Search Results (281)

Background/Objectives: This prospective observational cohort study aimed to evaluate the influence of heated tobacco (HT) and electronic cigarettes (ECs) on bone remodeling markers such as receptor activator of nuclear factor kappa-B ligand (RANKL) and osteoprotegerin (OPG), and periodontal status, at baseline and at 3 months after initial periodontal therapy. Methods: The sample comprised 236 participants (130 women, 106 men; mean age 38.96 ± 7.69 years), distributed across non-smokers (n = 72), heated tobacco/HT product users (n = 83), and electronic cigarette/EC users (n = 81). For each patient, the periodontal charting included periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL). Unstimulated saliva samples were analyzed for RANKL and OPG levels. All patients underwent nonsurgical periodontal therapy (scaling and root planing). Between-group comparisons were performed using the Kruskal–Wallis test followed by Bonferroni-adjusted pairwise comparisons, while within-group changes over time were assessed using the Wilcoxon signed-rank test. To complement the primary nonparametric analyses, two-way mixed-design ANOVA and ANCOVA models adjusted for baseline values and periodontitis stage were performed as sensitivity analyses. Statistical significance was set at p < 0.05. Results: At baseline, both product user groups exhibited significantly higher PPD (p = 0.005) and CAL (p = 0.001) compared with non-smokers, with no differences between HT and EC users. Salivary RANKL levels were significantly higher in HT and EC users than in non-smokers, and OPG levels did not differ significantly. Following non-surgical periodontal therapy, all parameters improved significantly across groups (p < 0.001). At the 3-month follow-up, both product user groups maintained higher PPD (p = 0.008), CAL (p = 0.001), and salivary RANKL levels, compared with non-smoking individuals (p < 0.001). The RANKL/OPG ratio remained significantly different only for EC users compared with non-smokers (p < 0.001). Conclusions: HT and EC use were associated with differences in periodontal parameters and higher RANKL levels, while differences in the RANKL/OPG ratio were observed in EC users compared with non-smokers. Non-surgical periodontal therapy improved clinical parameters and reduced the RANKL/OPG ratio, highlighting the importance of biofilm control. Full article

Background/Objectives: Methods of smoking have evolved over the years, including heated tobacco products. The impact of exposure to traditional tobacco smoke and heated/electronic tobacco products (IQOS) on biofilm formation has not been previously compared in vitro. Aims and objectives: The present study aimed to evaluate the impact of tobacco and electronic smoking on microbial biofilm formation on dental hard tissues. Materials and Methods: Thirty premolars were randomly assigned to six groups (n = 10 per group) according to tissue type and smoking exposure: Six experimental groups were defined: Group 1, non-exposed enamel; Group 2, enamel subjected to conventional cigarette smoke (CS); Group 3, enamel subjected to heated tobacco (HT); Group 4, non-exposed cementum; Group 5, cementum subjected to conventional cigarette smoke; and Group 6, cementum exposed to heated tobacco. Enamel and root discs were then immersed in 2 mL of an adjusted, standardized bacterial suspension of Streptococcus mutans (S. mutans) to allow bacterial biofilm adhesion after incubation for 48 h at 37 °C. The mean colony-forming unit (CFU) count was calculated, and the surface topography and roughness were assessed using scanning electron microscopy and ImageJ software with the SurfCharJ plugin, respectively. Results: Conventional cigarette smoking showed significantly higher S. mutans adhesion on the enamel and root discs compared with IQOS and control groups. Both IQOS and cigarette smoking increased roughness on enamel and root versus the control group, and cigarette smoking produced significantly higher roughness on the enamel surface when compared to IQOS; however, there were no significant differences in the roughness between the two smoking methods on the root surface. SEM analysis showed the most extensive enamel and root microtopography change in IQOS smoking. Conclusions: Aerosols from heated tobacco products (IQOS) alter the surface topography and roughness of enamel and root, while traditional cigarette smoking significantly increases bacterial colonization. Further in vivo studies are warranted to simulate the dynamic nature of the oral cavity. Full article

