Compartment differences of inflammatory activity in chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with local and systemic inflammation. The knowledge of interaction and co-variation of the inflammatory responses in different compartments is meagre. METHOD: Healthy controls (n = 23), smokers with (n = 28) and without (n = 29) COPD performed spirometry and dental examinations. Saliva, induced sputum, bronchoalveolar lavage (BAL) fluid and serum were collected. Inflammatory markers were assessed in all compartments using ELISA, flow cytometry and RT-PCR. RESULTS: Negative correlations between lung function and saliva IL-8 and matrix metalloproteinase-9 (MMP-9) were found in smokers with COPD. IL-8 and MMP-9 in saliva correlated positively with periodontal disease as assessed by gingival bleeding in non-smokers.Tumor necrosis factor-α (TNF-α) in saliva, serum and TNF-α mRNA expression on macrophages in BAL-fluid were lower in smokers than in non-smokers. There were positive correlations between soluble TNF-α receptor 1 (sTNFR1) and soluble TNF-α receptor 2 (sTNFR2) in sputum, BAL-fluid and serum in all groups. Sputum interleukin-8 (IL-8) or interleukin-6 (IL-6) was positively correlated with sTNFR1 or sTNFR2 in non-smokers and with sTNFR2 in COPD. CONCLUSION: Saliva which is convenient to collect and analyse, may be suitable for biomarker assessment of disease activity in COPD. An attenuated TNF-α expression was demonstrated by both protein and mRNA analyses in different compartments suggesting that TNF-α response is altered in moderate and severe COPD. Shedding of TNFR1 or TNFR2 is similarly regulated irrespective of airflow limitation.

Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970-2010.

AIM: To investigate the relationship between smoking rate and periodontal disease prevalence in Sweden. MATERIAL AND METHODS: National smoking rates were found from Swedish National Statistics on smoking habits. Based on smoking rates for the years 1970-2010, periodontal disease prevalence estimates were calculated for the age bracket 40-70 years and smoking-associated relative risks between 2.0 and 20.0. The impact of smoking on the population was estimated according to the concept of population attributable fraction. RESULTS: The age-standardized smoking rate in Sweden declined from 44% in 1970 to 15% in 2010. In parallel with the smoking decline the calculated prevalence estimate of periodontal disease dropped from 26% to 12% assuming a 10-fold smoking-associated relative risk. Even at more moderate magnitudes of the relative risk, e.g. 2-fold or 5-fold, the prevalence decrease was quite tangible, suggesting that the current prevalence in Sweden is about 20-50% of the level 40 years ago. The population attributable fraction, estimating the portion of the disease that would have been avoided in the absence of smoking, was 80% in 1970 and 58% in 2010 at a ten-fold relative risk. CONCLUSION: Calculated estimates of periodontal disease prevalence are closely related to real changes in smoking rate. As smoking rate drops periodontal disease prevalence will drop.

Clinical validation of a non-heteronormative version of the Social Interaction Anxiety Scale (SIAS).

INTRODUCTION: Despite welcomed changes in societal attitudes and practices towards sexual minorities, instances of heteronormativity can still be found within healthcare and research. The Social Interaction Anxiety Scale (SIAS) is a valid and reliable self-rating scale of social anxiety, which includes one item (number 14) with an explicit heteronormative assumption about the respondent's sexual orientation. This heteronormative phrasing may confuse, insult or alienate sexual minority respondents. A clinically validated version of the SIAS featuring a non-heteronormative phrasing of item 14 is thus needed. METHODS: 129 participants with diagnosed social anxiety disorder, enrolled in an Internet-based intervention trial, were randomly assigned to responding to the SIAS featuring either the original or a novel non-heteronormative phrasing of item 14, and then answered the other item version. Within-subject, correlation between item versions was calculated and the two scores were statistically compared. The two items' correlations with the other SIAS items and other psychiatric rating scales were also statistically compared. RESULTS: Item versions were highly correlated and scores did not differ statistically. The two items' correlations with other measures did not differ statistically either. CONCLUSIONS: The SIAS can be revised with a non-heteronormative formulation of item 14 with psychometric equivalence on item and scale level. Implications for other psychiatric instruments with heteronormative phrasings are discussed.

