Efficacy of Oral Hygiene Instructions on Proinflammatory Cytokines Among Cigarette Smokers and Individuals Vaping Electronic Cigarettes During Plaque Induced Gingivitis (Clinical Trial)

Periodontal diseases are defined as an inflammatory process associated with bacterial activity and mediated by the host's immunologic response (Armitage, 1999; Tonetti et al., 2018). Gingivitis, a reversible form of periodontal disease, is initially characterized by gingival inflammation cause by bacterial colonization forming the biofilm (Armitage, 1999; Tonetti et al., 2018). Cigarette smoking is a classical risk factor for both periodontal and peri-implant tissue damage (Sgolastra et al., 2013). It has been shown that patients who smoke suffer from more severe forms of periodontitis (Javed et al., 2013).

Disease progression is directly related to the frequency of smoking, where heavy smokers show more severe forms of the disease compared to light smokers (Tonetti et al., 2018). Different studies categorize the frequency of smoking differently but according to one review, smoking less than 9 cigarettes per day is considered light, and more than 31 is considered heavy smoking (Johnson & Guthmiller, 2000). Smoking also impacts the response to periodontal treatment; smokers show only 50%-75% improvement in their clinical parameters after scaling and root planing compared to non-smokers (Tonetti et al., 2018).

Another study analyzed the effects of cigarette smoking on periodontal parameters and found significant increases in plaque index, pocket depth, and clinical attachment loss levels in cigarette smokers compared to non-smokers (Javed et al., 2017). It has been evidenced that tobacco smoking results in a proinflammatory effect by stimulating the secretion of specific cytokines and radical oxygen species (ROS) that play a role in the destruction of periodontal tissues (Katz et al., 2005) Electronic cigarettes (e-cigs) are battery-operated handheld devices, in which an e-liquid (contain ning nicotine and sometimes artificial flavors such as menthol, coffee, candy, butter and fruits) is heated by a heating element releasing a chemical-filled aerosol for inhalation (Sundar et al., 2016).

In the United States (U.S.), the use e-cigs is escalating predominantly in younger adults (Delnevo et al., 2015). Vaping without nicotine still proposes risks of exposure to the chemicals that are released in the heating process of the device, such as aluminum, copper, and lead (Gaur & Agnihotri, 2019). E-cigarettes also pose a hazard for traumatic injuries. Blast injuries caused by battery explosion are also an associated risk, mainly in countries where there is no regulation on the manufacture and safety of e-cigarettes (Kite et al., 2016).

Focusing on a correlation between oral health and vaping, a recent study showed that e-cigarette exposure-mediated carbonyl stress leads to increased levels of prostaglandin-E2 and cyclooxygenase-2 in human gingival epithelium compared to control (Lerner et al., 2015) Several studies analyzed the impact of vaping on periodontal parameters and found increased levels of plaque index, pocket depth, clinical attachment loss, and marginal bone loss in vaping groups compared to non-smokers (Al-Aali et al., 2018) Despite all the evidence that smoking can negatively affect the periodontal tissues, there is still little evidence about the impact of vaping(Figueredo et al., 2020).