Environmental Tobacco Smoke and Periodontitis in United States Non-Smokers, 2009 to 2012

Background: Epidemiologic studies using half-mouth designs for assessment of periodontal disease prevalence have reported that environmental tobacco smoke (ETS) exposure of non-smokers is associated with a two-to three-fold increase in the odds of developing periodontitis. In response to the possibility of under-reporting of periodontitis, the Centers for Disease Control updated periodontal examination procedures in 2009 for the National Health and Nutritional Examination Survey (NHANES), including full-mouth, six-site periodontal probing, and attachment loss assessment. Aims of this study are to estimate prevalence of periodontitis among United States non-smoking adults exposed to ETS, report the values of the improved methods for estimating disease prevalence, and evaluate the predictive contribution of ETS exposure to periodontitis. Methods: A cross-sectional study was conducted using NHANES data from the 2009 to 2012 examination cycle. To address these aims, oral examination data were used to determine prevalence of periodontitis among United States non-smoking adults and to test the influence of ETS exposure on occurrence of periodontitis. Results: There was a 28% increase in the odds of periodontitis for those with any ETS exposure compared with those with no measurable exposure (Wald x(2) test statistic [ df] = 6.58 [ 1], P = 0.01; 95% confidence interval = 1.06 to 1.55). Conclusion: ETS exposure increases the risk of an individual developing periodontitis.