Relationship between the burden of major periodontal bacteria and serum lipid profile in a cross-sectional Japanese study.

BACKGROUND: The association of periodontal bacteria with lipid profile alteration remains largely unknown, although it has been suggested that chronic periodontitis increases the atherosclerotic risk. This cross-sectional study investigated the relationship between the prevalence and total burden of periodontal bacteria and serum lipid profile. METHODS: Saliva from enrolled participants was collected to detect 4 major periodontal bacteria (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, and Prevotella intermedia) using Polymerase Chain Reaction method. High-density lipoprotein (HDL) cholesterol, triglycerides (TG), and low-density lipoprotein cholesterol were assessed using blood samples. We compared the averages of each lipid in association with the prevalence of each bacterial species, their burden (low, moderate, and high), and the combination of bacterial burden and periodontal status, defined as periodontitis, using the Community Periodontal Index, after adjustment for other potential confounding factors, by employing general linear models with least square means. RESULTS: A total of 385 Japanese individuals (176 men, 209 women; mean age 69.2 years) were enrolled. The number of bacterial species and their co-existence with periodontitis were significantly related to a decrease in HDL (p for trend < 0.01) and increase in TG (p for trend = 0.04). The adjusted mean HDL levels (mg/dL) in individuals with low, moderate, and high levels of bacterial species were 66.1, 63.0, and 58.9, respectively, and those in the 6 groups defined by combination of the two factors were 67.9, 64.6, 64.3, 65.4, 61.5, and 54.7, respectively. CONCLUSION: Periodontal bacterial burden is suggested to be independently involved in lowering serum HDL level. Our findings suggest that bacterial tests in a clinical setting could be a useful approach for predicting the risk of HDL metabolism dysregulation.

Proteomic and transcriptional analysis of interaction between oral microbiota Porphyromonas gingivalis and Streptococcus oralis.

Porphyromonas gingivalis, a major periodontal pathogen, forms biofilm with other oral bacteria such as streptococci. Here, by using shotgun proteomics, we examined the molecular basis of mixed-biofilm formation by P. gingivalis with Streptococcus oralis. We identified a total of 593 bacterial proteins in the biofilm. Compared to the expression profile in the P. gingivalis monobiofilm, the expression of three proteins was induced and that of 31 proteins was suppressed in the mixed biofilm. Additionally, the expression of two S. oralis proteins was increased, while that of two proteins was decreased in the mixed biofilm, as compared to its monotypic profile. mRNA expression analysis of selected genes using a quantitative reverse transcription polymerase chain reaction confirmed the proteomics data, which included overexpression of P. gingivalis FimA and S. oralis glyceraldehyde-3-phosphate dehydrogenase in association with the biofilm. The results also indicated that S. oralis regulates the transcriptional activity of P. gingivalis luxS to influence autoinducer-2-dependent signaling. These findings suggest that several functional molecules are involved in biofilm formation between P. gingivalis and S. oralis.

Relationship between decayed teeth and metabolic syndrome: data from 4716 middle-aged male Japanese employees.

BACKGROUND: Epidemiological findings regarding the relationship between decayed teeth (DT) and metabolic syndrome (MetS) are scarce. We evaluated the relationship of DT with MetS, obesity, and MetS components in early middle-aged male Japanese employees. METHODS: We cross-sectionally analyzed dental and medical health checkup results from a total of 4716 participants aged 42 or 46 years. Logistic regression models were employed to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) after adjustment for age, breakfast consumption frequency, drinking habits, smoking status, and physical activity. RESULTS: Significant differences in the prevalence of MetS, obesity determined by body mass index, and the components of MetS between participating men with and without DT were detected (all P < 0.01). The adjusted OR of MetS was 1.41 (95% CI, 1.14-1.74) for those with 1 or 2 DT, and 1.66 (95% CI, 1.28-2.16) for those with ≥3 DT (P for trend = 0.01), and this significant relationship was observed even in those without periodontal pocket formation (P for trend = 0.03) or missing teeth (P for trend = 0.02). DT was significantly related to overweight/obesity and the MetS components of hypertension, dyslipidemia, and hyperglycemia, with adjusted ORs of 1.35 (95% CI, 1.19-1.53), 1.22 (95% CI, 1.07-1.39), 1.18 (95% CI, 1.03-1.34), and 1.33 (95% CI, 1.13-1.56), respectively. In addition, even in non-overweight/non-obese men, DT was found to be related to dyslipidemia and hyperglycemia, though with marginal significance (P < 0.05). CONCLUSIONS: Our findings suggest that having DT is related to MetS in early middle-aged Japanese men directly and through obesity and is independent of health behaviors, periodontal condition, and tooth loss.

