Association between cigarette smoking status and periodontal disease in adults: results from the 2012 Korea national health and nutrition examination survey

Young Soon Won; Ji Hyun Kim

doi:10.11149/jkaoh.2016.40.2.133

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Won and Kim: Association between cigarette smoking status and periodontal disease in adults: results from the 2012 Korea national health and nutrition examination survey

Original Article

J Korean Acad Oral Health 2016;40(2):133-139.

Published online: 15 June 2016

DOI: https://doi.org/10.11149/jkaoh.2016.40.2.133

Association between cigarette smoking status and periodontal disease in adults: results from the 2012 Korea national health and nutrition examination survey

Young Soon Won¹, Ji Hyun Kim^2,

¹Department of Dental Hygiene, Wonkwang Health Science University, Iksan, Korea

²Graduate 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

Received 18 May 2016 Revised 13 June 2016 Accepted 24 June 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.

Keywords: Diabetes mellitus, Periodontal diseases, Smoking

References

1. No smoke guide. Sight of smoking statistics. Trends in smoking among foreign [Internet]. [cited 2016 Apr 5]. Available from:. http://www.nosmokeguide.or.kr/mbs/nosmokeguide/subview.jsp?id=nosmokeguide_010200000000#.

2. Al-Amad SH, Awad MA, Nimri O. Oral cancer in young Jordanians: potential association with frequency of narghile smoking. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014; 118:560–565.

3. Han DH, Kim JB. The association between smoking and periodontitis: findings from The Korean National Oral Health Survey 2006. J Korean Acad Oral Health. 2009; 33:634–643.

4. Jung JO, Chun JY, Lee KH. The relationship between smoking and periodontal diseases in Korean adults: based on the data from the Korea National Health and Nutrition Examination Survey 2010. J Korean Soc Dental Hyg. 2013; 13:481–489.

5. Heasman L, Stacey F, Preshaw PM, McCracken GI, Hepburn S, Heas-man PA. The effect of smoking on periodontal treatment response: a review of clinical evidence. J Clin Periodontol. 2006; 33:241–253.

6. Jogezai U, Maxood A, Khan NA. Comparison of periodontal health status of smokers versus non-smokers. J Ayub Med Coll Abbottabad. 2013; 25:183–186.

7. Korea Health Statistics. 2014: Korea National Health and Nutrition Examination Survey (KNHANES VI-2). 2014. 63–216.

8. Kim BO, Cho MS, Kim SA, Shim HS, Han YG, Go EG, et al. Peri-odontology. 3th ed.Seoul: DaehanNarae;2012. p. 41–43.

9. Chen X, Wolff L, Aeppli D, Guo Z, Luan W, Baelum V, et al. Cigarette smoking, salivary/gingival crevicular fluid cotinine and periodontal status. A 10-year longitudinal study. J Clin Periodontol. 2001; 28:331–339.

10. Van Dyke TE. Risk factors of periodontitis. J Int Acad Periodontol. 2005; 7:3–7.

11. Won YS, Choi CH, Oh HN. Risk factors of periodontal disease in Korean adults. J Korean Acad Oral Health. 2014; 38:176–183.

12. Aljehani YA. Risk factors of periodontal disease: Review of the literature. Int J Dent. 2014; 2014:1–9.

13. Han GS, Kim YS, Kang JK, Hwang YS, Han DH, Bae KH. Relation of smoking and periodontal status among 30s-50s Adults in Metropolitan Area. J Korean Acad Oral Health. 2008; 32:250–260.

14. Korea Centers for Disease Control and Prevention. The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-3). 2012. 1–246.

15. World Health Organization. Oral Health Surveys; Basic Methods. 5th ed.Geneva: WHO;1997.

16. Genuth S, Alberti KG, Bennett P, Buse J, Defronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003; 26:3160–3167.

17. Preber H, Linder L, Bergstrom J. Periodontal healing and perio-pathogenic microflora in smokers and non-smokers. J Periodontol. 1995; 22:946–952.

18. Gye SB, Han SB. Effects of cigarette smoking on Periodontal status. J Korean Acad Periodontol. 2001; 31:803–810.

19. Calsina G, Ramon JM, Echeverria JJ. Effects of smoking on periodontal tissues. J Periodontol. 2002; 29:771–776.

20. Langhammer A, Johnsen R, Holmen J, Gulsvik A, Bjermer L. Cigarette smoking gives more respiratory symptoms among women than among men. J Epidemiol Community Health. 2000; 54:917–922.

21. Seo MK. Women’s smoking behavior: Factors and policy options. Health and Welfare Policy Forum. 2011; 172:59–67.

22. Jung-Choi KH, Khang YH. Cho HJ. Hidden female smokers in Asia: a comparison of self-reported with cotinine-verified smoking prevalence rates in representative national data from an Asian population. Tob Control. 2011; 21:536–542.

23. Cho KS. Prevalence of hardcore smoking and its associated factors in Korea. Health and social welfare review. 2013; 33:603–628.

24. Li P, He L, Sha YQ, Luan QX. Relationship of metabolic syndrome to chronic periodontitis. J Periodontol. 2009; 80:541–549.

25. Lacchetti C, Cohen J, Ashley MJ, Ferrence R, Bull S, De Groh M, et al. Is nicotine dependence related to smokers’ support for -restrictions on smoking? Nicotine Tob Res. 2001; 3:257–260.

26. Agnihotri R, Gaur S. Implications of tobacco smoking on the oral health of older adults. Geriatr Gerontol Int. 2014; 14:526–540.

27. Haffajee AD, Socransky SS. Relation of body mass index, periodontitis and Tannerella forsythia. J Clin Periodontol. 2009; 36:89–99.

28. Lee HS, Kim ME. Effects of smoking on oral health: Preliminary evaluation for a long-term study of a group with good oral hygiene. J Oral Med Pain. 2011; 36:225–224.

29. Ministry of Health and Welfare. Korean National Health 2010. KI-HASA. 2011; 8:102–117.

30. Johnson GK, Guthmiller JM. The impact of cigarette smoking on periodontal disease and treatment. Periodontol 2000. 2007; 44:178–194.

31. Grossi SG, Zambon JJ, Ho AW, Koch G, Dunford RG, Machtei EE, et al. Assessment of risk for periodontal disease. I. Risk indicators for attachment loss. J periodontol. 1994; 65:260–267.

32. Syrjälä AM, Ylöstalo P, Niskanen MC, Knuuttila ML. Role of smoking and HbA1c level in periodontitis among insulin dependent diabetic patients. J clin periodontol. 2003; 30:871–875.

Table 1.

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
			Total (N=1,003)	1-9 (N=233)	10-19 (N=394)	P-value	≥20 (N=375)	≥30 (N=72)	20-29 (N=419)	<20 (N=512)	<20 (N=395)	20-39.9 (N=428)	P-value	≥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 exposure^b, %
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.

Table 2.

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)	P trend^†	≥30 (N=35)	20-29 (N=151)	<20 (N=132)	P trend^†	<20 (N=51)	20-39.9 (N=174)	≥40 (N=93)	P trend^†
			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.

Table 3.

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^†
		Former (N=314)	1-9 Cigarettes/d	10-19 Cigarettes/d	≥20 Cigarettes/d	P trend^†	≥30	20-29	<20	P trend^†	<20	20-39.9	≥40	P trend^†
		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.

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