Associations of at home oral care practices and periodontitis among smokers and nonsmokers in a dental practice
Pamintuan, Erica Mae Pangilinan
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BACKGROUND: Periodontitis is prevalent among adults 30 years and older and its prevalence increases with age. By 2040, there is an expected 50% increase in adults over the age of 65 years old in the US population. Therefore, it is essential to maintain good oral health and prevent tooth loss, pain, discomfort, and poor nutrition from improper chewing of food. Adults directly influence their periodontitis risk factors through at home oral care practices and smoking habits. Thus, the importance of home oral care practices and better choices in smoking habits may prevent the progression of periodontitis. The purpose of this study is to assess the association of at home oral care practices and smoking to periodontitis. The findings may be useful in future oral health education to emphasize the importance of oral hygiene care at home and smoking cessation. It may help dentists identify patients that will benefit from oral care instructions and smoking cessation and possibly aid in the development of prevention programs to combat the high prevalence of periodontitis in the foreseen growing population of the elders over the age of 65 in the U.S. OBJECTIVES: To assess the association of at home oral care practices to periodontitis and compare smokers and nonsmokers with respect to their oral care practices. We expect that people who regularly brush their teeth, floss, and use mouthwash twice or more per day, and who are nonsmokers will have less periodontitis. METHODS: Three categories of brushing: two to six times/week, once a day, or two or more/day in the past week were used. Additionally, three categories of flossing and rinsing: never, once to six times/week, or one or more times/day in the past week were also used. Odds ratio was calculated controlling for age, bone loss, gender, socioeconomic status, and smoking. Additionally, odds ratio was calculated for the oral care practices comparing smokers versus non-smokers. RESULTS: A total of 141 adults participated in the survey, 18% never flossed, 23% never rinsed, 6% brushed less than daily, and 35% had periodontitis. After controlling for variables, the lack of flossing was associated to periodontitis (odds ratio=1,88, 95% 1.00, p<0.0492) while rinsing and brushing were not associated with periodontitis. There were five times higher odds of periodontitis for a participant who never flossed compared to counterparts (95% CI 2.10-13.56). A dose response was not observed. After calculating for the odds ratio of the association of oral care practices to periodontitis among smokers versus non-smokers, the lack of flossing was positively associated with periodontitis such that smokers who never flossed had twice the higher odds of periodontitis compared to counterparts (odds ratio=4.20, CI 1.30-13.50, p<0.012). Participants who were smokers, with bone loss, and from low socioeconomic status had higher odds of having periodontitis. DISCUSSION: The lack of flossing was associated with higher prevalence of periodontitis. Smokers and especially daily smokers were more likely to engage in poor oral hygiene behaviors. Participants with bone loss, low socioeconomic status, and smokers were also associated with higher prevalence of periodontitis. Flossing at least once a week had a protective association to periodontitis. However, this was a cross-sectional study so a causal relation between the oral care practices and periodontitis cannot be established.