Identification and characterization of Porphyromonas gingivalis client proteins that bind to Streptococcus oralis glyceraldehyde-3-phosphate dehydrogenase.

Coaggregation of Porphyromonas gingivalis and oral streptococci is thought to play an important role in P. gingivalis colonization. Previously, we reported that P. gingivalis major fimbriae interacted with Streptococcus oralis glyceraldehyde-3-phosphate dehydrogenase (GAPDH), and that amino acid residues 166 to 183 of GAPDH exhibited strong binding activity toward P. gingivalis fimbriae (H. Nagata, M. Iwasaki, K. Maeda, M. Kuboniwa, E. Hashino, M. Toe, N. Minamino, H. Kuwahara, and S. Shizukuishi, Infect. Immun. 77:5130-5138, 2009). The present study aimed to identify and characterize P. gingivalis components other than fimbriae that interact with S. oralis GAPDH. A pulldown assay was performed to detect potential interactions between P. gingivalis client proteins and S. oralis recombinant GAPDH with amino acid residues 166 to 183 deleted by site-directed mutagenesis. Seven proteins, namely, tonB-dependent receptor protein (RagA4), arginine-specific proteinase B, 4-hydroxybutyryl-coenzyme A dehydratase (AbfD), lysine-specific proteinase, GAPDH, NAD-dependent glutamate dehydrogenase (GDH), and malate dehydrogenase (MDH), were identified by two-dimensional gel electrophoresis followed by proteomic analysis using tandem mass spectrometry. Interactions between these client proteins and S. oralis GAPDH were analyzed with a biomolecular interaction analysis system. S. oralis GAPDH showed high affinity for five of the seven client proteins (RagA4, AbfD, GAPDH, GDH, and MDH). Interactions between P. gingivalis and S. oralis were measured by a turbidimetric method and fluorescence microscopy. RagA4, AbfD, and GDH enhanced coaggregation, whereas GAPDH and MDH inhibited coaggregation. Furthermore, the expression of luxS in P. gingivalis was upregulated by RagA4, AbfD, and GDH but was downregulated by MDH. These results indicate that the five P. gingivalis client proteins function as regulators in P. gingivalis biofilm formation with oral streptococci.

Necessity and readiness for smoking cessation intervention in dental clinics in Japan.

BACKGROUND: The necessity and readiness for smoking cessation intervention in dental clinics was assessed by investigating smoking status and stage of behavior change in patients and the attitudes of dentists toward the effects of smoking on their patients, respectively. METHODS: A self-administered questionnaire was mailed to 1022 dentists randomly selected from the Japanese Dental Association database. The questionnaire survey consisted of 1 section for dentists and 1 for patients aged 20 years or older and was scheduled to be completed at the dentists' clinics on a designated day in February 2008. RESULTS: The response rate to the questionnaire was 78.2% from among target dental clinics and 73.7% and 74.7% for patient and dentist questionnaires, respectively. Data from 11,370 patients and 739 dentists were analyzed. The overall smoking prevalence among the patients (25.1%) was similar to that reported by the National Health and Nutrition Examination Survey, and young female patients had a markedly higher smoking prevalence. More than 70% of patients who smoked were interested in quitting. Although the prevalence of current smoking among dentists (27.1%) was significantly higher than that reported among Japanese physicians (15.0%), approximately 70% of dentists were concerned about the effects of smoking on patient health and prohibited smoking inside their clinic. CONCLUSIONS: Many smokers who were interested in quitting, particularly young women, visited dental clinics, and most dentists believed that smoking was harmful for their patients. These results indicate that smoking cessation intervention in dental settings is necessary and that dentists are ready to provide such interventions.