The oral cone of Anomalocaris is not a classic ''peytoia''.

The Cambro-Ordovician anomalocaridids are large ecdysozoans commonly regarded as ancestors of the arthropods and apex predators. Predation is indicated partly by the presence of an unusual "peytoia"-type oral cone, which is a tetraradial outer ring of 32 plates, four of which are enlarged and in perpendicular arrangement. This oral cone morphology was considered a highly consistent and defining characteristic of well-known Burgess Shale taxa. It is here shown that Anomalocaris has a different oral cone, with only three large plates and a variable number of smaller and medium plates. Its functional morphology suggests that suction, rather than biting, was used for food ingestion, and that anomalocaridids in general employed a range of different scavenging and predatory feeding strategies. Removing anomalocaridids from the position of highly specialized trilobite predators forces a reconsideration of the ecological structure of the earliest marine animal communities in the Cambrian.

Therapygenetic effects of 5-HTTLPR on cognitive-behavioral therapy in anxiety disorders: A meta-analysis.

There is a recurring debate on the role of the serotonin transporter gene linked polymorphic region (5-HTTLPR) in the moderation of response to cognitive behavioral therapy (CBT) in anxiety disorders. Results, however, are still inconclusive. We here aim to perform a meta-analysis on the role of 5-HTTLPR in the moderation of CBT outcome in anxiety disorders. We investigated both categorical (symptom reduction of at least 50%) and dimensional outcomes from baseline to post-treatment and follow-up. Original data were obtained from ten independent samples (including three unpublished samples) with a total of 2,195 patients with primary anxiety disorder. No significant effects of 5-HTTLPR genotype on categorical or dimensional outcomes at post and follow-up were detected. We conclude that current evidence does not support the hypothesis of 5-HTTLPR as a moderator of treatment outcome for CBT in anxiety disorders. Future research should address whether other factors such as long-term changes or epigenetic processes may explain further variance in these complex gene-environment interactions and molecular-genetic pathways that may confer behavioral change following psychotherapy.

Periodontal health in children exposed to passive smoking.

AIM: To determine (1) the cotinine levels of saliva, urine and gingival crevicular fluid (GCF) of children in families with and without smoking members and (2) a possible association between the periodontal health of the children and exposure to passive smoking. MATERIAL AND METHODS: The study population comprised of 109 children in the age range 6-12 years. Children were classified as exposed to passive tobacco smoking (PTS-exposed, n=51) and as unexposed controls (PTS-unexposed, n=58). Plaque index, gingival index, bleeding on probing, probing depth and clinical attachment level (CAL) were recorded. GCF, saliva and urine samples were also collected. The levels of cotinine in these fluids were determined by enzyme-linked immunosorbent assay. RESULTS: The mean salivary cotinine concentration was significantly increased in PTS-exposed children compared with PTS-unexposed children (p<0.05). Further, in a dose-dependent way, the mean salivary concentration was significantly higher in children whose father or mother was a smoker (p<0.05) as compared, respectively, with children whose fathers and mothers were non-smokers. The mean CAL was significantly less in PTS-exposed children compared with non-PTS-exposed children (0.09 mm; p<0.05) and also in children whose father was a smoker (p<0.05), but not in children whose mother was a smoker as compared with non-smoker fathers and mothers, respectively. The GCF cotinine levels were below the detection limits with the assay method that was used. CONCLUSIONS: We have observed that children who are exposed to passive smoking have elevated cotinine levels in their saliva concomitant with a lowered CAL.

Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial.

BACKGROUND: Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internet-and group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions. METHODS: Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition. RESULTS: Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up. CONCLUSIONS: This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time. TRIAL REGISTRATION: ClinicalTrials.gov NCT00845260.

The COMTval158met polymorphism is associated with symptom relief during exposure-based cognitive-behavioral treatment in panic disorder.

