Association of Passive and Active Smoking with Periodontitis Progression

Objectives: Association between passive smoke exposure and periodontitis progression remains unclear. This study attempted to determine the relationship between passive and active smoking on the basis of salivary cotinine levels and periodontitis progression. Methods: Clinical attachment level (CAL) and probing pocket depth (PPD) were measured during annual health check-ups of workers in 2003 and 2005; additionally, subject lifestyle information was obtained via a self-administered questionnaire. In 2005, 203 of 273 (74%) workers examined at baseline completed periodontal measurements. For assessment of periodontitis progression, change in periodontal status was used if one site or more displayed an increase of ≥2 mm of CAL and PPD over 2 years. Salivary cotinine was determined using ELISA. Based on ROC analysis with self-reported smoking status, non-, passive and active smokers were defined as those subjects exhibiting cotinine levels of 0, 1-7 and ≥8 ng/ml, respectively; 57, 73 and 73 subjects were classified as non-, passive and active smokers, respectively. Statistical methods included simple and multiple logistic regression analyses. Results: Forty-five percent of subjects exhibited one site or more characterized by an increase in CAL and PPD of ≥2 mm over 2 years. Simple logistic regression analysis using periodontitis progression as a dependent variable showed that the significant lifestyle variables were passive smoking, active smoking, alcohol consumption, eating breakfast and working hours (p<0.05). Furthermore, multiple logistic regression analysis revealed significantly higher periodontitis odds ratios in passive and active smokers relative to non-smokers following adjustment for other lifestyle factors including alcohol consumption, eating breakfast and working hours; odds ratios were 2.23 (95%CI; 1.03-4.83) and 2.27(95%CI; 1.02-5.04), respectively. Conclusion: These findings suggest that passive and active smoking classified in terms of salivary cotinine level may be periodontitis risk. This work was supported by Health and Labour Science Research Grants, and Japan Foundation for Aging and Health.