Causal assessment of smoking and tooth loss: a systematic review of observational studies.

BACKGROUND: Tooth loss impairs oral function. The aim of the present review was to evaluate the causal association between smoking and tooth loss on the basis of high-quality studies. METHODS: Relevant literature was searched and screened, and the methodological quality was assessed. Information on the strength of the association between smoking and tooth loss, the dose-response relationship and natural experimental data was collected and evaluated with respect to consistency and study design. RESULTS: Our literature search yielded 496 citations, and 6 cross-sectional and 2 cohort high-quality studies examining 58,755 subjects in four countries. All studies reported significant associations, although the strength of the association was usually moderate. Four studies reported dose-response relationships between exposure to smoking and the risk of developing tooth loss. A decrease in the risk of tooth loss for former smokers was evident in six studies. Interpretation of evidence for each element was consistent, despite some shortcomings regarding study type and population. CONCLUSIONS: Based on the consistent evidence found with the existing biological plausibility, a causal association between smoking and tooth loss is highly likely. Further studies using a cohort design and different populations are necessary to confirm this association.

Impact of a tobacco curriculum on smoking behaviour and attitudes toward smoking in dental students in Japan: a three-year follow-up study.

AIM: Dental professionals have the potential to influence global smoking rates. This study evaluated the impact of a tobacco curriculum on smoking behaviour and attitudes toward smoking in dental students. METHODS: Immediately before and three years after the implementation of a tobacco curriculum with a no-smoking policy, a questionnaire was administered to students to obtain information about their smoking behaviour and attitudes toward smoking. RESULTS: The number of students who responded to the questionnaire was 580 in 2003 and 554 in 2006. The smoking rate decreased significantly from 35% in 2003 to 26% in 2006; however, analysis of data for each school year suggested that this was due to the prevention of smoking initiation rather than quitting smoking. Attitudes toward patient smoking and public policy were more positive in non-smokers than in current smokers. Improvement in attitudes toward patient smoking was smaller in current smokers than in non-smokers. Little improvement occurred in attitudes toward public policy in both non- and current smokers. CONCLUSIONS: Implementation of a tobacco curriculum was effective in preventing smoking initiation and improving attitudes toward patient smoking in students. Further measures are necessary to improve attitudes toward public policy and to discourage smoking among students.

Smoking and periodontal microorganisms.

Resolution of dysbiosis following treatment for periodontal disease and tobacco dependence has been reported in longitudinal intervention studies. In the present report, we evaluated the biological findings regarding the effect of smoking on the periodontal microbiome. A standardized electronic search was conducted using MEDLINE; overall, 1099 papers were extracted. Studies that addressed the relationship between tobacco and periodontal pathogens were included. Finally, 42 papers were deemed appropriate for the present review. Functional changes in periodontal pathogens exposed to nicotine and cigarette smoke extract support the clinical findings regarding dysbiosis of the subgingival microbiome. Dysbiosis of the periodontal microbiome was presented in smokers regardless of their periodontal condition (healthy, gingivitis, or periodontitis) and remained significant only in smokers even after the resolution of experimentally-induced gingivitis and following reduction of clinical signs of periodontitis with non-surgical periodontal treatment and over 3 months post-therapy. Based on these findings, smoking cessation in periodontitis patients is beneficial for promoting a health-compatible subgingival microbial community. To maximize the benefits of these interventions in dental settings, further studies on periodontal microbiome are needed to elucidate the impact of tobacco intervention on preventing recurrence of periodontal destruction in the susceptible subjects.

