BACKGROUND: To date only a few studies have evaluated the long-term influence of smoking and smoking cessation on periodontal health. The present study, therefore, was undertaken with the aim to prospectively investigate the influence of smoking exposure over time on the periodontal health condition in a targeted population before and after a follow-up interval of 10 years. METHODS: The primary study base consisted of a population of occupational musicians that was investigated the first time in 1982 and scheduled for reinvestigation in 1992 and 2002. The 1992 investigation included 101 individuals from the baseline study constituting a prospective cohort including 16 smokers, who had continued to smoke throughout the entire length of the 10-year period; 28 former smokers who had ceased smoking an average of approximately 9 years before the commencement of the baseline study; 40 non-smokers, who denied ever having smoked tobacco; and 17 individuals whose smoking pattern changed or for whom incomplete data were available. The clinical and radiographic variables used for the assessment of the periodontal health condition of the individual were frequency of periodontally diseased sites (probing depth > or =4 mm), gingival bleeding (%), and periodontal bone height (%). The oral hygiene standard was evaluated by means of a standard plaque index. RESULTS: The changes over the 10 years with respect to frequency of diseased sites indicated an increased frequency in continuous smokers versus decreased frequencies in former smokers and non-smokers. Controlling for age and frequency of diseased sites at baseline, the 10-year change was significantly associated with smoking (P
Abrasion lesions were recorded in 818 individuals representing the adult population of 430,000 residents of the Stockholm region, Sweden. The subjects were asked about toothbrushing habits, toothbrush quality and dentifrice usage; these factors were related to abrasion criteria. Abrasion was prevalent in 30% and wedge-like or deep depressions were observed in 12%. The relationship between abrasion and toothbrushing was evident, the prevalence and severity of abrasion being correlated to toothbrushing consumption. The importance of the toothbrushing technique for the development of abrasion lesions was elucidated. Horizontal brushing technique was strongly correlated to abrasion. It was demonstrated by treating the data with the statistical AID analysis that toothbrushing factors related to the individual (brushing frequency and brushing technique) exert a greater influence than material-oriented toothbrushing factor such as dentifrice abrasivity and bristle stiffness.
Patients admitted to the School of Dentistry, Stockholm, for treatment of chronic periodontal disease during the years 1980-82 were retrospectively investigated with respect to their smoking habits. The investigation was designed as a case control study and covered all patients 30, 40, or 50 yr of age upon admission, in all 155. As control served a random sample of the Stockholm population. The periodontal variables under scrutiny were frequency of periodontally diseased teeth, frequency of periodontally diseased sites (probing depth greater than 4 mm), gingival index, and plaque index. The overall occurrence rate of smokers in the sample of cases was 56%, which is significantly greater than the population at large. This held true for all three age cohorts and for men as well as women. The risk ratio was 2.5, indicating more prevalent disease among smokers. Further, significantly greater frequencies of periodontally involved teeth and diseased sites were found in smokers, indicating more severe disease among smokers. Gingival index and plaque index did not notably differ between smoking groups. The results suggest increased prevalence as well as severity in smokers. Smoking, therefore, should be considered a risk factor for chronic periodontal disease.
Possible dissimilarities between smokers and nonsmokers regarding oral hygiene, gingivitis, periodontal pocketing and alveolar bone loss were studied in a sample of 134 army conscripts. Compared to nonsmokers, smokers had a higher plaque index and greater severity of gingivitis, while no differences were found concerning pocket depth and bone loss. It could be demonstrated that the difference regarding gingivitis disappeared when a check was made for plaque values. It still remains to be explained why plaque deposition is more pronounced in smokers.
