100
Cigarette Smoking in
a
Periodontal
Practice
Jerome Haber* and Ralph L. Kenf
This case-control study compares the prevalence of cigarette smoking among patients in a periodontal practice (cases) with that of patients in referring general dental practices (controls). Smoking histories of patients (age >25 years) in a periodontal practice and five general dental practices were obtained by questionnaire. From the general practices, only patients reporting negative histories for Periodontitis were studied. Periodontal status of the periodontal practice patients was based on bone loss from full mouth radiographie surveys and gingival pocket depths. Patients were stratified by age (25 to 40, 41 to 55, and >55 years) and sex. The combined frequency of current or former cigarette smoking reported by 196 periodontal practice patients with moderate or advanced Periodontitis (M-A perio group) was higher than that reported by 209 general dental practice patients (gen prac group) in all age and sex catagories. The age and sex adjusted summary odds ratio for a positive smoking history among M-A perio subjects relative to gen prac subjects was 2.6 (P 4mm was computed for all sites and for descriptive subsets of sites. Comparisons of the mean percent sites >4 mm between current and never smokers in the M-A Perio group were done by analysis of variance with Tukey's multiple comparisons test.
RESULTS Summary characteristics of the M-A Perio and Gen Prac groups are shown in Table 1. The M-A Perio group had a mean age of 51.5 ±11.9 years (mean ± SD) and was 59% female. Current smokers consumed 24 ±12 cigarettes per day. The Gen Prac group had a mean age of 43.5 ± 13.6 years and was 54% female. Cigarette consumption was 18 ±12 cigarettes per day for current smokers. Overall, 75% of subjects in the M-A Perio group were either current (30%) or former (45%) smokers, while only 54% in the Gen Prac group were either current (20%) or former smokers (34%). Sex composition of the two study groups was similar, with slightly more females in the M-A Perio group. There were no differences between the M-A Perio and Gen Prac groups in mean values of age of onset of cigarette smoking or quityears. Among both current and former smokers, differences in mean duration of smoking between the M-A Perio and Gen Prac groups appeared to be largely a result of differences in age. All statistical comparisons of the smoking characteristics of these groups included adjustments for age and sex. The percentage of current, former, and never smokers in each group, stratified by age and sex, is shown in Table 2 and Figure 1 (females) and 2 (males). The combined frequency of current and former smokers was higher for both males and females in the M-A Perio group compared with the Gen Prac group. Over all age categories, although the difference was minimal among males aged 41 to 55, the
J Periodontol 1992
CIGARETTE SMOKING IN A PERIODONTAL PRACTICE
102
February
Table 2. Percent Current, Former, and Never Smokers in the M-A Perio and Gen Prac Groups by Sex and Age
M-A Perio
Sex/Age Males 25-40 41-55 56-80 Females 25-40 41-55 56-80 Totals
Group (%)
Gen Prac
Group (%)
No. Current Former Never No. Current Former Never 12 39 30
50 26 30
33 59 53
17 15 17
43 35 16
30 29 0
14 54 69
56 17 31
24 49 42
42 33 17
29 45 40
29 22 43
61 25 29
21 16 10
30 24 35
49 60 55
209
196
PRACTICE
GEN PERIO
GEN PERIO
GEN PERIO
25 40
41-55
56-up
AGE
-
2. The prevalence
Figure of current and former cigarette smoking among maleM-APerioandGenPracsubjectsbyagegroup. Currentsmokers \ Former smokers I
PRACTICE GEN PERIO 25
AGE
-
40
GEN PERIO
GEN PERIO
41-55
56-up
Figure 1. The prevalence of current and former cigarette smoking among female M-A Perio and Gen Prac subjects by age group. Current smokers
I
I Former smokers
smokers was higher in the Gen Prac group relative to the M-A Perio group.