Dental caries in 3-year-old children and smoking status of parents.

An association has been suggested between environmental tobacco smoke and oral disease. The present study examined the relationship between early childhood caries (ECC) and parental smoking, particularly paternal smoking, using records of 711 36-month-old children. The smoking status of parents as an independent variable was entered in the multivariable logistic regression model for caries experience as the dependent variable with confounders: sex, residential location, and possible risks of ECC such as order of birth, type of main drink, frequency of daily intake of sugar-containing snacks, daily toothbrushing by parents and use of fluoridated toothpaste. About 65% of children were caries free. Children whose parents did not smoke (CN), those in whom only the father smoked (CF), and those whose mother smoked regardless of the smoking status of the father (CM) comprised 33%, 33% and 34% respectively. The adjusted mean number [95% CI] of decayed teeth and caries experience prevalence for CN, CF and CM were 1.2 [0.8, 1.6], 1.6 [1.2, 2.0] and 2.1 [1.7, 2.5], and 25.6%, 35.3% and 45.7% respectively. The relationship between caries experience and parental smoking was significant on multivariable analysis. The adjusted OR [95% CI] of CF and CM relative to CN was 1.52 [1.01, 2.30] and 2.25 [1.51, 3.37] respectively. These results indicate the association of ECC with parental smoking, although the association with paternal smoking was weaker than with maternal smoking.

Effect of eucalyptus extract chewing gum on periodontal health: a double-masked, randomized trial.

BACKGROUND: Studies in vitro showed that eucalyptus extracts possess antibacterial activity against cariogenic and periodontopathic bacteria; however, the clinical effects with respect to periodontal health in humans remain unproven. The objective of this study was to evaluate the effect of chewing gum containing eucalyptus extract on periodontal health in a double-masked, randomized, controlled trial. METHODS: Healthy humans with gingivitis but not deep periodontal pockets were randomly assigned to the following groups: high-concentration group (n=32): use of 0.6% eucalyptus extract chewing gum for 12 weeks (90 mg/day); low-concentration group (n=32): use of 0.4% eucalyptus extract chewing gum for 12 weeks (60 mg/day); and placebo group (n=33): use of chewing gum without eucalyptus extract for 12 weeks. Plaque accumulation (PLA), gingival index (GI), bleeding on probing (BOP), periodontal probing depth (PD), and clinical attachment level (CAL) were measured at weeks 0, 4, 8, 12, and 14. Significance was analyzed with repeated-measures two-way analysis of variance followed by the Games-Howell pairwise comparison test. RESULTS: The interaction between the effects of eucalyptus extract chewing gum and the intake period was statistically significant for PLA, GI, BOP, and PD but not for CAL. The low- and high-concentration groups exhibited statistically significant (P <0.05) improvements compared to the placebo group for PLA, GI, BOP, and PD. CONCLUSIONS: Eucalyptus extract chewing gum had a significant effect on PLA, GI, BOP, and PD. The use of eucalyptus extract chewing gum may promote periodontal health.

Association between secondhand smoke exposure and early eruption of deciduous teeth: A cross-sectional study.