BACKGROUND: Cognitive behavioral therapy (CBT) represents a learning process leading to symptom relief and resulting in long-term changes in behavior. CBT for panic disorder is based on exposure and exposure-based processes can be studied in the laboratory as extinction of experimentally acquired fear responses. We have recently demonstrated that the ability to extinguish learned fear responses is associated with a functional genetic polymorphism (COMTval158met) in the COMT gene and this study was aimed at transferring the experimental results on the COMTval158met polymorphism on extinction into a clinical setting. METHODS: We tested a possible effect of the COMTval158met polymorphism on the efficacy of CBT, in particular exposure-based treatment modules, in a sample of 69 panic disorder patients. RESULTS: We present evidence that panic patients with the COMTval158met met/met genotype may profit less from (exposure-based) CBT treatment methods as compared to patients carrying at least one val-allele. No association was found with the 5-HTTLPR/rs25531 genotypes which is presented as additional material. CONCLUSIONS: We were thus able to transfer findings on the effect of the COMTval158met polymorphism from an experimental extinction study obtained using healthy subjects to a clinical setting. Furthermore patients carrying a COMT val-allele tend to report more anxiety and more depression symptoms as compared to those with the met/met genotype. Limitations of the study as well as possible clinical implications are discussed. TRIAL REGISTRATION: Clinical Trial Registry name: Internet-Versus Group-Administered Cognitive Behavior Therapy for Panic Disorder (IP2). Registration Identification number: NCT00845260, http://www.clinicaltrials.gov/ct2/show/NCT00845260.

Oral health risks of tobacco use and effects of cessation.

The purpose of this paper is to review the epidemiologic evidence for the effects of tobacco use and tobacco use cessation on a variety of oral diseases and conditions. Exposures considered include cigarette and bidi smoking, pipe and cigar smoking, and smokeless tobacco use. Oral diseases and disorders considered include oral cancer and precancer, periodontal disease, caries and tooth loss, gingival recession and other benign mucosal disorders as well as implant failure. Particular attention is given to the impact of tobacco use cessation on oral health outcomes. We conclude that robust epidemiologic evidence exists for adverse oral health effects of tobacco smoking and other types of tobacco use. In addition, there is compelling evidence to support significant benefits of tobacco use cessation with regard to various oral health outcomes. Substantial oral health benefits can be expected from abstention and successful smoking cessation in a variety of populations across all ages.

Consensus Report: 2nd European Workshop on Tobacco Use Prevention and Cessation for Oral Health Professionals.

Tobacco use has been identified as a major risk factor for oral disorders such as cancer and periodontal disease. Tobacco use cessation (TUC) is associated with the potential for reversal of precancer, enhanced outcomes following periodontal treatment, and better periodontal status compared to patients who continue to smoke. Consequently, helping tobacco users to quit has become a part of both the responsibility of oral health professionals and the general practice of dentistry. TUC should consist of behavioural support, and if accompanied by pharmacotherapy, is more likely to be successful. It is widely accepted that appropriate compensation of TUC counselling would give oral health professionals greater incentives to provide these measures. Therefore, TUC-related compensation should be made accessible to all dental professionals and be in appropriate relation to other therapeutic interventions. International and national associations for oral health professionals are urged to act as advocates to promote population, community and individual initiatives in support of tobacco use prevention and cessation (TUPAC) counselling, including integration in undergraduate and graduate dental curricula. In order to facilitate the adoption of TUPAC strategies by oral health professionals, we propose a level of care model which includes 1) basic care: brief interventions for all patients in the dental practice to identify tobacco users, assess readiness to quit, and request permission to re-address at a subsequent visit, 2) intermediate care: interventions consisting of (brief) motivational interviewing sessions to build on readiness to quit, enlist resources to support change, and to include cessation medications, and 3) advanced care: intensive interventions to develop a detailed quit plan including the use of suitable pharmacotherapy. To ensure that the delivery of effective TUC becomes part of standard care, continuing education courses and updates should be implemented and offered to all oral health professionals on a regular basis.

Sensory structures of Archaeostraca (Phyllocaridida, Crustacea).

