Differences in the Associations Between Tobacco Use and Poor Oral Health Based on Specific Type of Tobacco Use, Texas 2012

BACKGROUND: The study’s purpose is to inform tobacco prevention and cessation activities in Texas by describing the associations and poor oral health status. 

METHODS: Data came from the 2012 Texas Behavioral Risk Factor Surveillance System. Two binary variables characterized oral health issues: removal of six or more permanent teeth due to tooth decay or gum disease (yes/no) and last visit with dental health professional ≥ 5 years ago (yes/no). Eight variables characterized tobacco use: current cigarette smoking, former cigarette smoking, never cigarette smoking, chewing tobacco, snuff, or snus use, E-cigarette use, other tobacco use (cigar, pipes,  bidis, kreteks, other), at least one type of tobacco use, and two or more types of tobacco use. Respiratory illness (current asthma, COPD, emphysema, and/or chronic bronchitis), cancer (any type), cardiovascular disease, major depression, and diabetes were determined by self-reported doctor diagnosis. Logistic regression models were used to provide measures of associations (odds ratios) with associated 95% confidence intervals. Models were adjusted for age, sex, race/ethnicity, education level, household income, obesity status, marital status, heavy drinking status, the presence of at least one major chronic condition, and the co-presence of the other oral health condition. Sex and age were treated as potential effect modifiers. All analyses were conducted in Stata v 11.0.  

RESULTS: Respondents reporting delayed dental services and major tooth removal were more likely to report a major chronic condition, fair to poor general health, and lower socioeconomic status. They were also more likely to report current tobacco use, particularly current cigarette smoking and the use of E-cigarettes. There were significant unadjusted associations between current cigarette smoking (2.58 (2.11-3.16)) and E-cigarette use (1.93 (1.22-3.03)) and delayed dental services. These associations were attenuated with adjustment and only current cigarette smoking remained associated with delayed dental services after full adjustment (1.53 (1.07-2.18)). Current cigarette smoking (3.12 (2.29-4.27)), former cigarette smoking (2.03 (1.56-2.63)), and E-cigarette use (2.35 (1.40-3.94)) were strongly associated with major tooth removal in fully adjusted models. Chewing tobacco, snuff, or snus and other tobacco use were not associated with either oral health condition. No significant effect modification by sex or age was found. 

CONCLUSIONS: Delayed dental care and tooth removal have strong associations with current cigarette smoking and the use of E-cigarettes among Texas residents. Additional research is needed to determine the temporality of this association given the cross-sectional survey design. E-cigarettes especially may warrant additional attention for prevention and cessation activities.