|Year : 2021 | Volume
| Issue : 2 | Page : 79-83
Comparison of gingival health status and salivary magnesium levels in smokers and nonsmokers
Tania Kusuma Wijaya, Agus Susanto, Ina Hendiani
Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Indonesia
|Date of Submission||02-Feb-2021|
|Date of Decision||15-Mar-2021|
|Date of Acceptance||31-Mar-2021|
|Date of Web Publication||23-Jun-2021|
Department of Periodontics, Faculty of Dentistry, Universitas Padjadjaran, Sekeloa Selatan I, Bandung 40132,
Source of Support: None, Conflict of Interest: None
Background: Smoking is considered a major risk factor for the development and progression of periodontal diseases. The content of cigarettes can affect the composition of saliva, such as the levels of magnesium, calcium, and phosphate. Objectives: The purpose of this study is to compare gingival health status and salivary magnesium levels in smokers and nonsmokers. Materials and Methods: This research is a descriptive study based on a cross-sectional approach. Forty-two subjects participated in the study which was divided into two groups: smokers and nonsmokers. A purposive sampling technique was used, and a questionnaire was disseminated to collect data on age, gender, number of cigarettes smoked per day, duration of smoking, and types of cigarettes consumed. Oral health status was measured using the Löe and Silness gingival index. Saliva was collected using the spitting method, and salivary magnesium levels were measured by atomic absorption spectrometry. The data analysis was performed using the independent sample t-test and the Mann–Whitney test. Results: The gingival index scores for the smokers and nonsmokers were 0.49±0.195 and 0.26±0.207, respectively. There was a significant difference between smokers and nonsmokers gingival index (P = 0.001). The salivary magnesium levels in the smokers and nonsmokers were 54.43±17.37 and 51.29±15.97 µg/dL, respectively. There was no significant difference in the levels of magnesium saliva between the smokers and nonsmokers (P = 0.428). Conclusion: The findings of this study indicate that the gingival index in smokers is higher than that in nonsmokers. However, the results showed no difference in salivary magnesium levels between the smokers and nonsmokers in this study.
Keywords: Cigarettes, gingival health, magnesium, saliva, smokers
|How to cite this article:|
Wijaya TK, Susanto A, Hendiani I. Comparison of gingival health status and salivary magnesium levels in smokers and nonsmokers. Sci Dent J 2021;5:79-83
|How to cite this URL:|
Wijaya TK, Susanto A, Hendiani I. Comparison of gingival health status and salivary magnesium levels in smokers and nonsmokers. Sci Dent J [serial online] 2021 [cited 2021 Jul 31];5:79-83. Available from: https://www.scidentj.com/text.asp?2021/5/2/79/319055
| Background|| |
Smoking is considered an addictive behavior. The World Health Organization in 2008 predicted that approximately 2.5 billion smokers worldwide, i.e., two-thirds, are in developing countries. The prevalence of smoking has been found to be higher in countries with low per capita income and mainly the young adult population. Based on the Global Adults Tobacco Survey (GATS) of the population age group ≥15 years, the proportions of male and female smokers were 67.0% and 2.7%, respectively. According to the recent results reported by the National Report on Basic Health Research (RISKESDAS) 2018, the prevalence of smokers among men and women in Indonesia was 62.9% and 4.8%, respectively.
Smoking has been associated with the pathogenesis of periodontal disease and a significantly increased risk of periodontitis. Periodontal tissue is a functional system of tissue that surrounds the tooth and attaches it to the jawbone which supports the tooth firmly in its socket. Periodontal tissue consists of the gingiva, alveolar bone, periodontal ligament, and cementum. Compared with nonsmokers, smokers have a greater chance of having periodontal disease which can lead to alveolar bone loss, increased pocket depth, and tooth loss.
Periodontal disease is an inflammation of the tooth-supporting tissue caused by a bacterial infection. Periodontal disease includes gingivitis and periodontitis. Gingivitis is a form of inflammation that is limited to the marginal gingival tissue which is usually caused by the accumulation of dentogingival plaque due to poor oral hygiene. The characteristics of gingivitis are the discoloration of the gingiva as redder than normal, swelling of the gingiva, and bleeding due to the inflammatory process. However, if it is properly treated, gingivitis is reversible without permanent damage. However, if it is left untreated, gingivitis can progress to periodontitis, leading to the destruction of the alveolar bone and subsequent tooth loss. Gingival health status is determined by the severity of the measured gingival inflammation using the gingival index according to Löe and Silness. Clinical conditions are divided into normal gingiva, mild inflammation, moderate inflammation, and severe inflammation based on the gingival index.
