Smoking but not Snuff Use increases Periodontal Bone Loss Risk

Objectives:Little is known about the possible harmful effects of snuff use on periodontal health. The aim of the study, therefore, was to compare regular smokers and regular snuff users with reference to periodontal bone loss. Methods:25 smokers, 25 former smokers, 25 current snuffers, 21 former snuffers and 82 controls (non-smokers and non-users) in the age range 26-54 years, all apparently healthy men, were included. The periodontal bone height was evaluated from bitewing radiographs measuring the distance from the cement-enamel junction (CEJ) to the periodontal bone crest (PBC) at premolars and molars.Results:The mean (95% CI) CEJ-PBC distance was 1.72 (1.53-1.91) mm in current smokers, 1.62 (1.42-1.81) mm in former smokers, 1.08 (0.88-1.27) mm in current snuff users, 1.02 (0.81-1.23) mm in former snuff users, and 1.16 (1.05-1.27) mm in controls. Controlling for age, the differences between CS and controls (p < 0,001), between FS and controls (p < 0.001) were statistically significant, but not the differences between CU and FU, respectively, and controls (p > 0.05). Further, the differences between CS and CU (p < 0.001) or FU (p < 0.01) as well as between FS and CU (p < 0.001) or FU (p < 0.001) were statistically significant. The relative risk for periodontal bone loss in excess of 1. 45 mm (25th percentile) was 6.7-fold (95% CI 2.1-21.2, p = 0.001) elevated in current smokers and 2.7-fold (0.9-8.2, p = 0.067) in former smokers. Snuff use was not associated with increased risk for periodontal bone loss (p > 0.05). The relative risk of smokers was 10.5 greater than that of snuff users (3.2-34.2, p = 0.000). Conclusion: These observations in apparently healthy men suggest that use of moist snuff in contrast to smoking is not associated with elevated risk for periodontal bone loss.