Tupakka ja nuorten suun terveys

The present cross-sectional study examined the effect of smoking on oral health in a birth cohort of 15 to 16-year-old Finnish adolescents. The hypothesis was that oral health parameters were poorer among smoking than non-smoking subjects and that a tobacco intervention program could be effective among the adolescents. The study was conducted in the Kotka Health Center, Kotka, Finland. Altogether 501 out of 545 subjects (15- to 16-year-old boys [n = 258] and girls [n = 243]) were clinically examined in 2004 and 2005. The sample frame was a birth cohort of all subjects in 1989 and 1990, living in Kotka. A structured questionnaire was also filled in by the participants to record their general health and health habits, such as smoking, tooth brushing, and medication used. The participants were classified into nonsmokers, current smokers, and former smokers. Subgingival pooled plaque samples were taken and stimulated salivary samples were also collected. The subjects were asked from which of seven professional groups (doctors, school nurses, dental nurses, general nurses, dentists, teachers and media professionals) they would prefer to receive information about tobacco. The two most popular groups they picked up were dentists and school nurses. Current smokers (n=127) were then randomly assigned into three groups: the dentist group (n =44), the school-nurse group (n =42), and the control group (n =39). The intervention was based on a national recommendation of evidence based guidelines by The Finnish Medical Society Duodecim ( 5A counseling system). Two months after the intervention, a second questionnaire was sent to the smokers in the intervention groups. Smoking cessation, smoking quantity per week, and self-rated addiction for smoking (SRA) were recorded. The results were analyzed using the R-statistical program. The results showed that 15% of the subjects had periodontitis. Smokers (25%) had more periodontitis than non-smokers (66%) (p < 0.001). Smoking boys (24%) also had more caries lesions than non-smokers (69%) (p < 0.001), and they brushed their teeth less frequently than non-smokers. Smoking significantly impaired periodontal health of the subjects, even when the confounding effects of plaque and tooth brushing were adjusted. Smoking pack-years, intensified the effects of smoking. Periodontal bacteria Prevotella nigrescens, Prevotella intermedia, Tannerella forsythia and Treponema denticola were more frequently detected among the smokers than non-smokers, especially among smoking girls. Smoking significantly decreased the values of both the salivary periodontal biomarkers MMP-8 (p=0.04) and PMN elastase (p=0.02) in boys. The effect was strengthened by pack years of smoking (MMP-8 p=0.04; elastase p0.01). Of those who participated in the intervention, 19 % quit smoking. The key factors associated with smoking cessation were best friend`s influence, nicotine dependence and diurnal type. When the best friend was not a smoker, the risk ratio (RR) of quit smoking after the intervention was 7.0 (Cl 95% 4.6 10.7). Of the diurnal types, the morning people seemed to be more likely to quit (RR 2.2 [Cl 95% 1.4 3.6]). Nicotine dependence also elicited an opposite effect: those who scored between 3 and 5 dependence scores were less likely to quit. In conclusion, smoking appears to be a major etiological risk factor for oral health. However, the