, 26.59; P= 0.001), and (AOR= 1.17; 95% CI: 1.02, 1.36; P= 0.026), respectively. Conclusion: The results revealed that periodontal disease and oral leukoplakia-like lesions were significantly associated with shammah use. Therefore, it is important to develop comprehensive shammah prevention programmes in Yemen

A Systematic Review on the Implication of Minerals in the Onset, Severity and Treatment of Periodontal Disease

Periodontal disease is an inflammatory disease with high prevalence in adults that leads to destruction of the teeth-supporting tissues. Periodontal therapy has been traditionally directed at reduction of the bacterial load to a level that encourages health-promoting bacteria and maintenance of oral-hygiene. The role of nutrition in different chronic inflammatory diseases has been the subject of an increasing body of research in the last decades. In this sense, there has been an important increase in the volume of research on role of nutrition in periodontitis since the diet has known effects on the immune system and inflammatory cascades. Minerals play a key role in all these processes due to the multiple pathways where they participate. To clarify the role of the different minerals in the establishment, progression and/or treatment of this pathology, a systemically review of published literature cited in PubMed until May 2016 was conducted, which included research on the relationship of these elements with the onset and progression of periodontal disease. Among all the minerals, calcium dietary intake seems important to maintain alveolar bone. Likewise, dietary proportions of minerals that may influence its metabolism also can be relevant. Lastly, some observations suggest that all those minerals with roles in immune and/or antioxidant systems should be considered in future research

Impact of smoking on gingival inflammation in representative samples of three South American cities

The aim of this study was to investigate the impact of smoking on gingival inflammation in a representative sample of 1,650 adults from Santiago (Chile), Porto Alegre (Brazil), and Tucumán (Argentina). A questionnaire was administered to participants to gather demographic and behavioral characteristics, including smoking habits. The participants were clinically examined to obtain gingival index (GI), gingival bleeding index (GBI), visible plaque index (VPI), and calculus presence values. Gingival inflammation was defined as a mean GI > 0.5. Heavy smokers presented significantly lower levels of gingival inflammation, as reflected by both GI and GBI, than both light and moderate smokers, despite their having increased amounts of plaque and calculus. Being 50 years old or older [odds ratio (OR), 1.93], a VPI ≥ 30% (OR, 28.1), and self-reported diabetes (OR, 2.79) were positively associated with detection of gingival inflammation. In conclusion, the occurrence of clinically detectable gingival inflammation was lower in heavy smokers than light and moderate smokers. Older age, diabetes, and visible plaque emerged as risk indicators of gingivitis. Plaque and gingival indices are significantly associated regardless of the smoking status

Oral hygiene and periodontal health status among khat chewers. A case-control study

Habitual khat chewing is a widespread male habit in Southern Arabia and East Africa. The aim of this study was to assess the effect of Khat chewing on oral hygiene and periodontal health status among Yemeni male khat chewers. This case- control study included 310 khat chewers, aged 20-65 years, and 72 age- and gender- matched non-chewers as controls. Periodontal examination included recording of dental plaque index (PI), gingival index (GI), probing pocket depth (PPD), attachment level (AL) and gingival recession (GR). Demographic data, oral hygiene practices, and duration, frequency and site of khat chewing were obtained using questionnaires. SPSS was used for data analysis. ANOVA and t- tests were used to compare groups. Khat chewers had significantly higher mean PI, AL, GR scores than non-chewers (P 0.05). Interestingly, the results showed that the chewing side had less PI, GI and PPD than non-chewing side. However, gingival recession was significantly higher in the chewing side. The duration of chewing showed a significant effect on PI, PPD, AL, and GR but had no effect on the gingival condition. Likewise, the frequency of chewing showed a significant effect on PPD, AL, and GR, but had no effect on other indices (PI and GI). The results of this study indicate that khat chewing have a detrimental effect on the periodontium