The carapace of some Archaeostraca exhibits two kinds of structures that are best interpreted as corresponding to sensory organs. Dorsal ones are located either along the dorsal margin of the valves of the carapace, or on the median dorsal plate. Anterolateral ones are located in the anterior region of both valves. Both structures are respectively homologous of the anterior and posterior sensory organs known from extant Leptostraca and other Crustacea. These structures are described in adult Archaeostraca from the Ordovician to the Carboniferous. It is expected that they could have baroreceptor, mechanoreceptor, and/or chemoreceptor functions in some cases, and a function in osmotic regulation in others.

An open study of the effectiveness of Internet treatment for panic disorder delivered in a psychiatric setting.

Panic disorder with or without agoraphobia (PD/A) is common and can be treated effectively with selective serotonin reuptake inhibitor (SSRI) medication or cognitive-behaviour therapy (CBT). However, the lack of access to CBT services has motivated the development of self-help approaches requiring less therapist contact. A novel treatment modality in this field, showing efficacy in several randomized trials but until now not evaluated within the context of regular psychiatric care, is Internet-based treatment. The aim of the present study was to evaluate the effectiveness of Internet-based CBT for patients in a psychiatric setting. Twenty consecutively referred patients with PD were included in the study. A structured clinical interview with a psychiatrist was conducted for inclusion, as well as at post-treatment and at the 6-month follow-up. The treatment consisted of a 10-week CBT-based self-help programme, including minimal therapist support by e-mail. At post-treatment, 94% of patients no longer met DSM-IV criteria for PD (82% at 6-month follow-up). The within-group effect sizes (for the main outcome PDSS; Panic Disorder Severity Scale) were Cohen's d=2.5 (pre- to post-treatment) and 2.8 (pre-treatment to follow-up), respectively. The proportion of responders on the PDSS was 75% at post-treatment and 70% at 6-month follow-up. The results supports earlier efficacy data on Internet-based CBT for PD and indicates that it is effective also within a regular psychiatric setting. However, a larger randomized controlled trial should be conducted, directly comparing Internet-based CBT with traditionally administered CBT within such a setting.

Tobacco smoking and periodontal health in a Saudi Arabian population.

BACKGROUND: The objective of this study was to examine the association between tobacco smoking, in particular water pipe smoking, and periodontal health. METHODS: A total of 262 citizens of Jeddah, Saudi Arabia in the age range from 17 to 60 years volunteered to participate in the study. The clinical examinations were carried out at King Faisal Specialty Hospital and Research Center in Jeddah and included assessments of oral hygiene, gingival inflammation, and probing depth. Smoking behavior was registered through a questionnaire and confirmed by an interview. Participants were stratified into water pipe smokers (31%), cigarette smokers (19%), mixed smokers (20%), and non-smokers (30%). RESULTS: The mean probing depth per person was 3.1 mm for water pipe smokers, 3.0 mm for cigarette smokers, 2.8 mm for mixed smokers, and 2.3 mm for non-smokers. The association between smoking and probing depth was statistically significant controlling for age (P <0.001). The association between lifetime smoking exposure and mean probing depth was statistically significant in water pipe as well as cigarette smokers controlling for age (P <0.001). Using multivariate analysis, besides smoking, the gingival and plaque indexes were associated with increased probing depth. The prevalence of periodontal disease defined as a minimum of 10 sites with a probing depth > or =5 mm was 19.5% in the total population, 30% in water pipe smokers, 24% in cigarette smokers, and 8% in non-smokers. The prevalence was significantly greater in water pipe and cigarette smokers compared to non-smokers (P <0.001). The relative risk for periodontal disease increased by 5.1- and 3.8-fold in water pipe and cigarette smokers, respectively, compared to non-smokers (P <0.001 and P <0.05, respectively). CONCLUSIONS: An association was observed between water pipe smoking and periodontal disease manifestations in terms of probing depth measurements. The impact of water pipe smoking was of largely the same magnitude as that of cigarette smoking.

The use of the Internet in the treatment of anxiety disorders.

