Tobacco products use in any form ends up with adverse oral outcomes, including bleeding gums: JAMA

The nationally representative cohort study found that combustible tobacco use is linked with the incidence of various adverse oral health outcomes. The findings underscore the importance of longitudinal studies and stress the continued importance of counselling on tobacco cessation in clinical practice.

About 3.5 billion people globally are affected by diseases of the teeth and supporting structures. These conditions can lead to pain, tooth and bone loss, reduced quality of life, and costly treatments when not treated. Tobacco use is tied to oral disease, and the evidence for a causal relationship between smoking cigarettes and periodontal disease is adequate. Findings are similar for pipes, hookah, and cigars. However, most studies on periodontal disease and hookah smoking have been cross-sectional and conducted in only a few countries, limiting generalizability.

There has been an evolution of tobacco-use patterns among current adult smokers, particularly about increasing trends in nondaily cigarette smoking and lesser cigarettes smoked per day. Yet, cigarettes remain the most frequently used product among adults, followed by ENDS. The modifications in use patterns warrant a re-evaluation of the associations between the use of combustible and smokeless tobacco and the prevalence of adverse oral health outcomes using recent data. Also, there needs to be more literature on the oral health effects of ENDS use.

Against the above background, Marushka L. Silveira, National Institutes of Health, Bethesda, Maryland, and colleagues aimed to investigate associations between tobacco product use and the incidence of adverse oral health outcomes.

For this purpose, the researchers used evidence from wave (W) 1 to W5 (2013-2019) of the Population Assessment of Tobacco and Health Study. The W1 cohort included participants aged 18 years and above without a lifespan history of oral health results at W1 or W3, determined by when the effect was first assessed.

The exposures included current (someday or everyday use) established (lifetime use of at least hundred cigarettes or "fairly regular" of other products), use of ENDS, cigarettes, pipes, cigars, snus, smokeless tobacco, and hookah excluding snus at W1 to W4.

The authors recorded the past 12-month diagnosis of gum disease and precancerous oral lesions (W2-W5), loss of bone around teeth, loose teeth, one or more teeth removed, and bleeding after brushing or flossing.

The study led to the following findings:

• Sample sizes varied across the six oral health outcomes (14 993 respondents for the precancerous oral lesions sample, 15 686 respondents for the loose teeth sample, 16 312 participants for the bone loss around teeth sample, 13 149 participants for the gum disease sample, 10 286 respondents for the bleeding after flossing or brushing sample, and 12 061 respondents for the one or more teeth removed sample). More than half of the adults (52%-54% across the six samples) were women.
• The authors developed Cox proportional hazards models with covariates that comprised time-dependent tobacco use variables adjusted mutually for each other.
• There was a positive association between cigarette smoking and the prevalence of the diagnosis of gum disease (adjusted hazard ratio [AHR], 1.33), loose teeth (AHR, 1.35), and one or more teeth removed (AHR, 1.43).
• Cigar smoking was positively associated with the incidence of oral precancerous lesions (AHR, 2.18).
• Hookah smoking was positively associated with gum disease diagnosis (AHR, 1.78), and ENDS use was positively related to bleeding after brushing or flossing (AHR, 1.27).
• The authors did not observe any associations between snus and smokeless tobacco, excluding snus and the incidence of oral health outcomes.

"Our findings confirmed associations of the use of current combustible tobacco with the occurrence of adverse oral health outcomes and also revealed an association between current use of ENDS and the incidence of bleeding after flossing or brushing," the authors wrote.

"In addition to informing tobacco regulatory actions of the FDA, the results emphasize the continued importance of tobacco cessation and resources in clinical practice."

Reference:

Silveira ML, Everard CD, Sharma E, et al. Tobacco Use and Incidence of Adverse Oral Health Outcomes Among US Adults in the Population Assessment of Tobacco and Health Study. JAMA Netw Open. 2022;5(12):e2245909. doi:10.1001/jamanetworkopen.2022.45909