INTRODUCTION: Secondhand smoke (SHS) exposure is a risk factor for early childhood caries. Here we examined the association between SHS exposure and early tooth eruption (ETE) to clarify the additional etiology of an increased chance of contact between the tooth's surface and acid produced by fermenting oral bacteria. METHODS: Data of 388 child-mother pairs who attended health checkups at public health centers were assessed for children aged ≥18 months. SHS exposure was reported as maternal smoking during pregnancy and household smoking after birth. Associations between SHS exposure and ETE (≥3 canines in the oral cavity) were tested using multivariable analyses of the dose-response relationship. Subgroup and sensitivity analyses were performed for birth-weight subgroups and SHS exposure variables, respectively. RESULTS: ETE prevalence was 65.5%, 68.1%, and 76.9% in the no, medium-dose (ceased partway and sometimes), and highest-dose (every day) exposure groups, respectively, during pregnancy, and 61.5%, 75.0%, and 75.5%, respectively, after birth. The association between the highest dose exposure during pregnancy and ETE was not significant (OR=1.42, 95% CI: 0.34-5.96, p=0.631), whereas that between highest dose exposure after birth and ETE was significant (OR=2.13, 95% CI: 1.06-4.31, p=0.034); this association was distinct in the subgroup of children with smaller birth weights (<3000 g) (OR=3.19, 95% CI: 1.08-9.44, p=0.036). The dose-response relationship was consistently significant for exposure after birth (p<0.05). The sensitivity analysis that employed no SHS exposure, as a reference, revealed that exposure after birth but no exposure during pregnancy was significantly associated with ETE (OR=2.29, 95% CI: 1.19-4.40, p=0.013). However, the association between exposure during pregnancy and ETE was consistently non-significant (p>0.05). CONCLUSIONS: When controlling for variables of birth weight and exposure type, SHS exposure after birth was independently associated with the early eruption of deciduous canines. Further studies are warranted to examine the trajectory of SHS exposure after birth, ETE, and early childhood caries incidence. ABBREVIATIONS: ETE: Early tooth eruption, SHS: Secondhand smoke.

Cigarette smoking and tooth loss experience among young adults: a national record linkage study.

BACKGROUND: Various factors affect tooth loss in older age including cigarette smoking; however, evidence regarding the association between smoking and tooth loss during young adulthood is limited. The present study examined the association between cigarette smoking and tooth loss experience among adults aged 20-39 years using linked data from two national databases in Japan. METHODS: Two databases of the National Nutrition Survey (NNS) and the Survey of Dental Diseases (SDD), which were conducted in 1999, were obtained from the Ministry of Health, Labor and Welfare with permission for analytical use. In the NNS, participants received physical examinations and were interviewed regarding dietary intake and health practices including cigarette smoking, whereas in the SDD, participants were asked about their frequency of daily brushing, and received oral examinations by certified dentists. Among 6,805 records electronically linked via household identification code, 1314 records of individuals aged 20 to 39 years were analyzed. The prevalence of 1+ tooth loss was compared among non-, former, and current smokers. Multiple logistic regression models were constructed including confounders: frequency of tooth brushing, body mass index, alcohol consumption, and intake of vitamins C and E. RESULTS: Smoking rates differed greatly in men (53.3%) and women (15.5%). The overall prevalence of tooth loss was 31.4% (31.8% men and 31.1% women). Tooth loss occurred more frequently among current smokers (40.6%) than former (23.1%) and non-smokers (27.9%). Current smoking showed a significant association with 1+ tooth loss in men (adjusted OR = 2.21 [1.40-3.50], P = 0.0007) and women (1.70 [1.13-2.55], P = 0.0111). A significant positive exposure-related relationship between cigarette smoking status and tooth loss was observed (P for trend < 0.0001 and 0.0004 in men and women, respectively). Current smoking was also associated with the prevalence of decayed teeth (1.67 [1.28-2.20], P = 0.0002). CONCLUSION: An association between cigarette smoking and tooth loss was evident among young adults throughout Japan. Due to limitations of the available variables in the present databases, further studies including caries experience and its confounders should be conducted to examine whether smoking is a true risk of premature tooth loss in young adults.

Patient feedback as a motivating force to quit smoking.

