Release Date: March 29, 2004
BUFFALO, N.Y. -- Treating gum disease in smokers is daunting: Implants don't take hold as well, surgeries are less successful and infections heal more slowly than in nonsmokers.
Short of convincing patients to quit, oral biologists at the University at Buffalo School of Dental Medicine have found a way to help smokers respond better to treatment.
In a study conducted in UB's Periodontal Research Center, researchers showed that giving smokers a supplement containing the antioxidant vitamins C and E and grape seed extract improved the response to treatment, shown by better gum attachment and improved oral health in general.
"Smokers are a constant challenge in clinical practice," said Sara Grossi, D.D.S., senior research scientist in the Department of Oral Biology, UB School of Dental Medicine. "This antioxidant supplement shows significant benefit in smokers with severe periodontal disease and appears to be safe, with no side effects," she said, "To my knowledge, this is the first study to test the efficacy of a dietary supplement for oral health."
Grossi presented results of the study at the International Association for Dental Research meeting held March 10-13 in Hawaii.
"Smokers respond less favorably than nonsmokers to standard treatment, such as mechanically removing bacteria in plaque and tartar buildup, both of which lead to infection in gum tissue," she said. "The failure rate of implants is very high. Smoking contributes to the development of gum disease and increases its severity, which can lead to more intensive treatment. The more intensive the treatment, the more important the recovery, but smokers have delayed healing."
"The best management is to quit smoking," Grossi said, "but we wanted to find a way to help individuals who can't. We know that smokers have decreased levels of antioxidants to combat the increase in free radicals resulting from toxic damage to tissues, so we thought supplementing the antioxidants might be beneficial."
The study involved 75 smokers with gum disease who smoked more than 10 cigarettes a day for many years: "Probably the worst of the worst," said Grossi. The participants were assigned randomly to one of three study groups.
The first group took four chewable tablets daily containing 500 of vitamin C, 43 IUs (International Units) of vitamin E and 42 milligrams of grape seed extract (known to help fight plaque build-up). The second group took tablets containing double the dose of antioxidant vitamins and grape seed extract. The third group took identical tablets that contained no active ingredients, to serve as a control.
All participants received two sessions of deep scaling (below the gum line), the standard dental care for their gum infection, plus instructions on oral hygiene.
The study lasted six months. Researchers took blood samples at baseline and at six months to verify that participants were taking the supplements, determined by increased blood levels of the antioxidants.
At the end of the study, results showed that patients in the antioxidant groups had significantly fewer gum pockets deeper than 5 millimeters (sites where gum tissue had become detached from the tooth) compared to the control group.
Researchers also found that the gain in gum detachment in the supplemented groups was 1.20 millimeters and 1.26 millimeters, respectively, and 0.81 millimeters in the control. These gains indicate 15.3 percent and 17.6 percent increases in attachment, respectively, in the supplemented groups compared to 10.5 percent increase in the control.
Patients with gum disease could use the three antioxidant components separately, but they may not achieve the same results, Grossi noted. The test tablets contained natural Vitamin E, which has greater bioavailability than the Vitamin E contained in most supplements.
Grossi said the therapy provided a definite benefit for current smokers, and that more data will be forthcoming. "We are analyzing more measures of free radicals in the patients' blood samples and will be able to present a more complete picture of the antioxidant effect in the future."
Additional researchers on the study were Cynthia A Nowadly, clinical nurse specialist, Alex W. Ho, statistician, and Robert J. Genco, D.D.S., Ph.D., SUNY Distinguished professor, all from the UB Department of Oral Biology, and Akane Takemura from Sunstar Co., Ltd, in Osaka Japan.
The research was supported by a grant from the U.S. Public Health Service and Sunstar.
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