percentage of
never
The data shown in Table 3 summarize a major difference between the M-A Perio and Gen Prac groups. The overall frequency of patients with a positive smoking history (current and former smokers combined) in the M-A Perio group was 75% versus 54% in the Gen Prac group. The prevalence of never smokers in the Gen Prac group (46%) was approximately twice as high as in the M-A Perio group (25%). The age and sex adjusted odds ratio for the relative frequency of a positive smoking history was 2.6 (P < 0.001), indicating that the odds for a positive smoking history was 2.6 times higher among M-A Perio patients than among Gen Prac patients. The Gen Prac prevalence data are consistent with 1985 report by the Massachusetts Public Health Department, in which the prevalence of positive and negative smoking histories in the general adult population of Massachusetts was reported to be 54% and 46%, respec-
Volume 63 Number 2
HABER, KENT
Table 3. Frequency of Current, Former, and Never Smokers in the M-A Perio and Gen Prac Groups
Table 5. Frequency of 25 to 40 Year-Old Current Smokers in the M-A Perio and Gen Prac Groups by Duration of Smoking
Smoking Status Group M-A Perio Gen Prac
Totals Odds ratio* 95% confidence interval value
Duration of
Never
Current + Former
Former
Current
49 96
147 113
70
58 43
260 2.6
159 2.1
101 3.3
1.6-3.9 4 mm were more frequent in current smokers than former or never smokers in all regions of both arches (P 4 mm by Region and Smoking Status in M-A Perio Subjects
Smoking Region Number of teeth Maxillary anterior
Maxillary premolars Maxillary molars
Mandibular anterior Mandibular premolars Mandibular molars All sites
Status
Current*
Former
Never
(N 58)
(N 80)
(N 48)
23.3 ± 5.3 30.3 ±23.4+ 26.8 ±20.1 56.6±24.1 18.5 ±17.6 41.1 ±24.6 60.7 ±22.4 35.3 ±17.4
24.6± 3.8 14.4±11.6 15.9 ±17.0 38.6 ±23.0 9.4±15.1 29.3 ±22.3 47.6 ±22.7 22.3 ±14.9
23.3 ± 5.1 11.6±15.3 16.7 ±18.2 39.9±21.9 8.4 ±10.7 27.0 ±22.0 48.8 ±22.9 21.4 + 13.7
=
=
=
of variance indicated differences among current, former, and smokers (P
Cigarette Smoking in
a
Periodontal
Practice
Jerome Haber* and Ralph L. Kenf
This case-control study compares the prevalence of cigarette smoking among patients in a periodontal practice (cases) with that of patients in referring general dental practices (controls). Smoking histories of patients (age >25 years) in a periodontal practice and five general dental practices were obtained by questionnaire. From the general practices, only patients reporting negative histories for Periodontitis were studied. Periodontal status of the periodontal practice patients was based on bone loss from full mouth radiographie surveys and gingival pocket depths. Patients were stratified by age (25 to 40, 41 to 55, and >55 years) and sex. The combined frequency of current or former cigarette smoking reported by 196 periodontal practice patients with moderate or advanced Periodontitis (M-A perio group) was higher than that reported by 209 general dental practice patients (gen prac group) in all age and sex catagories. The age and sex adjusted summary odds ratio for a positive smoking history among M-A perio subjects relative to gen prac subjects was 2.6 (P 4mm was computed for all sites and for descriptive subsets of sites. Comparisons of the mean percent sites >4 mm between current and never smokers in the M-A Perio group were done by analysis of variance with Tukey's multiple comparisons test.