Background: Pre-Chronic Obstructive Pulmonary Disease (pre-COPD) and Preserved Ratio Impaired Spirometry (PRISm) phenotypes represent important components of the early obstructive lung disease spectrum, characterized by respiratory symptoms and structural lung abnormalities prior to the development of overt airflow limitation. Emphysema is considered one of the major structural phenotypes underlying airway disease and the COPD spectrum. Although cigarette smoking is the best recognized risk factor for these conditions, non-tobacco exposures may also contribute to early structural lung changes. In this study, we evaluated the radiological features, pulmonary function parameters, and dyspnea severity of CT-detected emphysema in symptomatic patients classified as having pre-COPD or PRISm, with particular attention paid to the potential influence of smoking status on disease characteristics. Methods: In this retrospective, single-center study, symptomatic patients aged 20–50 years classified as having pre-COPD or PRISm and in whom emphysema was detected on high-resolution computed tomography (HRCT) were evaluated. Only symptomatic patients who underwent HRCT for clinical indications and in whom emphysema was identified were included. Demographic characteristics, emphysema type and quantitative emphysema severity, pulmonary function parameters, and Modified Medical Research Council (mMRC) dyspnea scores were analyzed. The PRISm and pre-COPD groups were compared in terms of clinical and symptomatic characteristics. In addition, smoking-related clinical and radiological characteristics were also evaluated. Results: A total of 232 patients were included in the study. The median age was 43 years (38–48), and 84.1% of the participants were male. Among the study population, 68.5% were classified in the pre-COPD group and 31.5% in the PRISm group. The most frequently identified emphysema patterns were paraseptal (44.4%) and centrilobular (40.5%). The median total lung emphysema area was 18% (13–22). A weak negative correlation was observed between the degree of emphysema and FEV₁ (r = −0.185; p = 0.005), whereas a weak positive correlation was found between emphysema extent and the mMRC dyspnea score (r = 0.214; p = 0.001). Dyspnea severity was significantly higher in the PRISm group compared with the pre-COPD group (p < 0.001). In the smoking-status subgroup analysis, ever-smokers demonstrated significantly greater dyspnea severity and lower FEV₁ values, whereas never-smokers had a significantly higher proportion of emphysema extent > 18% (all p < 0.05). Conclusions: Radiologically detected emphysema in symptomatic patients without airflow limitation was associated with statistically significant but weak alterations in pulmonary function and dyspnea burden. Dyspnea severity was significantly higher in the PRISm phenotype. In a smoking-status subgroup analysis, ever-smokers had significantly greater dyspnea severity, whereas never-smokers showed a significantly higher proportion of extensive emphysema (>18%), despite similar functional impairment across groups. These findings underscore the importance of non-tobacco exposures in the development of emphysema within pre-obstructive spirometric phenotypes. Multicenter prospective studies incorporating healthy controls and systematic exposure documentation are needed to confirm these observations. Full article

Background and Aim: Passive smoking (PS) is a well-established risk factor associated with systemic and oral health impairments in children. However, its influence on perioperative physiological stability and recovery profiles during pediatric dental sedation remains insufficiently elucidated. This study investigated the association between PS exposure and perioperative vital parameters, recovery characteristics, and emergence behavioral outcomes in children undergoing dental extractions under sedation. Methods: This prospective cohort study (ClinicalTrials.gov: NCT06780189) included 100 ASA I children aged 4–6 years scheduled for primary molar extraction under midazolam-remifentanil-propofol sedation. Participants were stratified into three groups: no exposure, caregiver and household exposure, and household exposure only. An exposure-related relationship was evaluated based on daily household cigarette consumption. Perioperative vital signs (HR, blood pressure, and SpO₂) were continuously monitored. Postoperative recovery and emergence profiles were assessed using the Modified Aldrete Recovery Score (MASS), Richmond Agitation–Sedation Scale (RASS), and Pediatric Anesthesia Emergence Delirium (PAED) scale. Results: Children exposed to PS demonstrated significantly lower SpO₂ levels across all perioperative phases compared with non-exposed counterparts (p < 0.001), reflecting an exposure-related effect. In contrast, no statistically significant differences were observed in cardiovascular parameters (p > 0.05). Recovery time was significantly prolonged in PS-exposed children (p = 0.002). Furthermore, PS exposure was associated with significantly higher RASS and PAED scores, indicating increased agitation and emergence delirium (p < 0.001). Conclusions: Passive smoking adversely affects perioperative oxygenation, delays recovery, and exacerbates emergence neurobehavioral disturbances in children undergoing dental sedation. Environmental tobacco exposure must be integrated into preoperative risk assessments. Full article

