Tobacco use and dental caries: tobacco use status, product types, and mediation by saliva flow rate
Abuljadayel, Layla Waleed
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OBJECTIVES: Despite declining tobacco consumption in the U.S., it remains a public health concern. The aim of this study was to assess the impact of tobacco consumption, different tobacco products and smoking duration on dental caries risk among different populations. METHODS: National Health and Nutrition Examination Survey data were used in an epidemiological cross-sectional study of a representative sample of U.S. civilian non-institutionalized population to investigate the influence of tobacco use and different tobacco products on caries prevalence among adolescents and adults. The outcomes were DMFT and DFT indices. Data from the Dental Longitudinal Study (DLS), a closed-panel prospective cohort study of oral health and aging, was used in longitudinal design to determine if changes in tobacco use status change the risk of developing new caries in adult men. Caries increment was used as an outcome. In addition, a cross-sectional study, using DLS, evaluated the association between smoking duration and caries prevalence, and to determine if it is mediated by unstimulated saliva flow rate. DMFS was used as an outcome. Descriptive and bivariate analyses were conducted on dental caries outcomes by tobacco use status and product consumption. Multiple regression, GEE, and mediation analyses were conducted controlling for confounders. RESULTS: Active tobacco use was significantly associated with dental caries, with the highest caries prevalence compared to passive or non-use among adolescents and adults (P-value <.0001). Among adolescents, passive tobacco users had higher caries prevalence than non-tobacco users. In the DLS, continuous use, quitting and starting/ restarting tobacco use between examinations were all associated with higher caries increments (p-value <0.01). Smoking duration was significantly associated with caries prevalence as long smoking duration (31- 70 years) had on average 14 more DMFS than nonsmokers (p-value= 0.0002) and USFR may partially mediate this relation by about 8.70%. CONCLUSION: Dental caries was significantly associated with active tobacco use among adolescents and adults. Caries prevalence is also high among adolescents passively exposed to tobacco. In adult men, continuous tobacco use was associated with higher caries increments. Long-term smoking was associated with high caries prevalence and this relation could be partially mediated by unstimulated saliva flow rate.