RESULTS Summary characteristics of the M-A Perio and Gen Prac groups are shown in Table 1. The M-A Perio group had a mean age of 51.5 ±11.9 years (mean ± SD) and was 59% female. Current smokers consumed 24 ±12 cigarettes per day. The Gen Prac group had a mean age of 43.5 ± 13.6 years and was 54% female. Cigarette consumption was 18 ±12 cigarettes per day for current smokers. Overall, 75% of subjects in the M-A Perio group were either current (30%) or former (45%) smokers, while only 54% in the Gen Prac group were either current (20%) or former smokers (34%). Sex composition of the two study groups was similar, with slightly more females in the M-A Perio group. There were no differences between the M-A Perio and Gen Prac groups in mean values of age of onset of cigarette smoking or quityears. Among both current and former smokers, differences in mean duration of smoking between the M-A Perio and Gen Prac groups appeared to be largely a result of differences in age. All statistical comparisons of the smoking characteristics of these groups included adjustments for age and sex. The percentage of current, former, and never smokers in each group, stratified by age and sex, is shown in Table 2 and Figure 1 (females) and 2 (males). The combined frequency of current and former smokers was higher for both males and females in the M-A Perio group compared with the Gen Prac group. Over all age categories, although the difference was minimal among males aged 41 to 55, the
J Periodontol 1992
CIGARETTE SMOKING IN A PERIODONTAL PRACTICE
102
February
Table 2. Percent Current, Former, and Never Smokers in the M-A Perio and Gen Prac Groups by Sex and Age
M-A Perio
Sex/Age Males 25-40 41-55 56-80 Females 25-40 41-55 56-80 Totals
Group (%)
Gen Prac
Group (%)
No. Current Former Never No. Current Former Never 12 39 30
50 26 30
33 59 53
17 15 17
43 35 16
30 29 0
14 54 69
56 17 31
24 49 42
42 33 17
29 45 40
29 22 43
61 25 29
21 16 10
30 24 35
49 60 55
209
196
PRACTICE
GEN PERIO
GEN PERIO
GEN PERIO
25 40
41-55
56-up
AGE
-
2. The prevalence
Figure of current and former cigarette smoking among maleM-APerioandGenPracsubjectsbyagegroup. Currentsmokers \ Former smokers I
PRACTICE GEN PERIO 25
AGE
-
40
GEN PERIO
GEN PERIO
41-55
56-up
Figure 1. The prevalence of current and former cigarette smoking among female M-A Perio and Gen Prac subjects by age group. Current smokers
I
I Former smokers
smokers was higher in the Gen Prac group relative to the M-A Perio group.
percentage of
never
The data shown in Table 3 summarize a major difference between the M-A Perio and Gen Prac groups. The overall frequency of patients with a positive smoking history (current and former smokers combined) in the M-A Perio group was 75% versus 54% in the Gen Prac group. The prevalence of never smokers in the Gen Prac group (46%) was approximately twice as high as in the M-A Perio group (25%). The age and sex adjusted odds ratio for the relative frequency of a positive smoking history was 2.6 (P < 0.001), indicating that the odds for a positive smoking history was 2.6 times higher among M-A Perio patients than among Gen Prac patients. The Gen Prac prevalence data are consistent with 1985 report by the Massachusetts Public Health Department, in which the prevalence of positive and negative smoking histories in the general adult population of Massachusetts was reported to be 54% and 46%, respec-
Volume 63 Number 2
HABER, KENT
Table 3. Frequency of Current, Former, and Never Smokers in the M-A Perio and Gen Prac Groups
Table 5. Frequency of 25 to 40 Year-Old Current Smokers in the M-A Perio and Gen Prac Groups by Duration of Smoking
Smoking Status Group M-A Perio Gen Prac
Totals Odds ratio* 95% confidence interval value
Duration of
Never
Current + Former
Former
Current
49 96
147 113
70
58 43
260 2.6
159 2.1
101 3.3
1.6-3.9 4 mm were more frequent in current smokers than former or never smokers in all regions of both arches (P 4 mm by Region and Smoking Status in M-A Perio Subjects
Smoking Region Number of teeth Maxillary anterior
Maxillary premolars Maxillary molars
Mandibular anterior Mandibular premolars Mandibular molars All sites
Status
Current*
Former
Never
(N 58)
(N 80)
(N 48)
23.3 ± 5.3 30.3 ±23.4+ 26.8 ±20.1 56.6±24.1 18.5 ±17.6 41.1 ±24.6 60.7 ±22.4 35.3 ±17.4
24.6± 3.8 14.4±11.6 15.9 ±17.0 38.6 ±23.0 9.4±15.1 29.3 ±22.3 47.6 ±22.7 22.3 ±14.9
23.3 ± 5.1 11.6±15.3 16.7 ±18.2 39.9±21.9 8.4 ±10.7 27.0 ±22.0 48.8 ±22.9 21.4 + 13.7
=
=
=
of variance indicated differences among current, former, and smokers (P
