Is Trying to Quit Associated With Tooth Loss and Delayed Yearly Dental Visit Among Smokers? Results of the 2014 Behavioral Risk Factor Surveillance System

• Autores: Shatha S. AlHarthi, Sarah K. Al Motlag, Monika M. Wahi
• Localización: Journal of periodontology, ISSN 0022-3492, Vol. 88, Nº. 1, 2017, págs. 34-49
• Idioma: inglés
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• Resumen

  • Background: The rate of periodontitis in the US population has been estimated to be close to 50%. Patients with periodontitis, especially those who smoke, suffer from a high rate of tooth loss. The purpose of this analysis is to evaluate predictors of poor oral health and oral health habits among smokers and determine if trying to quit smoking is associated with better oral health or oral health habits in smokers in the United States.

    Methods: Data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) were used in the analysis. After limiting the dataset to smokers, the designated exposure was respondent’s report of trying to quit smoking (yes/no). Two logistic regression models were developed. One model identified factors associated with having a most recent dental visit longer than 1 year before the survey. The second model identified factors associated with loss of six or more teeth. Both models were controlled for confounding factors.

    Results: After controlling for confounding, among smokers in the 2014 BRFSS, trying to quit was associated with significantly lower odds of respondents having their most recent dental visit longer than a year before the survey (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.90 to 0.97) and was a significant risk factor for having lost six or more teeth (OR: 1.06; 95% CI: 1.02 to 1.10).

    Conclusions: Among smokers in the United States, trying to quit is associated with compliance with yearly dental visits and higher odds of lost teeth. Future research should investigate optimal approaches for providing smoking cessation services in the dental setting.

    Periodontitis is endemic in the United States population.1,2 National Health and Nutrition Examination Survey (NHANES) data have also been used to estimate rates of periodontitis in the United States, and prevalence in people aged 30 years and older has been reported to be near 50%,1 but this is perceived to be an underestimate.2 Challenges to surveillance for periodontitis have prompted the Centers for Disease Control and Prevention (CDC) to initiate in 2003 the CDC Periodontal Disease Surveillance Project in collaboration with the American Academy of Periodontology to enhance periodontal surveillance at federal, state, and local levels.3 Periodontitis causes tooth loss. In a 2012 prospective study of 600 adults being treated for periodontitis, 211 teeth were lost over the follow-up period of 11 to 14 years,4 and the main cause of tooth loss was periodontitis, which was significantly more prevalent in smokers.4 Therefore, as periodontitis is endemic in the US population, tooth loss is as well. In a study of Behavioral Risk Factor Surveillance System (BRFSS) data from 1995 to 1997, 26.7% of respondents aged ≥75 years reported being edentulous, and this rate was 22.9% in those aged 65 to 74 years.5 In an analysis of 2002 BRFSS data on those aged ≥65 years, state rates of edentulousness ranged from 13% to 42%.6 Smoking has been shown to accelerate tooth loss in patients with periodontitis.4,7 A 2011 analysis of BRFSS data showed smoking was associated with 1.5 to 2 times the risk of tooth loss.7 These findings were echoed in a prospective study of periodontal patients described earlier.4 However, it is only recently that studies have shown quitting smoking can reduce risk of tooth loss and other poor dental outcomes in periodontal disease.8-10 A 2014 systematic review of whether there is a positive effect of smoking cessation on periodontitis found that “smoking cessation seems to decrease the … progression of periodontitis, as well as to improve response to periodontal treatment.”9 The authors of this review remarked that evidence about effect of smoking cessation on periodontal outcomes in the literature is surprisingly scarce and encouraged researchers to pursue studying periodontal benefits associated with smoking cessation.9 The 2014 core BRFSS questions offer an opportunity to better understand the relationship between trying to quit smoking and periodontal health in smokers.11 Respondents were asked about: 1) frequency of dental visits; 2) number of teeth lost due to infection; 3) smoking habits; 4) their desire to quit smoking; and 5) other questions that measure important risk factors for periodontitis such as diabetes mellitus (DM).11 The objective of this analysis is to evaluate predictors of tooth loss and poor oral health habits in terms of missing dental visits among smokers in the United States and determine if trying to quit smoking is associated with lower odds of tooth loss or lower odds of respondent having had their most recent dental visit longer than a year before the survey among respondents in the United States.