PURPOSE OF REVIEW: The aim of this article is to review the emerging literature on the use of the Internet in the treatment of anxiety disorders. The questions asked are: (1) are Internet-delivered treatments for anxiety disorders supported by the research literature? (2) what is the quality of the evidence as it stands? (3) is there any evidence to suggest that Internet interventions can be harmful? RECENT FINDINGS: Recent and ongoing trials on panic disorder show that Internet-based self-help with minimal therapist contact is a promising approach in the treatment of panic disorder. However, trials have been small and there is a need for large-scale trials and studies conducted in psychiatric settings as most studies have recruited patients via advertisement. There is no evidence in the literature that Internet intervention is harmful, but most likely a stepped-care approach would be feasible to handle cases who fail to respond. SUMMARY: Internet-delivered interventions for anxiety disorders, and in particular panic disorder, are promising. There is however a need for further research and evaluation and there is also a need to find a proper place for such interventions in the clinical management of anxiety disorders, preferably using a stepped-care approach.

Smoking and vertical bone defects in a Saudi Arabian population.

PURPOSE: To investigate the relationship between water pipe and cigarette smoking and the prevalence and severity of vertical periodontal bone defects. MATERIAL AND METHODS: A study sample of 355 individuals in the age range 17 to 60 years was recruited from Jeddah, Saudi Arabia. Full sets of intra-oral radiographs for each individual were assessed with regard to the presence or absence of vertical bone defects. A vertical defect was defined as an angular resorption of the interdental marginal bone of 2 mm or more at either the mesial or distal aspect of the root. RESULTS: The overall prevalence of vertical defects was 39%, with a specific prevalence of 47% in water pipe smokers, 54% in cigarette smokers, and 23% in non-smokers. The prevalence was significantly elevated in both types of smokers compared with non-smokers (p < 0.001). Expressed as the proportion of sites with vertical defects per person, the severity was 2.6% for water pipe smokers, 2.8% for cigarette smokers, and 1.3% for non-smokers. The association between smoking and severity of vertical defects was statistically significant (p < 0.001). The severity of vertical defects was significantly greater in heavy exposure compared to light exposure smokers in water pipe as well as cigarette smokers (p < 0.001). The relative risk associated with water pipe and cigarette smoking was 2.9-fold and 6.6-fold increased, respectively, compared to non-smoking. CONCLUSION: The present observations suggest that prevalence and severity of vertical periodontal bone defects are increased in tobacco smokers. The association of vertical bone loss with water pipe smoking is comparable to the association with cigarette smoking.

Smartphone-Supported versus Full Behavioural Activation for Depression: A Randomised Controlled Trial.

BACKGROUND: There is need for more cost and time effective treatments for depression. This is the first randomised controlled trial in which a blended treatment--including four face-to-face sessions and a smartphone application--was compared against a full behavioural treatment. Hence, the aim of the current paper was to examine whether a blended smartphone treatment was non-inferior to a full behavioural activation treatment for depression. METHODS: This was a randomised controlled non-inferiority trial (NCT01819025) comparing a blended treatment (n=46) against a full ten-session treatment (n=47) for people suffering from major depression. Primary outcome measure was the BDI-II, that was administered at pre- and post-treatment, as well as six months after the treatment. RESULTS: Results showed significant improvements in both groups across time on the primary outcome measure (within-group Cohen's d=1.35; CI [-0.82, 3.52] to d=1.47; CI [-0.41, 3.35]; between group d=-0.13 CI [-2.37, 2.09] and d=-0.10 CI [-2.53, 2.33]). At the same time, the blended treatment reduced the therapist time with an average of 47%. CONCLUSIONS: We could not establish whether the blended treatment was non-inferior to a full BA treatment. Nevertheless, this study points to that the blended treatment approach could possibly treat nearly twice as many patients suffering from depression by using a smartphone application as add-on. More studies are needed before we can suggest that the blended treatment method is a promising cost-effective alternative to regular face-to-face treatment for depression. TRIAL REGISTRATION: Cognitive Behavioral Therapy Treatment of Depression With Smartphone Support NCT01819025.

Effect of tobacco smoking on neutrophil activity following periodontal surgery.

