JKAOH Journal of Korean Academy of Oral Health J Korean Acad Oral Health 1225-388X 2093-7784 Journal of Korean Academy of Oral Health 10.11149/jkaoh.2015.39.4.288 jkaoh-39-288 Original Article Effect of smoking on utilization of and expenses in ambulatory dental care JeongSun-Rak1 KimYoung-Hee1 JangJi-Eon2 LeeWon Kee3 Department of Public Health, Graduate School, Kyungpook National University, Daegu, Korea Department of Dental Hygiene, Suseong College, Daegu, Korea School of Medicine, Kyungpook National University, Daegu, Korea Corresponding Author: Won Kee Lee School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro Jung-gu, Daegu 41944, Korea Tel: +82-53-420-6939 Fax: +82-53-425-9937 E-mail: wonlee@knu.ac.kr 122015 12122015 39 4 288 294 01102015 23102015 05112015 Copyright © 2015 Journal of Korean Academy of Oral Health 2015 This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objectives

The objectives of this study were to evaluate the effect of smoking on utilization of and expenses in ambulatory dental care.

 Methods

The subjects of this study were 5,751 men aged over 20 years selected from the Korea Health Panel data collected during 2010-2012. Pack-years of smoking were calculated based on the survey data. Dental utilization was defined as dental outpatient clinic use least once in three years. The expenses in ambulatory dental care were summed to determine total dental health care spending for three years. To detect the effect of smoking, we used multiple logistic regression analysis for dental utilization and multiple linear regression for expenses in ambulatory dental care after changing log.

 Results

The pack-years had a significant effect on dental utilization and expenses in participants aged 40-59 years. After controlling for income level, bedtime brushing, and the presence of chronic disease, dental care utilization rates in the over 10 to less than 25 pack-year and the over 25 pack-year groups were about 1.4 (OR=1.37, (P=0.007)) and 1.6 times (OR=1.59, (P=0.001)) those in the 0 pack-year group. In comparison with the 0 pack-year group, the over 10 to less than 25 pack-year group spent 50,000 won more over dental expenses, while the corresponding number for the over 25 pack-year group was about 100,000 won. Thus, the ambulatory dental care expenses increased with the pack-years of smoking.

 Conclusions

Smoking significantly influenced the utilization and expense in ambulatory dental care in men aged 40-59 years.

 Expense in ambulatory dental care Pack-years of smoking Utilization of ambulatory dental care References Statistics Korea, News, Press Releases, Social statistics, The Summary Result of the 2014 Social Survey [Internet][cited 2015 Nov 05]. Available from:http://kostat.go.kr/portal/english/news/1/19/5/index.board JeeSHLeeJKKimISSmoking-attributable mortality among Korean adults: 1981-2003Korean J Epidemiol2006289299 YoonSJHaBMKangJWChangHCEstimation of attributable burden due to premature death from Smoking in KoreaKorean J Prev Med200134191199 JohnsonGKSlachNAImpact of tobacco use on periodontal statusJ Dent Educ200165313321 ScabbiaAChoKSSigurdssonTJKimCKTrombelliLCigarette smoking negatively affects healing response following flap debridement surgeryJ Periodontol2001724349 ShamASCheungLKJinLJCorbetEFThe effects of tabacco use on oral healthHong Kong Med J20039271277 HeasmanLStaceyFPreshawPMMcCrackenGIHepburnSHeasmanPAThe effect of smoking on periodontal treatment response: A review of clinical evidenceJ Clin Periodontol200633241253 BaelumVibekeCPITN and the epidemiology of periodontal diseaseCommunity Dent Oral Epidemiol1996243678 MillarWJLockerDSmoking and oral health statusJCDA200773155155 PetoRSmoking and death: the past 40 years and the next 40BMJ1994309937939 JungYHKoSJLeeYGParkSBLeeJHLifetime cost of obesity and smoking and long-term effectiveness of health promotionKI-HASA2010 National Health Insurance Service, Understanding for Korea Health PanelKIHASA2008 KimHSKimMKShinHSExpenditure in ambulatory dental care and factors related to its spendingHPM201222207224 Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention2013 6th(1st year) national health statistics HanDHKimJBThe association between smoking and periodontitis: finding from The Korean National Oral Health Survey 2006J Korean Acad Dent Health200933634643 RyuMHThe effects of smoking on oral mucosaThe Journal of Namseoul Univ200410449468 ReibelJTobacco and oral diseasesMed Princ Pract2003122232 PreberHLinderLBergstromJPeriodontal healing and perio-pathogenic microflora in smokers and non-smokersJ Periodontol199522946952 PindborgJJDental aspects of osteogenesis imperfectaAPMIS1947244758 ArnoAWaerhaugJLovdalAScheiOIncidence of gingivitis as related to sex, occupation, tabacco consumption, toothbrushing, and ageOral Surg Oral Med Oral Pathol195811587595 GrossiSGGencoRJMachteiEEHoAWKochGDunfordRAssessment of risk for periodontal disease. Ⅱ. Risk indicators for alveolar bone lossJ Periodontol1995662329 Martinez-CanutPLorcaAMarganRSmoking and periodontal disease severityJ Clin Periodontol199522743749 HarberJKentRLCigarette smoking in periodontal practiceJ Peri-odontol199263100106 HolmGSmoking as an additional risk for tooth lossJ Periodontol1994659961001 ParkHDThe impact of smoking on the utilization of dental health services [master’s thesis]SeoulGraduate School of Public Health Yonsei Univ2008Korean ParkJHKimYNYooJHKIMMYKimBIKwonHKRelationship between smoking and periodontal pocket formation in Korean adultsJ Korean Acad Dent Health200529293301 SongARParkJWA study on the attitudes about smoking and factor analysis among women students of college -By oriented students of Gimcheon CollegeGimcheon College Report200425113138 Figure and Tables

Crude utilization ambulatory dental care rate according to smoking pack-years in the 40-59 age group.

General Characteristics according to experience and pack-years of smoking

Smoking experience P1 Pack-years of smoking Median (Q1-Q3) P2
No Yes
n (%) n (%)
Age <40 671 (56.9) 508 (43.1) <.001 0 (0-4) <.001
40-59 523 (21.9) 1,860 (78.1) 12 (2-21)
60≤ 408 (18.6) 1,781 (81.4) 22 (7-40)
Marital status Marriage 897 (20.6) 3,452 (79.4) <.001 15 (3-29) <.001
Divorce etc. 40 (15.3) 221 (84.7) 19 (6-30)
Single 665 (58.3) 476 (41.7) 0 (0-5)
Education level ≤Middle school 282 (19.2) 1,189 (80.8) <.001 23 (7-40) <.001
High school 549 (26.7) 1,511 (73.3) 12 (0-24.5)
University≤ 771 (34.7) 1,449 (65.3) 5 (0-15)
Type of health insurance Workplace health insurance 1,067 (29.0) 2,610 (71.0) 0.030 10 (0-23) <.001
Regional health insurance 460 (25.6) 1,334 (74.4) 13 (0-27)
Medical care assistance 75 (26.8) 205 (73.2) 15 (0-30)
Family income Site 1 171 (21.2) 636 (78.8) <.001 20 (3-37) <.001
(based on 2010) Site 2 267 (25.2) 791 (74.8) 14 (0-30)
Site 3 308 (25.4) 906 (74.6) 11 (0-24)
Site 4 412 (30.9) 921 (69.1) 8 (0-20)
Site 5 444 (33.2) 895 (66.8) 7 (0-20)
Brushing teeth (after breakfast) (based on 2010) No 565 (29.6) 1,346 (70.4) 0.041 10 (0-23) <.001
Yes 1,037 (27.0) 2,803 (73.0) 11 (0-2)
Brushing teeth (after lunch) No 1,005 (27.3) 2,676 (72.7) 0.212 13 (0-28) 0.001
Yes 597 (28.8) 1,473 (71.2) 8 (0-20)
Brushing teeth (before bedtime) No 650 (25.3) 1,921 (74.7) 0.869 14 (0-29) <.001
Yes 772 (25.5) 2,259 (74.5) 10 (0-24)
Chronic Disease No 1,334 (31.3) 2,929 (68.7) <.001 8 (0-20) <.001
Yes 268 (18.0) 1,220 (82.0) 20 (6-35)
Total 1,602 (27.9) 4,149 (72.1)

P : Chi-square test, P : Wilcoxon's rank sum test or Kruskal-Wallis test.

Effects of pack-years of smoking on dental utilization by age

Age Pack- years of Smoking n Crude Adjusted
OR (95% C.I.) P OR (95% C.I.) P
<40 0.0 671 1.00 1.00
0.1-9.9 407 0.83 (0.64-1.08) 0.166 0.90 (0.67-1.20) 0.463
10.0-24.9 101 0.64 (0.40-1.02) 0.059 0.71 (0.43-1.15) 0.162
25.0≤
40-59 0.0 523 1.00 1.00
0.1-9.9 471 1.21 (0.93-1.57) 0.156 1.22 (0.94-1.58) 0.144
10.0-24.9 933 1.32 (1.06-1.66) 0.014 1.37 (1.09-1.71) 0.007
25.0≤ 456 1.53 (1.18-1.98) 0.001 1.59 (1.22-2.07) 0.001
60≤ 0.0 408 1.00 1.00
0.1-9.9 201 0.95 (0.68-1.33) 0.769 0.97 (0.70-1.36) 0.859
10.0-24.9 547 0.84 (0.65-1.09) 0.189 0.85 (0.65-1.10) 0.207
25.0≤ 1,003 0.93 (0.74-1.17) 0.522 0.97 (0.77-1.22) 0.771

Adjusted OR: adjusted for income level (stage 1-5), whether brushing teeth, and the presence or absence of chronic diseases.

Cure rate by treatment contents according to pack-years in 40-59 years (Unit : %)

Pack-years group P1 P2
0 0.1-9.9 10.0-24.9 25.0≤
(n=523) (n=471) (n=933) (n=456)
Dental caries 17.9 19.3 21.7 23.9 .100 .013
Dentures 0.6 0.2 0.9 0.9 .505 .317
Dental prothesis 1.9 3.6 3.0 5.7 .009 .006
Tooth to implant 3.8 4.7 4.3 4.8 .869 .541
Orthodontia 0.2 0.4 0.0 0.7 .112 .509
Gum treatment (Teeth scaling etc.) 20.7 24.2 23.4 25.9 .269 .088
Endodontic treatment 10.5 11.4 12.2 14.0 .386 .091
Extraction of teeth 6.3 9.1 10.1 16.5 <.001 <.001
Tooth sealant 1.2 1.5 1.5 1.1 .895 .966
Whitening 0.0 0.2 0.0 0.4 .129 .192
Etc. 11.5 11.5 11.4 12.7 .894 .631
Teeth pulling transfer, Teeth filling 5.2 5.3 5.3 4.4 .903 .604

P : Chi-square test, P : Mantel-Haensel linear trend test.

Effects of pack-years of smoking on expense of ambulatory dental care by age unit: won (￦)

Age Pack-years of smoking n Mean of expense (￦) SD of expense (￦) P post-hoc comparision
<40 0.0 671 260,020 994,958 0.154
0.1-9.9 407 194,206 767,414
10.0≤ 101 386,119 1,547,923
40-59 0.0 523 206,613 797,005 0.038 Reference
0.1-9.9 471 242,630 880,523 0.231
10.0≤ 933 250,086 989,309 0.048
25.0≤ 456 302,071 1,034,669 0.002
60≤ 0.0 408 365,699 1,033,658 0.049 Reference
0.1-9.9 201 384,036 960,048 0.982
10.0-24.9 547 372,722 1,179,926 0.088
25.0≤ 1,003 395,368 1,249,447 0.046

Post-hoc comparision: If the Kruskal-Wallis test showed a significant difference between the groups, then comparisons between reference and other one group for post-hoc test were done by employing the Mann-Whitney U-test using Bonferroni correction to adjust the probability.

Effects of smoking history on expense of ambulatory dental caer in the group of 40-59 years old

Estimated regressior coeficient S.E. t P1 P2
Constant 2.59 0.52 4.97 <.001
PaCk-Vears of smoking 0.0 Reference 0.001
0.1-9.9 0.42 0.37 1.14 0.255
10.0-24.9 0.80 0.32 2.52 0.012
7§0< 116 037 2,10 0,007
Family income (based on 2010) Site 1 Reference
Site 2 1.15 0.53 2.15 0.032
Site 5 1.85 0.51 3.60 0.000
Site 4 1.60 0.50 3.20 0.001
Site 5 1.84 0.50 3.65 0.000
Brushing teeth (before bedtime) (based on 2010) No Reference
Yes 70.40 0.25 71.61 0.109
Chronic disease No Reference
Yes 7044 ma 71%? 0186

The expense of ambulatory dental care was used ‘0’ won in case of ‘0’ won and natural log value in case of more than ‘1’ won, P1: Significance pro] ability of estimated regression coefficient, P2: Significance probability of linear trend according to paCk-years of smoking. Adi—R2=O.OH.