Comparison of periodontal parameters, salivary PH and cotinine levels among cigarette-smokers, e-cigarette smokers, and never-smokers in a selected population of Malaysia: a cross-sectional study

Abstract

The nicotine content in the e-liquid of electronic cigarettes (e-cigarette) may cause harm to the periodontal tissues by changing the pH in the mouth and cotinine levels. This may signify changes in the gingival environment which favour the breakdown of the tissues. Thus, the study aimed was to determine clinical periodontal parameters, salivary pH and cotinine levels among cigarette, e-cigarette, and non-smokers. A total of 144 participants were recruited from dental clinics at Klang Valley and Kota Bharu. Clinical periodontal parameters including plaque index (PI), bleeding-on-probing (BOP), periodontal probing pocket depth (PPD), and clinical attachment loss (CAL) were recorded from all teeth present except the third molar tooth. The level of unstimulated whole salivary pH was measured using a portable pH meter and the levels of salivary cotinine were measured using Enzyme-Linked Immunosorbent Assay (ELISA). Data was analysed statistically using analysis of variance. P-values less than 0.05 were considered statistically significant. Forty-eight cigarette smokers, 48 e-cigarette smokers, and 48 never-smokers were included. Mean scores of PPD, percentage of pocket depth ≥ 4mm and CAL (p < 0.05) were significantly higher among cigarette smokers than e-cigarette and never-smokers while BOP (p < 0.05) were significantly higher in e-cigarette smokers. The unstimulated salivary pH was more acidic among cigarette-smokers (p < 0.05) than e-cigarette smokers (p < 0.05) and never-smokers. The cotinine levels were higher among cigarette-smokers (p < 0.05) and e-cigarette smokers (p < 0.05) than never-smokers. Clinical periodontal parameters were poorer in cigarette than e-cigarette smokers and never-smokers. Cigarette smokers have more acidic salivary pH compared to e-cigarette and never smokers. Cigarette and e-cigarette smokers have higher cotinine levels than never smokers