early signs of periodontal disease were mild in the subjects studied. Based on the opinions of the adolescent s, dental professionals may have a key position in their smoking cessation. The harmful effects of smoking on oral health could be used in counselling. Best friend`s influence, nicotine dependence and diurnal type, all factors associated with smoking cessation, should be taken more carefully into account in the prevention programs for adolescents.Tässä tutkimuksessa selvitettiin tupakoinnin vaikutuksia 15 16-vuotiaiden nuorten suun terveyteen sekä mistä kotkalaisnuoret olisivat halukkaita saamaan tupakkavalistusta ja mikä vaikutus annetulla valistuksella on heidän tupakointikäyttäytymiseensä. Tutkimus tehtiin Kotkan terveyskeskuksessa, jossa 501:n (yksi ikäkohortti) 15-16-vuotiaan nuoren suun terveys tutkittiin kliinisesti erilaisin mittarein mahdollisimman tarkasti, lisäksi otettiin ientaskunäytteitä ja kerättiin sylkeä bioanalyysejä varten. Koehenkilöt täyttivät kyselylomakkeen, johon kirjattiin heidän terveyskäyttäytymisensä, kuten tupakointi, hampaidenpesu ja mahdolliset sairaudet sekä lääkitykset. Kyselyssä kartoitettiin myös tupakoinnin taustatekijöitä. Nuorilta kysyttiin myös keltä seitsemän ammattiryhmän (lääkärit, kouluterveydenhoitajat, hammashoitajat, yleishoitajat, hammaslääkärit, opettajat ja media) edustajalta he mieluiten vastaanottaisivat tupakkavalistusta. Tupakoivat (n=127) jaettiin tämän jälkeen satunnaistaen kolmeen ryhmään: hammaslääkäri-, kouluterveydenhoitaja- ja kontrolliryhmään, ensin mainitut ryhmät saivat tupakkavalistusta Käypä hoito-suosituksen mukaisesti, kontrolliryhmä sai vain tupakka-lehtisen. Kaksi kuukautta tutkimuksen jälkeen tupakoiville lähetettiin toinen kysely, jossa kysyttiin tupakoinnin lopettamisesta, viikoittaisesta tupakointimäärästä ja itsearvioidusta riippuvuusasteesta. Tutkimukseen osallistuneista 19 % lopetti tupakoinnin tupakkavalistuksen jälkeen. Lopettamisen vaikeuteen näyttivät vaikuttavan parhaan ystävän vaikutus, nikotiiniriippuvuus sekä vuorokausityyppisyys. Kun paras ystävä tupakoi, tupakoinnin lopettaminen oli 7-kertaa vaikeampaa kuin jos paras ystävä ei tupakoi. Osa nuorista oli jo merkittävästi nikotiiniriippuvaisia ja heidän oli vaikea lopettaa. Aamuihmiset lopettivat tupakoinnin todennäköisemmin. Nuorista 15%:lla oli hampaiden kiinnityskudossairaus. Tupakoiville, joita oli 25% nuorista, oli enemmän kiinnityskudossairautta kuin ei-tupakoivilla. Tupakoivilla pojilla oli enemmän kariesta kuin ei-tupakoivilla ja he harjasivat hampaitaan harvemmin kuin tupakoimattomat. Tupakointi näytti heikentävän nuorten hampaiden ja kiinnityskudosten kuntoa myös sen jälkeen, kun plakin ja hampaiden harjauksen vaikutukset oli otettu huomioon. Kiinnityskudossairauteen liittyviä bakteereja löytyi useammin tupakoijien kuin tupakoimattomien keskuudessa. Loppupäätelmänä voidaan sanoa, että tupakointi on riskitekijä myös nuorten suun terveydelle eri mittarein arvioituna. Tupakoinnin vaikutusta ei voi harjata pois. Nuorten mielipiteiden perusteella hammaslääkärin antamalla valistuksessa on merkitystä nuorten tupakoinnin lopettamisessa ja tupakoinnin suun terveydelle haittavaikutuksia voidaan käyttää avuksi tupakkaneuvonnassa. Tupakoinnin lopettamisen taustatekijöistä parhaan ystävän vaikutus, nikotiiniriippuvuus ja vuorokausityyppisyys ovat merkitseviä ja ne tulisi ottaa huomioon nuorten tupakointivalistusohjelmissa

