Periodontal attachment loss attributable to cigarette smoking in an urban Brazilian population

Aims: The present study estimated the percentages of cases with severe periodontal attachment loss (PAL) attributable to cigarette smoking in a representative adult urban population in southern Brazil.

Methods: A representative sample comprising 853 dentate individuals (age: 30–103 years) was selected by a multistage, probability sampling method. A full-mouth clinical examination of six sites per tooth was performed and an interview using a structured written questionnaire was undertaken. Cases were defined as individuals with 30% teeth with PAL 5 mm. A multivariate logistic regression analysis for complex surveys was performed, and adjusted for age, gender, race, socioeconomic status and dental calculus.

Results: The prevalence of cases in this population was 49.7%, or 739,000 subjects. Overall, 50.9% of this adult population, or approximately 757,000 subjects have had a lifetime exposure to cigarette smoking. Multivariate analysis showed that heavy and moderate smokers had a significantly higher risk for PAL 5 mm than non-smokers (odds ratio=3.6, 2.0, respectively) after adjusting for the above covariates. We estimated that the number of moderate and heavy smokers with 30% teeth with PAL 5 mm might be reduced by approximately 28% and 48%, respectively, had they not smoked cigarettes. We project that a smoking cessation program could result in a reduction in the number of cases by up to 12% in this population, or approximately 90,000 potential cases.

Conclusion: Cigarette smoking was strongly associated with severe attachment loss in this population. A significant percentage of cases may have been prevented if smoking cessation interventions had been implemented. The results support the implementation of population-based smoking cessation programs to reduce the prevalence of severe attachment loss in populations with high level of smoking exposure.