Table 6.24Cross-sectional and cohort studies on the association between smoking and dental caries

StudyPopulationDesignResults
Ludwick and Massler 19522,577 male navy enlistees
Aged 17–21 years
United States
Cross-sectionalMean DMFS* by mean number of cigarettes/day
Cigarettes/dayDMFTDMFS
09.520.4
59.120.5
109.821.7
159.7521.2
≥2010.223.0
A statistically significant difference was reported in DMFT and DMFS means between those smoking ≤5 cigarettes/day and those smoking ≥15 cigarettes/day
Ainamo 1971167 army recruits
Aged 18–26 years
Finland
Cross-sectionalMean DS and DMFS by cigarettes/day
Cigarettes/dayDSDMFS
013.836.4
1–920.751.7
10–2019.941.5
>2023.358.5
F-testp <0.05p <0.01
Modéer et al. 1980232 schoolchildren
Aged 13–14 years
Sweden
Cross-sectionalThe number of cigarettes/day was a significant correlate of the number of decayed tooth surfaces (β = 0.311; p <0.01) and filled tooth surfaces (β = 0.309; p <0.05) in this stepwise multiple linear regression(R2§ = 0.22)
Zitterbart et al. 199095 male dental patients
Aged 18–52 years(34 current smokers and 61 never smokers)
United States(Illinois)
Cross-sectionalMean DS and DMFS by smoking status
DSDMFS
 Current smokers3.924.6
 Never smoked2.419.4
In analysis of variance modeling, smokingwas significantly associated with the numberof untreated decayed tooth surfaces and thenumber of missing surfaces; dose-response relationships were seen between daily cigarette use and both MSΔ and DMFS; it is unclear if missing tooth surfaces were limited to those lost due to dental caries
Hirsch et al. 19911,122 male and 1,023 female dental patients
Aged 14–19 years
Sweden
Cross-sectionalMean DMFT by smoking status (but not adjusted for age)
 Smokers9.0
 Nonsmokers7.0
The text suggests that smoking was significantly associated with DMFT across age groups, but data were not presented
Källestål 1991Population-based sample283 persons aged 16 years and 287 persons aged 18 years
Sweden
Cross-sectionalAmong persons aged 18 years, smokers had more DFS than nonsmokers (p <0.05), but data were not presented
Locker 1992Population-based sample 907 persons
Aged ≥50 years
Canada (Ontario)
Cross-sectionalMean DS, FS**, and RDS†† by smoking status
DSFSRDS
 Current smokers1.218.71.2
 Former smokers0.822.10.6
 Never smoked0.725.60.6
Jette et al. 1993Population-based sample of community-dwelling persons
Aged 70–96 years
United States(New England)
Cross-sectionalCurrent smokers were significantly more likely than never smokers to have current coronal or root surface decay; prevalence of current decay was not specified
Ravald et al. 199327 periodontal patients
Aged 47–79 years
Sweden
Cohort, 12-year follow-upCompared with nonsmokers, smokers experienced higher median (8 vs. 1) and mean(14 vs. 7) numbers of new RDS following periodontal treatments
Thomas et al. 1994Population-based sample300 persons
Aged ≥60 years
India
Cross-sectionalMean decayed or missing teeth, by smoking status
 Smokers16.8
 Nonsmokers13.0
Hart et al. 1995Convenience sample 200 dental patients
Aged 14–88 years
United States(Tennessee)
Cross-sectionalNo significant difference in mean DMFT between smokers (23.9) and nonsmokers(21.2); not age-adjusted; unclear if missing teeth included only those missing due to dental caries
Locker 1996Population-based sample493 persons (of 699 in the baseline survey)
Aged ≥50 years at baseline
Canada (Ontario)
Cohort, 3-year follow-upMean RDFS‡‡ and RDS†† increments by smoking status
RDFSRDS
 Current or former smokers0.750.36
 Never smoked0.470.24
Persons (%) experiencing RDFS or RDS increments (≥1) by smoking status (RDS differences were not statistically significant)
RDFSRDS
 Current or former smokers31.619.0
 Never smoked24.012.7
Smoking was not a significant predictor of RDFS or RDS increments in this multiple logistic model
Drake et al. 1997Noninstitutionalized population-based sample234 blacks, 218 whites
Aged ≥65 years
United States(North Carolina)
Cohort, 3-year follow-upBlacks who smoked cigarettes or cigars were more likely than black nonsmokers to experience new DFS (odds ratio = 2.5[95% confidence interval, 1.1–5.3]) in this stepwise logistic regression model; smoking was not significant among whites
Axelsson et al. 1998Population-based sample
Aged 35 years (n = 155)
Aged 50 years (n = 510)
Aged 65 years (n = 310)
Aged 75 years (n = 310)
Sweden
Cross-sectionalMean DMFS* by age and smoking status
 Aged 35 years
  Current smokers48.9
  Never smoked38.1
 Aged 50 years
  Current smokers84.4
  Never smoked76.7
 Aged 65 years
  Current smokers98.8 (not significant)
  Never smoked93.0
 Aged 75 years
  Current smokers114.6
  Never smoked100.2
Largest difference at ages 50, 65, and 75 years was in the number of MSΔ; at 35 years, smokers had a higher mean DFS than never smokers (39.3 vs. 31.2); MS were not limited to those missing teeth due to caries
Tomar and Winn 1999Population-based sample6,945 dentate men
Aged ≥18 years
United States
Cross-sectionalMean DFT§§, DFS, and RDFS‡‡ by smoking status, adjusted for age, race, and ethnicity
DFTDFSRDFS
 Current smokers6.316.02.3
 Never smoked7.017.41.1
DFT and DFS differences were not statistically significant; current smokers were not significantly more likely than men who had never used tobacco to have ≥1 RDFS in multiple logistic regression models
*

DMFS = Decayed, missing (due to caries), or filled coronal permanent tooth surfaces.

DMFT = Decayed, missing (due to caries), or filled permanent teeth.

DS = Decayed coronal permanent tooth surfaces.

§

R2 = Prediction values.

Δ

MS = Missing tooth surfaces.

DFS = Decayed or filled coronal permanent tooth surfaces.

**

FS = Filled coronal permanent tooth surfaces.

††

RDS = Decayed root surfaces.

‡‡

RDFS = Decayed or filled root surfaces.

§§

DFT = Decayed or filled permanent teeth.

DMFS = Decayed, missing (due to caries), or filled coronal permanent tooth surfaces.

DMFT = Decayed, missing (due to caries), or filled permanent teeth.

DS = Decayed coronal permanent tooth surfaces.

R2 = Prediction values.

MS = Missing tooth surfaces.

DFS = Decayed or filled coronal permanent tooth surfaces.

FS = Filled coronal permanent tooth surfaces.

RDS = Decayed root surfaces.

RDFS = Decayed or filled root surfaces.

DFT = Decayed or filled permanent teeth.

From: 6, Other Effects

Cover of The Health Consequences of Smoking
The Health Consequences of Smoking: A Report of the Surgeon General.
Office of the Surgeon General (US); Office on Smoking and Health (US).

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