Salivary fluid is an exocrine secretion consisting of 99% water. The remaining 1% is a complex of organic and inorganic molecules. Saliva contains various electrolytes, such as calcium, magnesium, potassium, sodium, chloride, bicarbonate, and phosphate. Zuabi et al. found that smokers exhibited different salivary compositions, which were characterized by significantly smaller concentrations of calcium, magnesium, and sodium than in nonsmokers. However, this result contradicted Laine et al., who found that smoking was associated with high concentrations of calcium, magnesium, and potassium in saliva. There are contradictory studies on salivary magnesium levels in smokers and nonsmokers. Magnesium may play an important role in preventing periodontal disease because it has the unique ability to reduce inflammation caused by bacterial toxins. Thus, reduced magnesium concentrations are associated with enhanced inflammatory response to bacteria. This study aims to compare the gingival health index and salivary magnesium levels in smokers and nonsmokers at Padjadjaran University, Bandung, Indonesia.
| Materials and Methods|| |
This study was conducted using an observational analytic method with a cross-sectional approach. Forty-two research subjects were divided into two groups: 21 smokers and 21 nonsmokers. The research subjects were students at Padjadjaran University, Bandung, Indonesia, and the research was conducted from February to March 2020. The research protocol was approved by the research Ethics Committee of Padjadjaran University Bandung (1551/UN6.KEP/EC/2020).
Purposive sampling was used to recruit the sample. The questionnaire was distributed to the subjects to collect data regarding age, gender, number of cigarettes smoked per day, duration of smoking, and types of cigarettes consumed. The inclusion criteria in this study were male gender and smoking at least one cigarette per day for at least 1 year. The exclusion criteria were having a systemic disease such as diabetes or cardiovascular disease, taking drugs such as anticonvulsants, cyclosporin immunosuppressants, or calcium channel blockers, wearing a prosthesis or orthodontic appliance, vaping, having scaling treatment in the previous 3 months, and having asthma.
The subjects signed informed consent forms and agreed to undergo the examination. The examinations were conducted using the Löe and Silness gingival index. The gingiva surrounding the teeth was examined (i.e., mesial, distal, labial/buccal, and lingual/palatal), and all teeth in each subject were examined. Each tooth was assessed for the level of inflammation which was scored from 0 to 3. The criteria were 0 = normal gingiva; 1 = mild inflammation—a slight change in color and slight edema but no bleeding on probing; 2 = moderate inflammation—redness, edema and glazing, bleeding on probing; 3 = severe inflammation—marked redness and edema, ulceration with the tendency to spontaneous bleeding.
Assessment of the severity of gingival inflammation was conducted by running a periodontal probe (Schezzer, Germany) along the soft tissue wall of the gingival sulcus. The scores of the four areas of the tooth were summed and divided by four to determine the gingival index of the tooth. The gingival index in each subject was obtained by adding the values of each tooth and dividing by the number of teeth examined. Saliva was collected using the spitting method, and the subjects were instructed to collect saliva in a closed mouth and then spit into a container tube every 60 s five times. After the saliva was collected, the magnesium levels were measured using Analyst 400 Atomic Absorption Spectrometry (PerkinElmer, Inc., USA). The gingival index was analyzed using the independent sample t-test, and the salivary magnesium levels were analyzed by the Mann–Whitney test (SPSS version 20.0, New York, USA).
| Results|| |
[Table 1] shows the characteristics of the 21 smokers in terms of gender, age, number of cigarettes consumed, duration of smoking, and types of cigarettes consumed. All smokers in this study were males in the age range of 20–22 years. Based on the number of cigarettes consumed, 57.15% consumed 11–20 cigarettes per day, and 42.15% consumed 1–10 cigarettes per day.
Based on the duration of smoking, 71.43% had consumed cigarettes for more than 5 years, and 28.57% had consumed cigarettes for more than 2 years. Based on the type of cigarettes consumed, white cigarettes were consumed by 85.72% of the smokers, and the rest consumed kretek cigarettes.
[Table 2] shows the gingival health status of the smokers and nonsmokers. Based on the results of the examination of gingival health status using the gingival index according to Löe and Silness, among the 21 smokers, 85.72% had mild inflammation, and 14.28% had normal gingiva. In the 21 nonsmokers, 57.15% had mild inflammation, and 42.85% had normal gingiva.
|Table 2: Gingival health status and gingival index in smokers and nonsmokers|
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As shown in [Table 2], the gingival index scores for the smokers and nonsmokers had means of 0.49 and 0.26, respectively, indicating that the average gingival index of the smokers was higher than the average gingival index of the nonsmokers. In the entire sample, the number of smokers who experienced mild inflammation was higher than that in the nonsmokers. Based on the calculation of the independent sample t-test, the P-value (Sig.) = 0.001 <α = 0.05, which indicated that there was a significant difference between the mean gingival indices of the nonsmoking group and the smoking group.
As shown in [Table 3], the levels of magnesium in the saliva drawn from the nonsmokers and the smokers had different means (51.29–54.43), which indicated that the average magnesium saliva level in the smokers was higher than the average magnesium saliva level in the nonsmokers. The results of the analysis using the Mann–Whitney test showed a P-value (sig.) = 0.428. The P-value was greater than α = 0.05, indicating that there was no significant difference between the mean magnesium saliva levels of the nonsmokers and the smokers.
|Table 3: Comparison of salivary magnesium levels in smokers and nonsmokers|
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| Discussion|| |
Smoking has been associated with the pathogenesis of periodontal disease and a significantly increased risk of periodontitis. The risk of periodontitis is much greater at an estimated ratio of 2.5–7.0 or higher in smokers compared with nonsmokers. Even when the levels of plaque accumulation and gingival inflammation did not differ significantly between smokers and nonsmokers, the smokers showed an increased prevalence and severity of the destructive disease.