Background/Objectives: Over the past decade, the popularity of smokeless tobacco products, particularly heated tobacco products (HTPs), has increased among adolescents and young adults. This study aimed to determine the effects of HTPs and conventional cigarettes on oral health and quality of life (QoL). Methods: This stratified cross-sectional study included 90 participants divided into three groups: conventional cigarette smokers (N = 30), HTP users (N = 30), and non-smokers (N = 30). Sociodemographic data and oral-medical status [salivary pH, halitosis, sialometric measurements, Decayed, Missing, Filled Teeth (DMFT) index, and oral lesions] were recorded for all participants. Results: There was no statistically significant difference in salivary pH, unstimulated whole saliva (UWS), or stimulated whole saliva (SWS) among the three groups (p = 0.343, p = 0.982, and p = 0.793, respectively). There was also no statistically significant difference in DMFT index values (p = 0.495) or total QoL (p = 0.856) among the groups. However, there was a statistically significant difference in halitosis among the groups (p < 0.0001), with moderate (40.0%, N = 12) and strong (33.3%, N = 10) halitosis most frequent among HTP users. There was no statistically significant difference in the incidence of pathological oral lesions among the groups (p = 0.112), with 63.3% (N = 19) among conventional cigarette smokers. Conclusions: HTP users exhibited a higher frequency of moderate and strong halitosis, while conventional cigarette smokers more frequently presented with smoker’s melanosis and lesions located on the hard palate. Full article

Background/Objectives: Electronic cigarettes (e-cigarettes) are an important public health concern, particularly amongst young individuals. This study aimed to assess the attitudes and factors, including mental distress, that influence e-cigarette use amongst university students in Southern Thailand, including in armed conflict areas. Methods: A cross-sectional survey was conducted at the Prince of Songkla University across two campuses: Hat yai and Pattani. Data on demographics, attitudes towards e-cigarettes, usage patterns, and mental health (using the 21-item Depression, Anxiety, and Stress Scale) were collected and analysed using R software. Results: Amongst 901 participants (236 men and 665 women), the prevalence of e-cigarette use was 6.9%. Men (OR = 2.65; 95% CI = [1.28, 5.46]), tobacco users (OR = 97.56; 95% CI = [26.77, 355.66]), and those living alone (OR = 13.48; 95% CI = [1.21, 150.47]) were more likely to engage in e-cigarette use. Additionally, Islamic students reported lower usage rates than their Buddhist counterparts (OR = 0.32; 95% CI = [0.11, 0.9]). Conclusions: E-cigarette users exhibited higher scores on the depression, anxiety, and stress subscales than non-users. Smokers perceived e-cigarettes as a means of reducing tobacco consumption, alleviating stress, and enhancing their image. Moreover, non-smokers believed that e-cigarettes should be ‘illegal’ in Thailand. Full article

This study investigates the use of type A zeolite as a filtering material for the removal of toxic and carcinogenic compounds from cigarette smoke, which contains nicotine and other harmful substances produced by tobacco combustion. The aim is to evaluate the effectiveness of zeolite in reducing exposure to secondhand smoke, with particular attention to health and environmental impacts. The zeolite was characterized using SEM-EDS, XRD, DSC, and TGA to determine its morphology, chemical composition, crystalline structure, and thermal stability. An experimental setup was designed to simulate realistic smoking conditions and test filter efficiency based on the active mass. The system allowed identification of harmful substances trapped in the filter and those remaining in the air. Performance was assessed through gravimetric analysis and GC-MS, enabling identification of adsorbed and non-adsorbed compounds. Results demonstrate significant efficiency in selective removal of toxic components. Finally, filter performance was compared with carbon nanotubes, tested under the same experimental protocol. Full article

