title: Effect of cigarette smoking on oral elastase activity in adult periodontitis patients.
abstract: BACKGROUND
  We have previously reported that elastase activity in oral fluids is significantly increased in most adult periodontitis patients. In some patients, however, elastase levels remain low despite the presence of deep periodontal pockets. In this study we explored whether or not smoking is related to the unexpected low elastase values in these patients.
  
  
  METHODS
  We determined what proportion of the periodontitis patients that showed low oral elastase values were smokers. Paraffin-stimulated saliva or oral rinse samples (3 ml of water, 30 second rinse) were assayed for elastase activity by incubating with 1 mM succinyl-alanyl-alanyl-valine-p-nitroanilide for 20 hours at 37 degrees C, and the color formation read with a spectrophotometer. Neutrophil numbers were analyzed by staining the cells in the oral rinse smear samples.
  
  
  RESULTS
  In 2 patient groups, one in Helsinki, Finland (n = 46) and the other in Vancouver, British Columbia (n = 25), 63% and 83%, respectively, of the adult periodontitis patients who had one or more pockets > or =6 mm and had low oral elastase values (increase of optical density <0.5) were smokers. Non-smoking periodontitis patients had elevated neutrophil numbers compared to healthy subjects, while the smoking patients showed no significant change. Next we analyzed elastase levels in stimulated whole saliva in a group of smokers (n = 300) and those who had quit smoking (n = 102). Smokers had significantly lower oral elastase levels than former smokers in both advanced and moderate periodontitis groups. In this subject group, 56% of all smokers with periodontitis (at least one pocket > or =6 mm) had oral elastase values less than 0.5 U while only 31% of those patients who had quit smoking had low values.
  
  
  CONCLUSIONS
  Cigarette smoking leads to lowered elastase and neutrophil levels in the oral cavity. The oral neutrophil elastase assay, therefore, cannot be used to measure the periodontal status of smokers.
authors.affiliation: Department of Oral Biological and Medical Sciences, Faculty of Dentistry, University of British Columbia, Vancouver.
authors.forename: N C
authors.initials: NC
authors.lastname: Pauletto
authors.forename: K
authors.initials: K
authors.lastname: Liede
authors.forename: A
authors.initials: A
authors.lastname: Nieminen
authors.forename: H
authors.initials: H
authors.lastname: Larjava
authors.forename: V J
authors.initials: VJ
authors.lastname: Uitto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004396:Coloring Agents; D006801:Humans; D007958:Leukocyte Count; D019272:Leukocyte Elastase / Q000032:analysis; D008875:Middle Aged; D009061:Mouth Mucosa / Q000201:enzymology / Q000473:pathology; D009067:Mouthwashes; D009504:Neutrophils / Q000473:pathology; D010196:Pancreatic Elastase / Q000032:analysis*; D010514:Periodontal Pocket / Q000201:enzymology / Q000473:pathology; D010518:Periodontitis / Q000201:enzymology* / Q000473:pathology; D012463:Saliva / Q000166:cytology / Q000201:enzymology*; D012907:Smoking / Q000378:metabolism*; D016540:Smoking Cessation; D013053:Spectrophotometry
chemical_list: D004396:Coloring Agents; D009067:Mouthwashes; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase