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.2016.40.2.133 jkaoh-40-133 Original Article Association between cigarette smoking status and periodontal disease in adults: results from the 2012 Korea national health and nutrition examination survey WonYoung Soon1 KimJi Hyun2 Department of Dental Hygiene, Wonkwang Health Science University, Iksan, Korea Graduate Study of Public Health Graduate School, Korea University, Seoul, Korea Corresponding Author: Ji Hyun Kim Department of Dental Hygiene, Wonkwang Health Science University, 514 Iksan-daero, Iksan 54538, Korea Tel: +82-63-840-1268 Fax: +82-63-840-1269 E-mail: muchicchun@naver.com 062016 15062016 402 133139 18052016 13062016 24062016 Copyright © 2016 by Journal of Korean Academy of Oral Health 2016 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 aim of this study was to evaluate the association between smoking status and periodontitis risk in Korean adults.

 Methods

This study used data collected from the 2012 Korea National Health and Nutrition Examination Survey. The final sample included 5,513 subjects over 19 years of age who had completed the necessary health behaviors survey and health examinations.

 Results

First, based on a stratification analysis by gender, women who smoked more than 20 cigarettes daily had a 9.99-fold greater risk of periodontal disease than men. The risk of periodontal disease was higher in patients who began smoking at a later age. In patients with less than 20-40 lifelong smoking years, there was an increased risk of periodontitis, especially in men. Second, in a stratification analysis based on the presence of diabetes, patients with diabetes and a history of past smoking had a 2.53-fold higher risk of periodontal disease than non-smoking patients with diabetes. In both healthy and diabetic patients, the risk of periodontal disease increased with the daily smoking quantity and with age, and was also increased in individuals with less than 20-40 lifelong smoking years. The risk of periodontal disease was higher in the diabetes group overall, regardless of smoking status.

 Conclusions

These results suggest that a high level of smoking can increase periodontal disease risk independently of sex and the presence of diabetes in Koreans. This study implies that smoking may be an independent risk factor for periodontal disease.

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General characteristics of study subjects

Current smoker
Characteristics Non-smoker (N=3,200) Former (N=1,054) Total (N=1,003) Cigarette per day
 P-value Age at first smoking
 Lifetime years smoking
 P-value
1-9 (N=233) 10-19 (N=394) ≥20 (N=375) ≥30 (N=72) 20-29 (N=419) <20 (N=512) <20 (N=395) 20-39.9 (N=428) ≥40 (N=176)
Sex, %
Male 22.6 33.5 43.9 6.4 18.2 19.2 <0.001 0.9 16.8 26.1 <0.001 19.3 19.7 4.8 <0.001
Female 86.2 5.8 8.0 4.6 3.0 0.4 1.8 2.9 3.2 5.7 2.0 0.2
Mean age, y* 50.5 55.5 45.6 44.9 44.2 47.5 <0.001 57.4 49.7 40.6 <0.001 32.2 48.8 67.7 <0.001
(Mean±SD) (16.6) (15.7) (14.9) (16.7) (15.4) (13.0) (11.0) (14.7) (13.6) (8.2) (7.8) (6.6)
Body mass index, kg/m2, %
Under 67.3 9.9 22.8 7.9 8.4 6.6 <0.001 0.02 6.8 15.9 0.0004 16.9 3.8 2.1 <0.001
Standard 56.0 19.9 24.1 5.8 10.5 7.9 1.5 9.9 12.9 10.8 10.4 3.0
Obese 50.9 20.1 29.0 4.6 11.0 13.5 1.4 10.2 17.5 14.9 12.5 1.6
Drinking, %
No 90.2 4.9 4.9 1.4 1.9 1.6 <0.001 0.7 2.7 2.1 <0.001 1.5 1.9 1.5 <0.001
Yes 50.8 21.1 28.1 6.0 11.5 10.6 1.5 10.6 15.9 13.7 11.7 2.6
Education, %
Elementary school 65.2 19.4 15.4 3.7 5.1 6.7 <0.001 2.4 6.8 6.2 <0.001 1.5 6.7 7.2 <0.001
Middle school 53.9 22.6 23.5 4.2 8.2 11.1 1.8 8.9 12.9 6.1 13.1 4.4
High school 51.8 17.8 30.4 6.0 13.0 11.3 1.4 10.1 18.9 16.5 12.5 1.4
≥College 53.5 20.7 25.8 6.2 10.9 8.7 0.6 11.4 14.0 15.3 9.9 0.6
Marital status, %
Married 53.2 22.9 23.9 4.5 9.0 10.4 <0.001 1.3 10.0 12.5 <0.001 7.4 13.3 3.2 <0.001
Never married 54.7 12.0 33.3 9.0 15.6 8.7 0.3 10.0 23.0 29.6 3.6 0.03
Separated, divorced, 66.6 14.4 19.0 3.7 8.2 7.1 4.1 7.8 7.1 4.5 10.6 3.8
widowed
ETS exposureb, %
No 53.7 20.9 25.4 4.5 11.7 9.1 0.0001 0.9 10.7 13.8 0.0001 10.3 11.5 3.5 <0.001
Yes 45.4 21.1 33.5 6.3 13.2 14.0 11.5 20.5 17.8 14.8 0.9
History of diabetes mellitus, %
No 55.2 18.9 25.9 5.6 10.5 9.8 0.0009 1.3 9.7 15.0 0.0001 12.9 10.9 2.1 <0.001
Yes 48.2 28.3 23.5 1.3 8.1 11.0 2.2 11.8 9.4 2.8 13.4 7.3

*Unless otherwise indicated, values are expressed as mean±SD.

bETC: Environmental tobacco smoke.

Odds ratio (95% Confidence Interval) for periodontitis by sex and smoking status

Current smoker
Characteristics Nonsmoker (N=684) Former (N=344) Cigarette per day
 P trend† Age at first smoking
 P trend† Lifetime years smoking
 P trend†
1-9 Cigarettes/d (N=49) 10-19 Cigarettes/d (N=113) ≥20 Cigarettes/d (N=155) ≥30 (N=35) 20-29 (N=151) <20 (N=132) <20 (N=51) 20-39.9 (N=174) ≥40 (N=93)
All cases ref 1.43 1.73 (1.28-1.83)a
(1.03-2.00) 0.84 1.63 2.74 <0.001 2.82 1.76 1.51 0.243 0.93 2.66 1.22 0.045
(0.52-1.36) (1.10-2.39) (1.92-3.94) (1.39-5.74) (1.23-2.52) (1.06-2.16) (0.60-1.45) (1.88-3.76) (0.78-1.93)
Sex (Male)
Periodontal dx
Cases, n 96 311 34 97 152 16 139 129 34 160 90
Age-adjusted ref 1.33 0.76 1.56 2.70 <0.001 4.34 1.95 1.80 0.001 0.94 2.77 1.57 0.115
odds ratio (0.88-2.02) (0.40-1.45) (0.99-2.46) (1.82-4.03) (1.45-13.01) (1.26-3.01) (1.19-2.72) (0.54-1.63) (1.84-4.17) (0.91-2.70)
Multivariate* ref 1.33 0.74 1.53 2.54 0.001 3.76 1.89 1.71 0.500 0.87 2.72 1.38 0.038
(0.87-2.04) (0.37-1.45) (0.96-2.44) (1.69-3.82) (1.18-12.04) (1.21-2.97) (1.12-2.62) (0.49-1.53) (1.78-4.16) (0.79-2.41)
Sex (Female)
Periodontal dx
Cases, n 588 33 15 16 3 19 12 3 17 14 3
Age-adjusted ref 1.37 0.98 1.48 6.28 0.064 2.29 1.40 0.29 0.240 1.04 1.96 0.50 0.235
odds ratio (0.81-2.34) (0.51-1.88) (0.81-2.68) (1.62-24.36) (1.07-4.88) (0.71-2.76) (0.07-1.16) (0.56-1.9) (1.06-3.63) (0.10-2.59)
Multivariate* ref 1.61 0.96 1.61 9.99 0.099 2.41 1.56 0.28 0.006 1.07 2.14 0.39 0.938
(0.92-2.84) (0.48-1.93) (0.84-3.06) (1.99-50.94) (0.94-6.14) (0.79-3.07) (0.07-1.78) (0.54-2.14) (1.09-4.19) (0.08-2.00)

*Adjusted for age, education, marital status, and diabetes.

†P-trend calculated by likelihood ratio test for trend.

Odds ratio (95% Confidence Interval) for periodontitis by diabetes and smoking status

Current smoker
Characteristics Nonsmoker (N=626) Former (N=314) Cigarette per day
 P trend† Age at first smoking
 P trend† Lifetime years smoking
 P trend†
1-9 Cigarettes/d 10-19 Cigarettes/d ≥20 Cigarettes/d ≥30 20-29 <20 <20 20-39.9 ≥40
Normal
Periodontal dx
Cases, n 528 248 38 91 123 25 114 114 43 144 66
Age-adjusted ref 1.73 0.94 1.99 3.60 <0.001 3.29 2.26 2.27 <0.001 1.17 3.47 1.65 <0.001
odds ratio (1.31-2.29) (0.59-1.49) (1.40-2.83) (2.66-4.87) (1.59-6.78) (1.62-3.14) (1.64-3.14) (0.76-1.80) (2.57-4.70) (1.01-2.71)
Multivariate* ref 1.34 0.80 1.54 2.63 0.681 2.94 1.62 1.49 0.420 0.87 2.59 1.14 0.028
(0.93-1.96) (0.49-1.32) (1.02-2.34) (1.80-3.85) (1.36-6.35) (1.12-2.36) (1.02-2.16) (0.54-1.40) (1.80-3.72) (0.67-1.93)
Diabetes mellitus
Periodontal dx
Cases, n 98 66 7 18 25 8 28 14 5 25 20
Age-adjusted ref 1.80 1.08 2.03 2.77 - 2.38 2.71 1.48 0.033 2.13 2.27 1.82 0.033
odds ratio (1.05-3.10) (0.37-3.18) (0.76-5.45) (1.34-5.74) (0.58-9.77) (1.29-5.69) (0.67-3.25) (0.48-9.40) (1.09-4.71) (0.82-4.05)
Multivariate* ref 2.53 1.24 2.76 3.66 0.681 2.60 3.38 1.78 0.151 2.54 2.83 2.08 0.188
(1.17-5.50) (0.38-4.07) (0.97-7.84) (1.31-10.23) (0.63-10.82) (1.30-8.76) (0.68-4.62) (0.56-11.48) (1.14-7.02) (0.76-5.73)

Adjusted for age, education, marital status, and diabetes.

†P-trend calculated by likelihood ratio test for trend.