OBJECTIVES: The effectiveness of a brief intervention by dental professionals utilizing feedback of oral symptoms and dental treatments specifically relevant to smoking was examined in terms of it being a motivating factor to quit smoking. METHODS: Information pertaining to the present study was mailed to 208 dental clinics and 45 dentists agreed to participate. Dental patients who currently smoked were assigned consecutively to either an intervention (IG) or nonintervention group (NG) in each clinic during the 6-month experimental period. In IG, dental professionals provided brief explanations regarding oral symptoms and dental treatments specifically relevant to smoking. The effectiveness of intervention was evaluated with respect to attempts to quit and progression through the stages of behavioral changes involved in quitting using the standardized questionnaire. RESULTS: Dropout was considerable; 10 clinics terminated their participation. Questionnaires of 797 patients (IG, 416; NG, 381) were received from 35 clinics and the records of 497 patients (IG, 248; NG, 249) were analyzed. Among patients in IG and NG, 12.1% and 4.8% reported attempts to quit, respectively. Odds ratios of quitting attempts and progression and regression through the stages of behavioral changes adjusted for sex, age, and stage at the first visit were 2.2 (95% confidence interval: 1.04, 4.5), 1.7 (1.1, 2.8), and 0.28 (0.15, 0.53) for all patients, respectively, and 3.1 (1.3, 7.5), 2.1 (1.3, 3.4), and 0.21 (0.11, 0.44), respectively, for patients who were not ready to quit. Trends in the movement through stages differed because of the stage at the first visit. CONCLUSIONS: As a result of the limitation imposed by the considerable dropout number, we concluded that a brief intervention by dental professionals potentially motivates smokers with respect to their attempts to quit smoking and promotes behavioral changes involved in quitting.

Relationship of serum advanced glycation end products with deterioration of periodontitis in type 2 diabetes patients.

BACKGROUND: A close relationship between diabetes and chronic periodontitis has been demonstrated. We previously found that Porphyromonas gingivalis with the type II fimA gene is an infectious factor closely associated with the deterioration seen in diabetic periodontitis patients. In the present study, we examined whether other biomarkers are related to the development and deterioration of periodontitis often seen in type 2 diabetic individuals. METHODS: A total of 97 type 2 diabetes patients with and without periodontitis were recruited, and their periodontal and diabetic conditions were analyzed. The ratio (%) of teeth with an attachment loss >5 mm among all teeth in each subject was used as an index of periodontal deterioration. Peripheral blood was tested for levels of glycated hemoglobin (HbA1c), advanced glycation end products (AGEs), C-reactive protein (CRP), and cytokines (tumor necrosis factor [TNF]-alpha and interleukin [IL]-1beta). Subgingival plaque samples were also examined for the occurrences of Actinobacillus actinomycetemcomitans, Tannerella forsythensis, Treponema denticola, and Prevotella intermedia. RESULTS: Serum AGEs were significantly associated with deterioration of periodontitis, whereas no other serum biochemical marker or bacterial occurrence showed a clear relationship with that condition. CONCLUSION: AGEs may be factors associated with diabetic periodontitis and may be useful as biomarkers that reflect such deterioration.

Association of smoking in household and dental caries in Japan.

OBJECTIVES: The study investigated the relationship between smoking in the household and dental caries in Japanese children using nationally representative cross-sectional data. METHODS: This study included 925 children aged 1-14 years. A child was considered to have decayed and/or filled teeth if a dentist diagnosed these conditions in deciduous or permanent teeth. Smoking in the household was defined as positive if someone in the household reported smoking cigarettes. RESULTS: No statistically significant relationship was observed between household smoking and caries experience. However, smoking in the household was independently associated with an increased prevalence of decayed teeth. The adjusted mean of filled teeth among children exposed to household smoking was higher than that among non-exposed children. CONCLUSIONS: The results of the study failed to substantiate a positive association between passive smoking and caries experience in Japanese children.

Comparative study of plaque removal efficacy of twin-motor sonic toothbrush with floating bristles and conventional powered toothbrushes in posterior teeth.