Periodontal and gingival changes amongst pregnant women in Lagos, Nigeria

Objective: To assess the periodontal and gingival changes during different stages of pregnancy among women in a Nigerian Teaching Hospital. Method : Fifty three pregnant women attending the ante-natal clinic of the Lagos University Teaching Hospital, (LUTH), were included in the study while, 53 non- pregnant with mean age 29.40 ± 3.8years, and apparently healthy women with mean age 30.96 ±2.3years served as the control. Periodontal and oral hygiene status were assessed using the Community Periodontal Index of Treatment Needs (CPITN) and the Simplified Oral Hygiene (OHI-S) Indices respectively. Result: There were a higher number of sextants with gingival bleeding and shallow pockets among the pregnant women in the 2nd and 3rd trimesters of pregnancy compared to that of the non-pregnant women. The number of sextants with gingival bleeding and shallow pocket however reduced post partum. Thus, in the pregnant women the mean number of sextants with gingival bleeding was 0.9 in 1st trimester, 1.4 in the 2nd trimester, 1.0 in the 3rd trimester and 0.1 postpartum. The mean number of sextants with pocket (code 3) was 0.1 in the 1st trimester, 0.4 in the 2nd trimester, 0.3 in the in 3rd trimester & 0.1 postpartum. Whereas in the non- pregnant group, the mean no of sextants with gingival bleeding was 0.6 at the 1st examination ,0.5 at the 2nd examination and 0.4 at the 3rd examinations and the mean number of sextants with pocket was 0.1at the 1st examination, 0.2 at the 2nd and 3rd examination. The mean OHI-S score of pregnant women increased from 2.36 ± 0.91 at the beginning of the study to 3.03±0.72 at the end of the study. While the score of the control group increased from 2.06±1.1 to 2.65±0.99. Conclusion: The OHI-S score, gingival bleeding and pockets were higher in the pregnant than in the non –pregnant women. It is suggested that pregnant women should have routine dental check-up and early management of periodontal disease through adequate plaque control

Assessing the association between unstimulated whole salivary flow rate (UWSFR) and oral health status among healthy adult subjects : a cross-sectional study

This study aimed to test the association between the unstimulated whole salivary flow rate (UWSFR) and the oral health status represented by dental and gingival status among healthy adult subjects. This work was a cross-sectional study of patients attending the undergraduate dental clinics at AlFarabi College for Dentistry and Nursing, Riyadh, Saudi Arabia. The study population consisted of 502 systemically healthy adults aged 18?35 years. UWSFR was collected for all study participants and expressed as ml/min. Oral health status was estimated using the Community Periodontal Index (CPI) and the Oral Hygiene Index-Simplified (OHI-S). The number of decayed teeth and the number of available teeth were also calculated to evaluate dental status. The mean UWSFR was 0.42 (±0.3) ml/min, and the male participants significantly had more UWSFR than the females. UWSFR was significantly affected by CPI, OHI-S, body mass index (BMI) and gender as indicated in the univariate analysis. However, multiple regression analysis revealed that only gender was a significant predictor of UWSFR. The male subjects were shown to have a higher average of 0.133 ml/min than the females. High BMI scores, moderate-to-severe gingivitis and low level of oral hygiene increased UWSFR. However, further longitudinal studies are recommended to test the role of salivary cytokine levels to validate the exact association between the UWSFR and the oral health status

Oral hygiene status, interdental cleaning and perception of gingival bleeding among a group of pregnant women in Nigeria

Background: Hormonal and vascular changes in pregnancy can lead to exaggeration of inflammatory response to local irritants like dental plaque causing pregnancy gingivitis which if not treated can result in advanced periodontal diseases and consequent adverse pregnancy outcomes. Objective: To assess the oral hygiene and gingival bleeding perception of pregnant women Methods: Self-administered questionnaires were used to collect data. Oral hygiene status and gingival status were assessed with Simplified Oral Hygiene Index (OHI-S) and gingival bleeding index respectively. Data was analysed using IBM SPSS (Statistical Package for the Social Sciences) version 25. Results were presented in frequency and percentages and chi square analysis done for the categorical variables with statistical significance set at P < 0.05. Results: One hundred and fifty-one participants with age range of 20 to 43 years with a mean age of 29.85±4.05years participated in the study. All participants used toothbrush to clean their teeth and 44.4% used medium bristled toothbrush. Two-third used herbal toothpaste. More than two-thirds (84.1%) of the participants used both horizontal and vertical tooth brushing technique. Only 33.8% brushed twice daily. Though 92.1% claimed to clean interdentally, only 19.4% used dental floss.  Prevalence of gingival bleeding was 31.8%. Two persons (1.3%) thought it normal to bleed from the gum while brushing and 86.8% did not know one can bleed from the gum during pregnancy Forty-four (29.1%) and 18(11.9%) of participants had fair and poor oral hygiene status respectively. 55.6% bled on probing and had gingival bleeding index of 1 and 2. Four (2.6%) of participants had gingival recession measuring 3mm to 4mm and 8.6% had halitosis. Statistical analysis of the association between participants’ perception of gum bleeding and oral hygiene status showed statistical significance. Conclusion: The knowledge of pregnancy gingivitis is poor among the participants. There is the need to educate them about this and incorporate periodontal care into antenatal care so as to increase their quality of life during pregnancy