1. Puffing and perio
This research aimed to discover periodontal measurements and self-perceived oral symptoms (OS) among cigarette smokers (CS – group 1), individuals exclusively vaping electronic cigarettes (group 2) and never-smokers (NS – group 3). Personal data, self-perceived OS and duration and daily frequency of vaping and smoking were gathered using a questionnaire. Full mouth plaque index (PI), bleeding on probing (BOP), probing depth (PD)>=4mm and clinical attachment loss (AL) were measured and marginal bone loss (MBL) around all teeth was measured on digital radiographs. Numbers of missing teeth (MT) were also recorded. PI (P<0.01), and PD>=4mm (P<0.01) were significantly higher among individuals in groups 1 and 2 compared with group 3. BOP was significantly higher in group 3 than individuals in groups 1 and 2. There was no difference in number of MT, clinical AL and MBL among all groups. Pain in gums was more often reported by individuals in group 1 compared with individuals in groups 2 and 3. Overall, periodontal inflammation and self-perceived OS were poorer among CS compared with vaping individuals and NS.

Javed F et al. Comparison of periodontal parameters and self-perceived oral symptoms among cigarette-smokers, individuals vaping electronic-cigarettes and never-smokers: a pilot study. J Periodontol 2017 Jun 23.

Q Periodontal inflammation and self-perceived oral symptoms were highest amongst which group?
A Individuals who vaped
B Cigarette smokers
C Those who had never smoked
D All individuals in the study were the same

  1. Does insulin resistance affect obesity and periodontitis?
One hundred and ten obese and 102 lean individuals, were evaluated for periodontal disease and divided into three groups according to insulin resistance (IR): lean without IR (LWIR), obese without IR (OWIR), and obese with IR (OIR). Medical history, metabolic, inflammatory and periodontal parameters were recorded. Periodontitis was more prevalent in obese (80.9%) than lean subjects (41.2%), with the former showing a six-fold increased risk. Obese subjects in general displayed higher diastolic blood pressure and lower blood cholesterol than lean subjects. OIR had higher systolic blood pressure, glucose, insulin, triglycerides and number of teeth with pocket depth (PD) >= 4 mm than OWIR, although other periodontal variables were the same. Analysis showed that probing depth, bleeding on probing and insulin resistance were independent predictors of the number of teeth with PD >= 4 mm. The data support an association between obesity and periodontitis, and point to a central role of insulin resistance. Periodontitis tends to be more extensive in obese patients with IR.

Martinez-Herrera M et al. Involvement of insulin resistance in normoglycaemic obese patients with periodontitis: A cross-sectional study. J Clin Periodontol 2017; Jul 11.

Q Obesity:
A And periodontitis seem to be linked
B Seems to lower the chances of patients having periodontitis
C Showed a two-fold increased risk in periodontitis
D Caused a lower diastolic blood pressure in subjects in this study

  1. Osteoporosis and periodontitis
Is there any relationship between bone mineral density (BMD), tooth loss and periodontal status with age, number of years since onset of menopause and educational level? The aim of this study was to find out, since these factors can lead to greater tooth loss. BMD was determined for lumbar spine region and proximal femur for 112 women aged 45-80 years, while dental and periodontal status were evaluated clinically and on panoramic radiographs. To analyse tooth loss frequency the participants were divided into four age groups. A significant inverse realtionship was found between the number of lost teeth and BMD in the hip region but not at the lumbar spine. Several indicators of periodontal condition were significantly correlated with BMD, but not with postmenopausal period length. Importantly, participants missing one or more incisors or canines had significantly lower mean value of BMD compared to those who had retained these teeth. Although osteoporosis is not the main cause of periodontitis, it may be a factor that leads to enhanced pocket depth and greater risk of tooth loss in ageing women.

Savic Pavicin I et al. The relationship between periodontal disease, tooth loss and decreased skeletal bone mineral density in ageing women. Gerodontol 2017; Aug 15.

Q Which of the following statements is true based on the results of this study?
A Participants missing one or more molars had significantly lower mean value of BMD
B Postmenopausal period length dictates pocket depth
C Osteoporosis is not the main cause of periodontitis
D Osteoporosis may be a factor that leads to enhanced loss of attachment

  1. Forty years on
This study was able to assess long-term attachment and periodontitis-related tooth loss (PTL) in untreated periodontal disease over a period of 40 years using data from a previous study in 1970. In 2010, 75 subjects (15.6%) from the original study were re-examined. PTL over 40 years varied between 0 and 28 teeth (4 individuals had no tooth loss, 12 were edentulous). Attachment loss was statistically significantly associated with PTL, and smoking and calculus were associated with disease initiation. Calculus, plaque and gingivitis were associated with loss of attachment and progression to advanced disease. Mean attachment loss <1.81mm at the age of 30 indicated subjects were likely to have a dentition of at least 20 teeth at 60 years of age. The results highlight the importance of treating early periodontitis along with promoting smoking cessation in those under 30 years of age. They further show that calculus removal, plaque control and reduction of gingivitis are essential in preventing disease progression, further loss of attachment and ultimately tooth loss.

Ramseier CA et al. Natural history of periodontitis: Disease progression and tooth loss over 40 years.  J Clin Periodontol 2017 Jul 22.

Q A low attachment loss at age 30 meant that subjects:
A Needed oral hygiene instruction and gum surgery urgently
B Had a good chance of no tooth loss at the age of 60
C Could be told that moderate smoking was acceptable to their oral health
D Did not have to worry about calculus, plaque and gingivitis