Uremia has been reported as a risk factor for the occurrence of infection with Clostridium difficile. During the two-year period 1984-86, 110 episodes of Clostridium difficile infection were encountered in 70 patients on a nephrology ward. Sixty-two patients had chronic renal failure and eight had acute renal failure. Sixty-seven of the patients were uremic and were treated with hemodialysis (n = 35), CAPD (n = 21), intermittent peritoneal dialysis (n = 6) or conservatively with a low protein diet (n = 5). Most of the patients were female (n = 41) and elderly (64 +/- 2 years). Malnutrition was common as indicated by low serum albumin concentrations (26 +/- 1 g/l) prior to the Clostridium difficile infection. Clostridium difficile infection was confirmed by stool culture and/or cytotoxin assay. Asymptomatic infections were found in eight patients. The highest relative risks of subsequent Clostridium difficile infection were calculated for patients treated with cephalosporins and isoxazolyl penicillins. All patients were treated with vancomycin, which often resulted in a dramatic improvement. One to six relapses of Clostridium difficile infection were observed in 22 of the patients. Sixty of the original 70 patients died during the five-year follow-up period. Thirty-four patients died during the first year of follow-up. Seven patients were transplanted, two are still on CAPD treatment and one has only moderate chronic renal failure (serum creatinine 200 mumol/l). Elderly debilitated uremic patients are especially susceptible to infection with Clostridium difficile which may be a poor prognostic sign in chronic renal failure.(ABSTRACT TRUNCATED AT 250 WORDS)
The investigation covered 250 professional musicians employed in 3 leading national orchestras in Stockholm, Sweden. The aims were to describe dental care habits, such as frequency of dental visits and frequency and methods of oral hygiene, and to relate these habits to oral cleanliness and gingival health in wind and non-wind instrument musicians. The results showed that 81.2% visited their dentist at least once a year and that 82.8% had had such a regular habit for the past 5 years or more. All subjects claimed to brush their teeth daily, and 66.0% used supplementary oral hygiene aids. The clinical examination showed that oral cleanliness and gingival health were of good standard. Mean plaque index was 0.9 and mean gingival index 1.2. Both measures increased with age and were closely correlated (r = 0.80). The relationships between the dental care habits studied and the clinical conditions with regard to oral cleanliness or gingival health were rather weak, although trends towards better gingival condition and oral cleanliness were observed with increasing frequency of toothbrushing. The results indicate a high degree of dental conscientiousness in professional musicians. No differences were observed between wind and non-wind instrument musicians.
A study has been performed covering the oral health of 247 professional musicians in Stockholm aged 21-60 yr. In an earlier study the oral hygiene was found to be of a high standard. The following part of this study concerned dental health i.e. remaining and intact teeth, decayed and filled proximal surfaces. All registrations were made on intraoral full mouth surveys. The number of remaining teeth was large, but decreased with age. In the 51-60 age group, 24.1 teeth remained on average. The number of teeth intact ranged from 55-28% of remaining teeth in the youngest and oldest age group respectively. A total of 555 caries lesions were registered on proximal surfaces, 49.1% being primary lesions in the enamel, 21.4% primary lesions into the dentin and 29.5% secondary lesions. Only 3.3% of all filled surfaces showed secondary lesions. The number of secondary lesions increased with age. A total of 30.9% of the subjects showed no proximal lesions. It was concluded that in adults who have adopted proper oral hygiene it is possible to preserve a large number of teeth and to limit the deterioration caused by caries.
Signs of protein-energy malnutrition are common in maintenance hemodialysis (HD) patients and are associated with increased morbidity and mortality. To evaluate the nutritional status and relationship between various parameters used for assessing malnutrition, we performed a cross-sectional study in 128 unselected patients treated with hemodialysis (HD) thrice weekly for at least two weeks. Global nutritional status was evaluated by the subjective global nutritional assessment (SGNA). Body weight, skinfold thicknesses converted into % body fat mass (BFM), mid-arm muscle circumference, hand-grip strength and several laboratory values, including serum albumin (SA1b), plasma insulin-like growth factor I (p-IGF-I), serum C-reactive protein (SCRP) and plasma free amino acids, were recorded. Dose of dialysis and protein equivalence of nitrogen appearance (nPNA) were evaluated by urea kinetic modeling. The patients were subdivided into three groups based on SGNA: group I, normal nutritional status (36%); group II, mild malnutrition (51%); and group III, moderate or (in 2 cases) severe malnutrition (13%). Clinical factors associated with malnutrition were: high age, presence of cardiovascular disease and diabetes mellitus. nPNA and Kt/V(urea) were similar in the three groups. However, when normalized to desirable body wt, both were lower in groups II and III than in group I. Anthropometric factors associated with malnutrition were low body wt, skinfold thickness, mid-arm muscle circumference (MAMC), and handgrip strength. Biochemical factors associated with malnutrition were low serum levels of albumin and creatinine and low plasma levels of insulin-like growth factor 1 (IGF-1) and branched-chain amino acids (isoleucine, leucine and valine). The serum albumin (SAlb) level was not only a predictor of nutritional status, but was independently influenced by age, sex and SCRP. Plasma IGF-1 levels also reflected the presence and severity of malnutrition and appeared to be more closely associated than SAlb with anthropometric and biochemical indices of somatic protein mass. Elevated SCRP (> 20 mg/liter), which mainly reflected the presence of infection/inflammation and was associated with hypoalbuminemia, was more common in malnourished patients than in patients with normal nutritional status, and also more common in elderly than in younger patients. Plasma amino acid levels, with the possible exception of the branched-chain amino acids (isoleucine, leucine, valine), seem to be poor predictors of nutritional status in hemodialysis patients.
BACKGROUND: Patients treated at the haemodialysis (HD) centre in Tassin, France have been reported to have superior survival and blood pressure (BP) control. This control has been ascribed to maintenance of an adequate fluid state, antihypertensive drugs being required in