Background/Objectives: A sub-anesthetic dose of ketamine has shown promise in reducing craving, withdrawal symptoms, and use of drugs such as alcohol, cocaine, and opioids among individuals with substance use disorders. Ketamine’s therapeutic potential for tobacco use is unknown. Here, we investigated a single sub-anesthetic dose among adults with tobacco use disorder who were not interested in changing their smoking behavior. Methods: Utilizing a randomized, within-subject crossover, double-blinded, counter-balanced, midazolam-controlled design, participants (n = 18) received a 0.71 mg/kg infusion of ketamine and a 0.025 mg/kg infusion of midazolam (i.e., active placebo) at least two weeks apart. Participants were asked to abstain from smoking after the infusions until the post-infusion sessions, 1 day following infusion, where participants completed measures of smoking behavior, craving, and withdrawal symptoms. Participants continued to record their smoking behavior over the 7 days following infusion. Participants also completed a semi-structured qualitative interview regarding their experiences. Results: Compared to midazolam, ketamine infusion led to a non-significant reduction (p = 0.10, η_p² = 0.153) in the number of cigarettes smoked during the requested abstinence period. Following this period, there were no significant differences in ad lib smoking. Ketamine showed no effect on craving or withdrawal symptoms. Participants reported more intense psychological experiences following ketamine infusion (p < 0.001, η_p² = 0.830) and about half reported it felt easier to abstain from smoking after the ketamine infusion. Conclusions: While well tolerated, these findings suggest ketamine has little to no direct effect on quantitative measures of cigarette smoking, craving, or withdrawal. However, the qualitative measures suggest ketamine improves mood and reduces craving in some individuals for several days. Future studies should investigate whether ketamine can indirectly support smoking cessation among individuals with comorbid psychiatric indications for ketamine treatment. Full article

Introduction: Smoking cigarettes is widely recognized as a significant risk factor for tooth loss. Objectives: The aim of this study was to assess the association between cigarette smoking, smoking cessation, and the number of remaining teeth in an adult population. Methods: Data from the Bialystok Plus population study, collected between November 2018 and January 2024, were analyzed. Participants were stratified into young (20–44 years), middle-aged (45–64 years), and older (65 years and above) groups. The outcome was the number of lost teeth. Smoking status (non-smoker vs. ever smoker and former smoker vs. current smoker) and smoking duration were the main independent variables. Additional variables included age, sex, dental habits and medical history. Risk factor analysis was done with generalized linear models using the negative binomial family. Results: Ever smoking was significantly associated with tooth count. Differences in the number of remaining teeth between former and current smokers were observed across age groups but not in the overall population. Current smokers exhibited a significantly greater decline in the number of teeth with an increasing fraction of life spent smoking compared to former smokers. Negative binomial regression models showed that ever smoking, when adjusted for age and diabetes, was a risk factor of tooth loss, but a protective effect of smoking cessation was not confirmed. Conclusions: This study confirmed that tobacco addiction is associated with tooth loss. Being a current smoker remained non-significant as a risk factor for tooth loss when compared to former smoker status. Full article

Cigarette smoke contains a high concentration of carcinogenic substances to which smokers are regularly exposed. Passive smoking is seriously harmful to the health of non-smoking humans and animals. Domestic cats are particularly vulnerable because of their constant grooming activity, which can promote oral ingestion of smoke-derived residues. Cotinine, a nicotine metabolite, is a reliable biomarker for tobacco exposure. Considering these observations, our study aimed to (1) characterize cytological alterations in oral mucosal epithelial cells by conventional morphology and automated digital cytomorphometry; (2) quantify urinary cotinine concentration and investigate its possible correlation with oral epithelial cytological alterations. To this aim, oral smears were collected from 30 cats divided into two groups (20 exposed; 10 non-exposed). Smears were stained with May–Grünwald–Giemsa and Papanicolaou to assess inflammation and dysplasia; digital cytomorphometric analysis was used to quantify the nucleus-to-cytoplasm (N/C) ratio. Urinary cotinine was measured by ELISA. Our results showed that exposed cats had significantly higher urinary cotinine levels and higher N/C ratios (p < 0.01) than non-exposed controls, along with mild-to-severe inflammation and dysplastic-like epithelial alterations. These findings support urinary cotinine as a valid biomarker of household tobacco smoke exposure in domestic cats and suggest that such exposure may be correlated with early cytological and cytomorphometric changes in the oral mucosa. Further studies are needed to better investigate the relationship between exposure duration and cytological, cytomorphometric, and molecular alterations. Full article

