Periodontal disease in a group of Swedish adult snuff and cigarette users

The aim of this study was to compare the prevalence of periodontal disease in different groups of tobacco users. Participants (n = 1674) were selected from an initial random sample of residents in the Stockholm region. Socio-demographic characteristics and life-time history of tobacco use were registered in a self-completed questionnaire, followed by a clinical examination. Cumulative life-time tobacco use was analyzed in pack-years and can-years as the exposure of interest. Among participants, 50.8% were females and 49.2% were males. Life-time tobacco use was categorized into four mutually exclusive categories. Approximately, two-thirds of snuff users had combined snuff use with cigarette smoking during their life. Tobacco users had a higher prevalence of periodontal disease compared to never users. Exclusive smokers and mixed users presented the less favorable situation. Unhealthy periodontal conditions increased with increasing exposure to smoking, most evidently at the level of 15 or more pack-years. There was a significant positive association between current or former smoking and periodontal disease (OR = 2.7, Cl = 1.7-4.3 and OR = 2.0, Cl = 1.2-3.3, respectively) even after adjustment for plaque level. An indication of association was also apparent with former snuff use. Plaque was independently associated with periodontal disease, with a dose gradient. Smoking is associated with periodontal disease independently of plaque. Combining cigarette smoking and snuff use during life does not convey a decreased probability of being diagnosed with periodontal disease compared to smoking exclusively.