Comparison of Tobacco, E-Cigarette, and Marijuana Smoking on Periodontal Health

Objectives: To assess and compare periodontal parameters among tobacco, e-cigarette, marijuana smokers, and non-smokers.
Methods: This was a pilot retrospective case-control study that was approved by the IRB. Based on self-reported history, subjects were divided into four groups (A) Tobacco smokers (B) E-cigarette smokers (C) Cannabis smokers and (D) Non-smokers. Electronic Health Records (EHR) from January 1, 2012 – December 31, 2021 were reviewed on axiUm. Full mouth periodontal parameters, including probing depth (PD), inter dental clinical attachment loss (CAL), plaque index, bleeding on probing (BoP), missing teeth (excluding third molars) and periodontal diagnosis was recorded from the latest comprehensive examination. Any periodontal therapy performed was also recorded. In addition, the latest set of full mouth radiographs were analyzed to record bone loss. Differences in mean clinical attachment loss between smoking statuses was analyzed with a multilevel linear regression model. P-values less than 0.05 were considered statistically significant.
Results: A preliminary analysis was conducted with 10 subjects in each smoking group for a total of 40 subjects. The average age across all four groups was 56 years old, with the highest average being in the control group (68), and the lowest average being in the e-cigarette smoking group (42.8). The average age for the tobacco and marijuana groups were 62 and 51 respectively. Across all groups, males made up 60% of subjects. Multi-level linear regression analysis showed tobacco smokers show higher PD (3.91 ± 1.49) and CAL (4.69 ± 1.99) compared to non- smokers (PD 3.09 ± 1.34 & CAL 2.77 ± 1.59). Both parameters were statistically significant p = 0.003 and p=0.001 respectively.
Conclusions: Tobacco smoking is associated with significantly higher periodontal disease parameters than e-cigarette and marijuana smoking compared to non-smokers.