BACKGROUND: Tobacco smoking has considerable negative effects on the outcome of periodontal treatment. The reason for the inferior therapeutical effect might be related to an altered neutrophil activity in terms of elastase and/or matrix metalloproteinase-8 (MMP-8), as well as in the protease inhibitor alpha-1-antitrypsin (alpha-AT) and alpha-2-macroglobulin (alpha-2-MG) activities. The aim of the present study, therefore, was to elucidate the effect of tobacco smoking on gingival crevicular fluid (GCF) levels of these substances following surgical treatment. METHODS: The study population included 15 smoking and 15 non-smoking patients with moderate to severe periodontitis receiving surgical treatment. Clinical examinations and collection of GCF were done prior to surgery and 1 and 5 weeks following treatment. The elastase activity was measured with a chromogenic low-molecular substrate and the levels of alpha-1-AT, alpha-2-MG, and MMP-8 with enzyme-linked immunosorbent assay. RESULTS: The results showed unaltered levels of alpha-1-AT, alpha-2-MG, and MMP-8 in smokers following surgery. In non-smokers, the levels of alpha-1-AT and alpha-2-MG increased, whereas MMP-8 levels decreased. The levels of elastase remained unaltered in both smokers and non-smokers. CONCLUSIONS: These results indicate that in the presence of smoking, the levels of alpha-1-AT, alpha-2-MG, and MMP-8 remained unaltered during the recovery period following surgical treatment. This is interpreted as a possible interference of smoking with the treatment response and may, in part, explain the clinical evidence of an inferior treatment outcome in smokers.

The association of smoking with vertical periodontal bone loss.

BACKGROUND: Knowledge about the relation between smoking and vertical periodontal bone loss is scant. The objective of the present study was to investigate the association between smoking and the prevalence and severity of vertical bone defects. METHODS: Full sets of intraoral radiographs of 249 individuals in 1982 and 229 individuals in 1992 both with an age range 21 to 70 years were assessed with regard to presence or absence of vertical bone defects. A vertical defect was defined as a resorption of the interdental marginal bone > or = 2 mm that had a typical angulation towards either the mesial or distal aspect of the root. RESULTS: The prevalence of vertical defects in 1982 was 47% for current smokers, 49% for former smokers, and 24% for non-smokers. In 1992 the prevalence was 42%, 28%, and 19% for current smokers, former smokers, and non-smokers, respectively. Both in 1982 and 1992 the prevalence was significantly related to smoking status (chi2 = 14.4 and chi2 = 9.9, P<0.01). Furthermore, the severity of vertical defects was significantly associated with smoking after controlling for age both in 1982 and 1992 (P<0.05). The relative risk associated with current smoking was 2.0-fold increased in 1982 and 3.4-fold increased in 1992 (P<0.05). CONCLUSIONS: The observations suggest that smoking is associated with increased levels of prevalence as well as severity of vertical bone loss. Smoking is considered a potential risk factor for vertical periodontal bone loss.

Tobacco smoking and gingival health in a Saudi Arabian population.

PURPOSE: While cigarette smoking is recognized as being detrimental to periodontal health, the effect of water pipe smoking on gingival health is not known. The present study was conducted to determine whether water pipe smoking has an influence on gingival health. MATERIAL AND METHODS: A cross-sectional study was carried out in 244 individuals aged 25-70 years. The levels of plaque and gingivitis were recorded on four sites of all present teeth, using the plaque index (PI) and gingival index (GI). Information about oral hygiene practices, dental care and smoking habits was obtained at the time of the clinical examination in accordance with a predetermined questionnaire. RESULTS: The means of plaque index and gingival index values were 1.2 and 0.9, respectively. Similarly, the mean percentages of surfaces with plaque and gingival bleeding sites were 66.7% and 30.4%, respectively. There was an overall significant association between smoking and plaque index and gingival index (F = 22.9 and F = 10.8, respectively, p < 0.001). Oral hygiene was inferior in water pipe smokers, cigarette smokers, and mixed smokers when compared to non-smokers. The correlation between plaque % and gingival bleeding % in cigarette smokers was significantly weaker than in non-smokers. It was also weaker in water pipe smokers, but the difference was not statistically significant. CONCLUSION: The gingival bleeding response to plaque was significantly suppressed in cigarette smokers. There was a tendency towards suppression also in water pipe smokers.