Background/Objectives: Tobacco use is a leading cause of preventable death worldwide and is linked to major health and economic burden. Many smokers attempt to quit, yet long-term success rates with current medicines and counseling are still modest. Long-term nicotine exposure distorts brain systems involved in reward, craving, and self-control. These changes weaken inhibitory control and strengthen responses to smoking cues, which increases the risk of relapse. Transcranial magnetic stimulation (TMS) is a non-invasive technique that delivers magnetic pulses to specific cortical regions, most commonly the dorsolateral prefrontal cortex, to influence neural activity. This narrative review explored how transcranial magnetic stimulation may aid smoking cessation by acting on neural circuits linked to nicotine dependence. Methods: Five major databases were searched for studies published between 2015 and 2026. After removal of duplicates and screening, a total of 34 studies were included in this narrative synthesis. Randomized controlled trials, clinical studies, and neuroimaging investigations involving adults with nicotine dependence were included. A thematic narrative method was employed to synthesize findings due to the differences in study designs, protocols, and outcome measures. Results: TMS has been shown to attenuate cravings, decrease daily cigarette consumption, and decrease nicotine dependence in various studies. Several trials reported higher abstinence rates with active stimulation compared with sham treatment. Meta-analytic findings indicate stronger effects with 10 Hz stimulation and treatment courses of 20 sessions or more. Neuroimaging studies report changes in functional connectivity within reward, executive control, and salience networks, suggesting partial restoration of disrupted circuits. Treatment response varies according to age, educational level, baseline dependence, and stimulation parameters. Conclusions: These findings support transcranial magnetic stimulation as a promising brain-based approach for smoking cessation, while further well-designed trials with longer follow-up are still needed. Full article

Background: E-cigarette use has risen sharply among young never-smokers, largely driven by the availability of several thousand appealing flavours. This narrative review synthesises evidence on the health effects of vaping, flavour toxicology and attractiveness, designs and outcomes of flavour bans, and complementary measures. Methods: Peer-reviewed publications and institutional reports (up to January 2026) were retrieved from PubMed, Web of Science, Google Scholar, and reference lists of included articles. Evidence from about 200 references was synthesised by a multidisciplinary working group. Results: Although flavouring substances are generally considered safe for ingestion, their inhalation toxicity remains uncertain. In vitro and in vivo studies have reported oxidative stress, inflammation, cytotoxicity, impaired ciliary function, transcriptomic changes, genotoxicity, and DNA damage. These findings—along with the strong youth appeal of fruit/sweet flavours, the inconclusive effects of flavours on smoking cessation, and persisting uncertainties—support banning non-tobacco e-cigarette flavours under the precautionary principle. Flavour bans can reduce e-cigarette use and initiation, especially among young adults, although partial substitution towards combustible cigarettes has been reported in some U.S. states. Policy success requires effective enforcement, prevention of industry circumvention, curbing cross-border sales, and closing regulatory loopholes—ideally at the international level (e.g., EU-wide). Conclusions: E-cigarette flavours may increase vaping toxicity and strongly appeal to youth, justifying flavour bans to prioritise youth protection. To maximise effectiveness, accompanying measures and sustained investment in tobacco prevention, youth education, and accessible evidence-based smoking cessation support are essential. Full article

Background/Objectives: Sexual minority (SM) adults experience higher cigarette smoking prevalence and poorer cessation outcomes than heterosexual adults, yet few empirically supported cessation programs are tailored to SM populations. In addition, the social and behavioral determinants of smoking disparities among SM remain understudied. A clearer understanding of factors associated with cessation in this population is necessary to inform targeted interventions. This study examined predictors of smoking cessation over a one-year period among sexual minority adults. Methods: Data were drawn from Waves 6 and 7 of the Population Assessment of Tobacco and Health (PATH) Study. Complex Samples logistic regression models assessed whether baseline smoking intensity, nicotine dependence, race, income, education, psychological distress, and quality of life predicted cessation one year later. An eight-category intersectional variable combined race, sex, and sexual orientation. Results: Smoking intensity and psychological distress were among the strongest predictors of cessation outcomes. Lower income and non-White race were also associated with reduced cessation likelihood. Cessation outcomes varied significantly across the combined race by sex by sexual orientation groups, with White heterosexual men exhibiting the most favorable cessation profile. Several other groups demonstrated reduced likelihood of quitting after accounting for smoking intensity, nicotine dependence, socioeconomic factors, psychological distress, and quality of life. Conclusions: Smoking cessation disparities operate across intersecting social identities. Behavioral dependence, socioeconomic disadvantages, and psychological distress collectively shape cessation outcomes. Effective interventions should address nicotine dependence within the broader structural and mental health contexts influencing racially and sexually minoritized populations. Full article

