Smokeless Tobacco and Severe Active Periodontal Disease, NHANES III

Smokeless Tobacco and Severe Active Periodontal Disease, NHANES III
2005
M.A. Fisher1,*, G.W. Taylor2, and K.R. Tilashalski1
Journal of Dental Research

© 2005 International and American Associations for Dental Research

1 Department of Diagnostic Sciences, University of Alabama at Birmingham School of Dentistry, SDB 219, 1530 3rd Avenue South, Birmingham, AL 35294-0007, USA; and
2 Department of Cariology, Restorative Sciences and Endodontics, University of Michigan School of Dentistry, Ann Arbor, USA;

* corresponding author, mafisher@uab.edu.

ABSTRACT

Whereas smoking is a major risk factor for periodontal disease, the role of smokeless tobacco is unclear. The purpose of this US population-based study of 12,932 adults participating in the Third National Health and Nutrition Examination Survey was to evaluate the association between smokeless tobacco use and severe active periodontal disease. Univariable and multivariable logistic regression modeling quantified the associations between tobacco use and severe active periodontal disease. All adults and never-smokers who currently used smokeless tobacco were twice as likely to have severe active periodontal disease at any site [respective odds ratios (ORAdj) and 95% confidence intervals: ORAdj = 2.1; 1.2Ò3.7 and ORAdj = 2.1; 1.0Ò4.4] or restricted to any interproximal site [respective ORAdj = 2.1; 1.0Ò4.2 and ORAdj = 2.3; 0.9Ò6.3], simultaneously adjusted for smoking, age, race, gender, diabetes, and having a dental visit in the past year. These results indicate that smokeless tobacco may also be an important risk factor for severe active periodontal disease.

KEY WORDS: periodontal diseases Ô periodontal attachment loss Ô tobacco Ô smoking Ô smokeless tobacco

INTRODUCTION

Cigarette smoking is a major risk factor for periodontal diseases (AAP, 1999; USDHHS, 2000). Smokers have more bone loss and clinical attachment loss, increased numbers of deep pockets, and greater calculus formation than do non-smokers (AAP, 1999). The effect of smoking on periodontal health is so widespread that more than one-half of the cases of adult periodontitis may be attributable to cigarette smoking (Tomar and Asma, 2000). The biological plausibility of the increased periodontal disease severity and rate of progression associated with smoking has been hypothesized to be due to interactions among smoking, bacterial periodontal pathogens, and the host (Kazor et al., 1999; USDHHS, 2000; Mariggi? et al., 2001; Taybos, 2003; Johnson and Hill, 2004). Smokeless tobacco has also been shown to affect the immune response in both in vitro (Payne et al., 1994; Johnson et al., 1996; Bernzweig et al., 1998) and in vivo studies (Poore et al., 1995; Payne et al., 1998).

Previous findings of the effect of smokeless tobacco on periodontal health have been limited to attachment loss manifested as gingival recession at the usual site of tobacco placement (Weintraub and Burt, 1987; USDHHS, 2000). The recession has been postulated to be a result of mechanical injury from either the abrasive nature of the smokeless tobacco products or from vigorous toothbrushing at the site of its placement (Robertson et al., 1990; Christen, 1992). Data are insufficient to support an association between smokeless tobacco use and severe periodontitis (Weintraub and Burt, 1987; Robertson et al., 1990). There is a gap in knowledge regarding the effect of smokeless tobacco on periodontal diseases; existing information has been derived from case reports (Christen et al., 1979) and several cross-sectional studies in young adults (Greer and Poulson, 1983; Offenbacher and Weathers, 1985; Robertson et al., 1990). There are no reports of an association between smokeless tobacco and severe active periodontal disease from large, population-based epidemiologic studies.

The purpose of this study was to assess the association between smokeless tobacco use and severe active periodontal disease using the population-based Third National Health and Nutrition Examination Survey (NHANES III), a dataset representative of the civilian, non-institutionalized US population.

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