A Competition between Care Teams Improved Recording of Diagnoses in Primary Dental Care: A Longitudinal Follow-Up Study

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Salivary Diagnostics : Point-of-Care diagnostics of MMP-8 in dentistry and medicine

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Low association between bleeding on probing propensity and the salivary aMMP-8 levels in adolescents with gingivitis and stage I periodontitis

Background and Objective Bleeding on probing (BOP) is a widely accepted measure used in periodontal diagnostics. Previous studies suggest that several factors can affect BOP propensity. The aim of this study was to investigate the relative impact of different local and modifying factors on BOP levels. Materials and Methods The oral health of five hundred and forty-four adolescents (two birth cohorts) aged 15-17 years living in Kotka, Finland, was examined including periodontal probing depth, visible plaque index, root calculus, and BOP. Whole saliva samples were collected and measured for active matrix metalloproteinase-8 (aMMP-8) by time-resolved immunofluorometric assay (IFMA). Results Bacterial plaque/calculus accumulation (oral hygiene) had a major influence on BOP levels. The relative impact was several times greater compared with the extent of periodontal pocketing, aMMP-8 levels, smoking, toothbrushing, or gender. Furthermore, BOP levels were significantly elevated among adolescents with poor oral hygiene than good oral hygiene even if adjusted for the extent of periodontal pocketing (P = 4 mm deep periodontal pockets existed. The difference in the extent of periodontal pocketing was not significant between the two birth cohorts of adolescents (P = .731). Conclusions BOP levels can be regarded as an important indicator of the extent of bacterial challenge and its adverse effects on the gingival inflammation. However, the level of oral hygiene may mask the association between the extent of gingival bleeding and the severity of the periodontal inflammatory condition. Thus, relying on BOP levels (below 10% or 20%) may provide insufficient information about the periodontal treatment need of an adolescent depending on his/her level of oral hygiene. Yet, more research is needed to confirm the results, also in adult populations.Peer reviewe

Comparing the effectiveness of competition as a method of reminding primary oral health care dentists to record diagnoses with two alternative methods used to enhance the recording of diagnoses in primary health care

The purpose of this study was to investigate whether competition is an effective method to remind primary oral health care dentists to record diagnoses (RRD). The effectiveness of competition was examined in comparison with financial group bonuses (FGBs) and electronic reminders (ERs) of the electronic health record, together with superior-subordinate or development discussions. Putative differences in the diagnosis recording cultures of Finnish public health care physicians and dentists were studied. This was a retrospective quasi-experimental observational study in which the effects of the interventions on the rate of recording diagnoses were identified using a general linear regression model and proportions of visits with recorded diagnoses. The rate of increase in the recording of diagnoses in dentists was 0.995 +/- 0.273%/month (mean +/- SEM) after the implementation of RRDs and this did not differ from that obtained after starting FGBs (0.919 +/- 0.130%/month) or ERs with superior-subordinate or development discussions (1.562 +/- 0.277%/month) in physicians. As the rates of increase did not differ none of the applied methods seemed to be more effective than the others when trying to influence the behaviour of primary health care clinicians. Altogether, public primary health care physicians were more active than respective primary oral health care dentists to record diagnoses.Peer reviewe

Periodontitis in early and chronic rheumatoid arthritis : a prospective follow-up study in Finnish population

Objectives To investigate the association between rheumatoid arthritis (RA) and periodontitis with special emphasis on the role of antirheumatic drugs in periodontal health. Design Prospective follow-up study. Patients with early untreated RA and chronic active RA were examined at baseline and 16months later. Controls were examined once. Settings and participants The study was conducted in Finland from September 2005 to May 2014 at the Helsinki University Hospital. Overall, 124 participants were recruited for dental and medical examinations: 53 were patients with early disease-modifying antirheumatic drug (DMARD) na1ve RA (ERA), 28 were patients with chronic RA (CRA) with insufficient response to conventional DMARDs. After baseline examination, patients with ERA started treatment with synthetic DMARDs and patients with CRA with biological DMARDs. Controls were 43 age-matched, gender-matched and community-matched participants. Outcome measures Degree of periodontitis (defined according to the Center for Disease Control and Prevention and the American Academy of Periodontology). Prevalence of periodontal bacteria (analysed from plaque samples), clinical rheumatological status by Disease Activity Score, 28-joint count (DAS28), function by Health Assessment Questionnaire (HAQ) and treatment response by European League Against Rheumatism (EULAR) criteria. Results Moderate periodontitis was present in 67.3% of patients with ERA, 64.3% of patients with CRA and 39.5% of control participants (p=0.001). Further, patients with RA had significantly more periodontal findings compared with controls, recorded with common periodontal indexes. In the re-examination, patients with RA still showed poor periodontal health in spite of treatment with DMARDs after baseline examination. The prevalence of Porphyromonas gingivalis was higher in patients with ERA with periodontal probing depth 4mm compared with patients with CRA and controls. Antirheumatic medication did not seem to affect the results. Conclusions Moderate periodontitis was more frequent in patients with RA than in controls. Patients with ERA and CRA exhibited poorer periodontal health parameters when compared with controls. There was no association between antirheumatic treatment and periodontal parameters.Peer reviewe

