Periodontal Health Among Cigarette, Electronic Cigarettes, and Narghile Smokers

Primary outcomes

1. Plaque Index (PI)

   Time frame: At enrollment

   Plaque Index (PI) The PI was evaluated according to the Silness and Löe (1964) system. This system assesses the plaque thickness at the tooth cervical margin (closest to the gum) and has four scores:

   0: no plaque;

   • a film of plaque adhering to the free gingival margin which is nonvisible and it can be scraped from the tooth surface using a probe;
   • moderate accumulation of soft deposits within the gingival pocket or between the tooth and the gingival margin;
   • abundance of soft matter within the gingival pocket and/or on the tooth and the gingival margin. The presence of visible dental plaque was recorded on the four sites (vestibular, lingual, mesial, and distal) of all the teeth, except the third molars. three PI classes (PI%; [0-1[; [1-2[; [2-3]) were arbitrarily defined

2. Gingival Index (GI)

   Time frame: At enrollment

   The gingival status was evaluated using the method of Löe and Silness (1963). The GI score perfectly evaluates the marginal and inter proximal tissues separately on the basis of the following three criteria (Löe & Silness, 1963):

   0: no inflammation, healthy gingiva;

   • mild inflammation, slight change in color, slight edema, no bleeding on pressure;
   • moderate inflammation, moderate glazing, red ness, bleeding on pressure;
   • severe inflammation, marked redness and hypertrophy, ulceration, tendency to spontaneous bleeding.

3. Probing Pocket Depth (PPD)

   Time frame: At enrollment

   PPD is the distance between the gingival margin and the apical depth of the periodontal probe tip penetration. The depth of the sulci or pockets was probed using a Williams periodontal probe with markings 1, 2, 3, 5,7,8, 9, 10 mm. The clinical measurements were based on the four sites (buccal, mesial, distal, and lingual) of all the teeth, except the third molars (Natto et al., 2005b).

4. Clinical Attachment Level (CAL)

   Time frame: At enrollment

   Clinical attachment level (CAL) is measured from the cementoenamel junction to the bottom of the sulcus or pocket at the four sites. The mean is then calculated for each patient.

5. Bleeding On Probing (BOP)

   Time frame: At enrollment

   The bleeding on probing was assessed through gentle probing of the orifice of the gingival crevice .If bleeding occurs within 10 seconds, a positive finding was established and the number of positive sites was recorded and then expressed as the percentage of the number of sites examined.

6. Tooth Mobility (TM)

   Time frame: At enrollment

   Tooth mobility, was performed by alternatively pressing on the tooth buccal and lingual surfaces using one finger and one metallic instrument Tooth mobility was recorded (Fleszar et al., 1980) as follows:

   0: physiologic mobility, firm tooth;

   • slightly increased mobility;
   • definite to considerable increase in mobility but no function impairment;
   • extreme mobility, a loose tooth that would be incomparable in function

7. Gingival Recession (GR)

   Time frame: At enrollment

   Gingival recession is measured by measuring the distance from the cementoenamel junction to the free gingival margin at the midpoint of the buccal surface.

8. Furcation Involvement ( FI)

   Time frame: At enrollment

   Furcation involvement, is investigated clinically with a probe and classified according to the Hamp's classification system:

   Class 0 = no horizontal loss of periodontal tissue support (apart from the original scoring scale).

   Class I ≤3mm horizontal loss of periodontal tissue support. Class II > 3 mm horizontal loss of periodontal tissue support, no through-and-through furcation Class III through-and-through furcation (required to see the tip of the probe at the contralateral furcation opening) and additionally