Background/Objectives: Heated tobacco products (HTPs) are a gateway to nicotine addiction for non-smokers, especially young people. The short- and long-term health effects of using heated tobacco products are not yet fully understood. The study aimed to assess the effect of heated tobacco use on blood pressure and heart rate in young, healthy individuals aged 18–30. The study also assessed exposure to tobacco smoke by measuring salivary cotinine concentration. Methods: The case–control study was conducted in 2022–2025 among 200 healthy individuals aged 18–30 years: 70 I-Quit-Ordinary-Smoking users (IQOS), 65 daily traditional cigarette smokers (DS), and 65 non-smokers (NS). The research tool was a questionnaire containing information on the use of tobacco products. The participants completed a questionnaire and then underwent blood pressure measurements, anthropometric measurements, and saliva collection for cotinine levels. Results: The average age of initiation of IQOS use was 18.5 years, and smoking had continued for an average of 2.3 years. The average age of initiation of smoking traditional cigarettes was 16.3 years, and smoking had continued for 4.4 years. There were no statistically significant differences in median values between systolic blood pressure (SBP) and diastolic blood pressure (DBP) between the IQOS, DS, and NS groups (p > 0.05). High SBP values ≥ 140 mm Hg were observed in 10% of the IQOS users, 18.5% of the daily smokers of conventional cigarettes, and 12.3% of the non-smokers. High DBP values ≥ 90 mm Hg were observed in 11.4% of IQOS, 7.7% of DS, and 7.7% of NS. The cigarette smokers demonstrated significantly higher median cotinine levels compared to the IQOS users and non-smokers: 153.7 vs. 64.3 vs. 0.5 ng/mL (p < 0.01). Salivary cotinine levels were positively correlated (ρ = 0.38; p < 0.01) with the daily number of heated tobacco sticks among IQOS users (weak correlation), as well as among DS (ρ = 0.42; p < 0.01) with a higher daily number of cigarettes (moderate correlation). Conclusions: Long-term studies are needed to determine the health effects of heated tobacco products among young people in Poland. Furthermore, the potential impact of HTP aerosols on passive smokers should be examined. Further studies should consider the use of salivary cotinine as a biomarker. Full article

Introduction: cigarette smoking is a major source of systemic oxidative stress and a well-established risk factor for cardiovascular disease. Heated tobacco products (HTPs) are increasingly promoted as reduced-risk alternatives, yet their cellular effects remain incompletely understood. Methods: this study compared the oxidative stress-mediated effects of conventional cigarette smoking and HTP use on human erythrocytes. Erythrocytes from healthy non-smokers, conventional smokers, and HTP users were analyzed using biochemical, functional, and cytological approaches to assess redox status, membrane and cytoskeletal organization, anion exchanger 1 (AE1) function, antioxidant response, and redox-sensitive signaling pathways. Results: conventional smokers exhibited higher intracellular reactive oxygen species (ROS) levels, thiol depletion, methemoglobin and hemichrome formation, whereas HTP users showed marked lipid peroxidation despite lower ROS availability. Both groups instead displayed altered expression and distribution of key membrane and cytoskeletal proteins, including glycophorin A, AE1, spectrin, ankyrin, and band 4.1, indicating impaired membrane–cytoskeleton interactions. Functional analyses revealed an accelerated AE1-mediated anion exchange in erythrocytes from conventional smokers, whereas cells from HTP users exhibited a reduced sulfate accumulation, indicating altered transport capacity. In both groups, G6PDH activity was significantly increased, and redox-sensitive signaling pathways involving ERK, AKT, and eNOS were activated, accompanied by sex-dependent alterations in estrogen receptor expression and distribution. Conclusions: collectively, these findings identify erythrocytes as sensitive biomarkers of tobacco-related systemic damage and indicate that smoking-induced erythrocyte dysfunction, including that associated with HTP use, may actively contribute to vascular impairment. This evidence challenges the assumption that heated tobacco products confer a substantially reduced cardiovascular risk compared with conventional cigarettes. Full article