Oral Health in Women with a History of High Gestational Diabetes Risk

We studied oral health in 115 women with and without a history of gestational diabetes (GDM), expecting poorer oral health in the GDM group. Full-mouth examinations were performed 5 years postpartum and the number of teeth, total dental index (TDI) and decayed, missing, filled teeth (DMFT) index were calculated. Bleeding on probing (BOP), probing depth (PD), visible plaque index (VPI), and clinical attachment level (CAL) were recorded. The periodontal inflammatory burden index (PIBI) was calculated. Panoramic radiographs were taken and signs of infections recorded. Oral health habits, symptoms and participants’ own opinion of oral health were recorded with questionnaires. At the time of examination, 45% of the women had a history of GDM in the index pregnancy. Mild periodontitis (62%) and bleeding on probing (46%) were common. VPI (13% and 17%, p = 0.009) and PIBI (13.1 and 17.5, p = 0.041) were lower among women with a history of GDM compared with those with no history of GDM. There was no difference between groups in DMFT scores. All women reported good subjective oral health. Thus, contrary to our hypothesis, women with a history of GDM showed better oral health parameters than women without a history of GDM

Tobacco Products, Periodontal Health and Education Level: Cohort Study from Sweden

Background: The aim of this study is to investigate if using tobacco products (including snuff, smoking tobacco and dual-using) associates with periodontal health, education level and mortality in a Swedish cohort, hypothesizing that tobacco products affect periodontal health, associate with lower education and increase the risk of death. Method: Study cohort of 1080 subjects aged 31–40 years (528 men, 552 women) was clinically examined and interviewed in 1985 and followed for mortality until 2015. Subjects were classified into two groups: “tobacco users” and “non-users”. Associations between periodontal health parameters, tobacco products, education level and age of death were analysed. SPSS was used for analyses. Results: Tobacco products, as well as education level associated, with poor periodontal health. Tobacco users and lower education was linked to higher plaque-, calculus- and gingival-index scores than non-users (

A point-of-care test of active matrix metalloproteinase-8 predicts triggering receptor expressed on myeloid cells-1 levels in saliva

Background This cross-sectional study aims to investigate if a point-of-care (PoC) test of active matrix metalloproteinase-8 (aMMP-8) predicts levels of inflammation amplifier triggering receptor expressed on myeloid cells-1 (TREM-1) and its putative ligand the neutrophil peptidoglycan recognition protein 1 (PGLYRP1) in saliva. Methods Forty-seven adolescents, aged 15 to 17 years, were tested with aMMP-8 PoC test, which was followed by a full-mouth clinical examination of the assessment of periodontal, mucosal, and oral health. TREM-1 and PGLYRP1 levels were analyzed by ELISA. The immunofluorometric assay (IFMA) specific for aMMP-8 was used as the reference method. Results Fourteen saliva samples out of a total of 47 showed positivity for aMMP-8 PoC test. Both the TREM-1 and the aMMP-8 (IFMA) levels were significantly elevated among the aMMP-8 PoC test positives compared with the PoC test negatives (P = 4 mm was significantly lower among the adolescents that had a negative aMMP-8 PoC test result, and TREM-1 levels = 4 mm (P <0.001). Conclusion The present study validated usability of aMMP-8 PoC test for predicting "proinflammatory" salivary profile and periodontal health status in adolescents.Peer reviewe