Periodontitis
Conditions
Keywords
smoking cessation, tobacco, periodontal, subgingival microorganisms
Brief summary
The aim of this prospective interventional study is to verify the efficacy of smoking cessation on clinical and microbiological outcomes of non-surgical periodontal therapy of chronic periodontitis patients. Smokers willing to quit received periodontal treatment and concurrent smoking cessation therapy. Periodontal maintenance was performed every 3 months. A single calibrated examiner, blinded to smoking status, assessed periodontal clinical outcomes and applied a structured questionnaire in order to collect demographic and behavioural information. Further, expired carbon monoxide concentration were measured with a monoximeter. A pooled subgingival plaque sample was collected from the deepest periodontal pocket from each participant. The presence and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were determined using (RT-PCR).
Detailed description
Smokers willing to quit, with 10 teeth or more, and with periodontitis (30% or more of their teeth with proximal attachment loss ≥ 5 mm) were enrolled in the study. All subjects received periodontal treatment and concurrent smoking cessation therapy. Smoking cessation therapy was performed by a team comprising physicians, nurses, a psychologist and dentists, and consisted of four 1-h counselling lectures, psychologist-assisted cognitive behavioral therapy, nicotine replacement therapy and medication (bupropion or varenicline). Smoking cessation motivation was reinforced by dentists at the maintenance sessions, by means of motivational interviewing techniques. Periodontal therapy consisted in full-mouth supra and subgingival scaling and root planing (with curettes and ultrasonic scaler); oral hygiene instruction and motivation and removal of intra-oral plaque retentive factors. Further, periodontal maintenance was performed every 3 months. A single calibrated examiner, blinded to smoking status, assessed periodontal clinical outcomes (recession, pocket depth, clinical attachment level, plaque index and bleeding on probing). A structured questionnaire was applied in order to collect demographic and behavioral information. Expired carbon monoxide concentration was measured with a monoximeter, in order to validate smoking status. A pooled subgingival plaque sample was collected from the deepest periodontal pocket from each participant. The presence and quantification of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola were determined using real time - PCR (RT-PCR).
Interventions
BEHAVIORALSmoking cessation counseling
Multidisciplinary smoking cessation counseling, performed by a team comprising physicians, nurses, a psychologist and dentists. It consisted of four 1-h counselling lectures delivered by physicians, psychologist-assisted cognitive behavioural therapy, and counseling provided by dentists during the active phase of the treatment and maintenance session, using motivational interviewing techniques
PROCEDURENon-surgical periodontal therapy
Full-mouth supra and subgingival scaling and root planing (with curettes and ultrasonic scaler); oral hygiene instruction and motivation and removal of intra-oral plaque retentive factors
DRUGNicotine replacement therapy
Nicotine replacement therapy: chewing gum (Nicorette chewing gum 2-4mg) and patches (Nicorette patches 15-25mg)
bupropion hydrochloride 150mg
DRUGVarenicline
Varenicline 0,5mg
Sponsors
Claudio Mendes Pannuti
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Masking description
The outcome assessor was blind to smoking status. Before each follow-up periodontal examination (3, 6 and 12 months), the following procedures were performed by a periodontist: (1) removal of all tobacco stains from subject's teeth and/or dental polishing, with a standardized duration of up to 30 min., (2) 0.12% chlorohexidine rinse (1min.) aimed to hide any possible cigarette odour exhaled from the oral cavity. After these procedures, the examiner entered the examination room fully equipped (including a mask), in order to avoid noticing the smoking status by odour
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* smokers willing to stop smoking * \>10 teeth * periodontitis (30% or more of their teeth with proximal attachment loss ≥ 5 mm)
Exclusion criteria
* systemic conditions considered as risk factors for periodontal disease, * periodontal therapy in the last 6 months * continuous systemic use of anti-inflammatory or steroidal drugs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Clinical Attachment Level | baseline - 12 months | Change in Clinical Attachment Level (millimeters) after 12 months |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Pocket depth | baseline - 12 months | Change in Pocket depth (millimeters) after 12 months |
| Change in bleeding on probing | baseline - 12 months | Change in bleeding on probing (percentage of sites with bleeding) after 12 months |
| Change in visible plaque | baseline - 12 months | Change in visible plaque (percentage of sites with visible plaque) after 12 months |
| Change in Gingival recession | baseline - 12 months | Change in Gingival recession (millimeters) after 12 months |
| Prevalence and levels of Porphyromonas gingivalis | baseline - 12 months | Prevalence and levels of Porphyromonas gingivalis, determined by means of (RT-PCR). |
| Prevalence and levels of Tannerella forsythia | baseline - 12 months | Prevalence and levels of Tanerella forsythia, determined by means of RT-PCR |
| Prevalence and levels of Treponema denticola | baseline - 12 months | Prevalence and levels of Treponema denticola, determined by means of RT-PCR |
| Prevalence and levels of Aggregatibacter actinomycetemcomitans | baseline - 12 months | Prevalence and levels of Aggregatibacter actinomycetemcomitans determined by means of (RT-PCR). |
Outcome results
None listed