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Epidemiological evidence has been accumulated to suggest a relationship between periodontal degradation and smoking. However, the mechanism underlying this effect is unknown and may be related to the host responses. The aim of this study was to investigate the effects of active/secondhand smoking on the gingival neutrophil elastase activity and the biochemical markers of periodontal degradation. Ninety-two healthy male subjects with no clinical signs of periodontitis volunteered to take part in the investigation. Clinical records of the probing pocket depth (PPD), plaque index (PlI), gingival index (GI) and amount of gingival crevicular fluid (GCF) were prepared for each individual. The extracellular elastase activity was measured in the GCF samples using a chromogenic low-molecular-weight substrate, while the levels ofα1-antitrypsin, elastase-α1-antitrypsin complex and salivary cotinine levels were measured by ELISA. The following results were obtained. 1, Based on the salivary cotinine levels, 40 of the self-reported non-smokers were actually secondhand smokers, and 14 were actually non-smokers. 2, There were no significant differences in the clinical parameters between non-smokers, secondhand smokers and active smokers. 3, The salivary cotinine levels were correlated with the extracellular elastase activity and free elastase levels in secondhand smokers. 4, The salivary cotinine levels were negatively correlated with the active elastase-α2-macroglobulin complex levels in active smokers. These results indicate that active/secondhand smoking enhanced gingival neutriphil elastase activity during the initial phase of activity of the periodontal host defense system. In other words, the results appeared to underline more strongly that secondhand smoking as well as active-smoking are major environmental factors for periodontal disease. Furthermore, in addition to measurement of the GCF extracellular elastase activity, measurement of the salivary cotinine levels was also suggested to be a useful index. 260

Usefulness of active/secondhand smoking inspection by measurement of the salivary level of cotinine-GCF elastase activity as an index-