PURPOSE: To compare twin-motor sonic toothbrushes (TST) with conventional sonic (CST) and electric (CET) toothbrushes in terms of plaque removal efficacy. METHODS: A single-blind, triple-treatment cross-over study was conducted involving 36 participants. Each subject refrained from brushing for 24 hours; subsequently, subjects were screened for dental plaque in premolars and molars with the Rustogi Modified Navy Plaque Index. Plaque removal efficacy was determined according to percentage of plaque score reduction in a single toothbrushing under supervision for 2 minutes at the base of whole tooth surfaces and approximal areas. RESULTS: 35 subjects completed this study. No meaningful difference in pre-brushing plaque score was observed among the three toothbrushes. In molars, TST (48.3+/-3.3%) was higher in plaque removal efficacy relative to CST (40.4+/-2.4%, P= 0.0064) and CET (36.7+/-2.8%, P= 0.0001). This trend was obvious in approximal areas of the lingual aspect of the mandible; 24.8% for TST versus 13.4% for CST (P= 0.0048) and 15.0% for CET (P= 0.0168). In premolars, TST displayed the greatest plaque removal efficacy, although the difference was significant exclusively for comparison with CET. These findings indicate that TST is more efficacious than CST and CET in terms of removal of plaque from molars, in particular, at approximal areas in the lingual aspect of the mandible, possibly due to new functions such as floating bristles and twin magnetic motors, which produce sonic vibration.

[Stage progression of dental patients following brief interventions for smoking cessation].

PURPOSE: Potential effects of brief intervention for smoking cessation were evaluated by examination of stage progression with respect to quitting the habit in dental patients. METHODS: Stage progression was retrospectively evaluated in 25 patients undergoing brief interventions since April 2001 at a university dental hospital. Stage of cessation was requested prior to and following interventions (June to December 2003) according to the modification method of Prochaska's model. Brief interventions were conducted by indication of effects of smoking in the mouth and on dental treatment at each visit. Cessation techniques were explained in instances where subjects displayed an interest in smoking cessation. RESULTS: The intervals between dental visits varied (1-6 months). Prior to intervention, numbers of patients in the pre-contemplation, contemplation and preparation stages were 15, 5 and 5, respectively; this changed to 6, 2 and 1, respectively, following intervention, with 16 participants attempting smoking cessation, and 9 reporting continued abstinence. Stage progression was noted in 18 subjects. In the remaining 7 patients, 6 in the pre-contemplation and 1 in the contemplation stage, no change was registered. More than half of the patients (11/20) who had not prepared for cessation prior to intervention and all patients (5/5) in the preparation period reported smoking cessation following the brief interventions. CONCLUSION: Brief interventions in dental practice can induce smoking cessation in patients.

Effect of follow-up intervention of toothbrushing on periodontal health in workplace dental examination.

This study examined the effect of follow-up intervention on periodontal health of workers on the basis of clinical assessment and a laboratory test. Toothbrushing instruction was given to 26 workers (41.4 +/- 7.8 yr of age). In the experimental group (EG), 13 workers received re-instruction and reminder messages after the initial intervention. The remaining 13 workers, who served as a control group (CG), underwent no follow-up. Brushing skill was assessed on the basis of plaque scores for the whole mouth (Plaque Control Record, PCR) and for eight representative teeth (Plaque Index, PLI). Periodontal health was evaluated with the Community Periodontal Index (CPI). Assessment of gingival inflammation (Modified Gingival Index, MGI), measurements of pocket depth (PD) and attachment level (AL), and collection of gingival crevicular fluid (GCF) were performed at the representative sites. Aspartate aminotransferase (AST) in GCF was determined. Periodontal assessments were conducted prior to and three months after the first examination. Data were analyzed on site- and subject-bases. Both groups exhibited a significant reduction in PLI and MGI. PCR and PD significantly decreased exclusively in the EG. No significant change was observed in the CPI or AL. A significant reduction in PD in shallow pockets (PD<=3 mm) and declines in AL and AST in deeper pockets (PD>=4 mm) were detected in EG. A reduction in PD in deeper pockets was significant in the CG. These results indicate that intervention with follow-up is more effective with respect to periodontal health of workers than is a single intervention; moreover, the laboratory GCF test could be employed to ascertain the outcome of behavioral change.