The results of this study indicated that the gingival health status in the smokers was significantly different compared with the nonsmokers, and gingival inflammation in the smokers was higher. These findings support previous evidence of low gingival health in smokers. Natto et al. confirmed that gingival health was impaired by smoking, which was evidenced by the gingival bleeding response influenced by plaque and calculus. Another study found that smokers who had periodontitis showed a high gingival index. This finding was in accordance with the results of previous studies conducted on smokers and nonsmokers, which showed that the gingival health status in smokers was significantly different compared with nonsmokers, where gingival inflammation in smokers was higher. The poor gingival health of smokers was found to be influenced by poor oral hygiene. Moreover, smokers were found to accumulate markedly more dental calculus than nonsmokers did, and the quantity of calculus was correlated with the frequency of smoking. These findings were related to the frequency of teeth brushing and the number and duration of cigarettes consumed. The tar in cigarettes causes the surface of the teeth to become rough so that food debris and germs adhere easily, which eventually forms plaque. Plaque then becomes tartar which becomes thicker over time. Thick plaque causes the gums to become susceptible to inflammation.
Smoking not only affects periodontal tissue. Based on previous research, smoking also affects the inorganic composition of saliva, such as calcium, magnesium, sodium, and phosphate. Manea et al. reported that salivary magnesium concentrations were significantly higher in the periodontitis group compared with the controls, and they were higher in smokers with periodontitis than in nonsmokers who were also affected by periodontitis.
Based on the results of the previous research, the average magnesium salivary level in smokers is higher than that in nonsmokers, but the difference is not significant. The results of the present study differed slightly from those reported by Manea et al. because other influencing factors, such as periodontitis, were not presented in the sample examined in the present study.
Magnesium ion is also present in dental calculus, and there is about 1% of magnesium ion in dental calculus. Dental calculus consists of 70–90% of inorganic components. More than two-thirds of the inorganic components of calculus are calcified in various morphologies, have stoichiometric compositions with various maturation phases, and have different ratios of calcium to phosphates. Two or more crystalline forms are generally found in calculus, and the largest and most common are hydroxyapatite (HAP) and octacalcium (OCP). These forms are present in supragingival calculus at 97–100%. Brushite (B) is most commonly found in the anterior region of the mandible, whereas magnesium whitlockite (TCP) is found posteriorly. Magnesium may also play an important role in preventing periodontal disease, as it has the unique ability to reduce inflammation caused by bacterial toxins. In periodontal inflammation, the activation of neutrophils is an important factor in tissue injury. The invasion of neutrophils into periodontal tissues maintains the inflammatory process and participates in tissue destruction which is manifested by the loss of attachment and by systemic reactions. Magnesium status has a strong relationship with the immune system, acting as a modulator of the immune response. The activation of neutrophils is an early effect of hypomagnesemia, and high Mg concentrations inhibit free-radical generation. Thus, reduced Mg concentrations have been associated with an enhanced inflammatory response to bacterial challenge.
The length of time spent consuming cigarettes has a huge impact on the health status of periodontal tissue. The health status of the periodontal tissue gradually worsens as the length of smoking duration increases. The poor health status of periodontal tissue is difficult to treat if it is accompanied by cigarette consumption, so smoking cessation is crucial. In this study of 21 smokers, 12 subjects consumed 11–20 cigarettes a day, and the remaining 9 subjects consumed 1–10 cigarettes per day. White cigarettes were the most frequently consumed. Based on the number of cigarettes smoked per day, smokers have been classified into three groups: light smokers smoke 1–10 cigarettes a day; moderate smokers smoke 11–20 cigarettes a day, and heavy smokers smoke more than 20 cigarettes a day.
The findings of the present study provide information to the public about magnesium salivary levels in smokers and the dire effects of smoking on oral health, especially periodontal tissue. It is hoped that the findings will serve to increase awareness of the need to maintain oral health. Increased levels of magnesium saliva due to smoking indirectly affect calculus formation. This calculus subsequently affects gingival health and, if it continues, leads to periodontitis.
However, a limitation of the present study is the absence of an examination to determine the calculus index in the study subjects. Therefore, the effects of salivary magnesium levels on calculus were not determined. Therefore, it is recommended that further research be conducted to investigate the relationship between salivary magnesium levels and the calculus index. In addition, more than one examiner should conduct the examination to ensure that the results of the examination are objective.
| Conclusion|| |
The results of the present study confirmed differences in the gingival health status of smokers and nonsmokers in which the smokers showed greater gingival inflammation. However, no differences in salivary magnesium levels between the smokers and nonsmokers were found in this study.
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Conflicts of interest
The authors declare that there are no conflicts of interest.
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