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TL;DR
A key limitation is the cross-sectional design, which cannot establish causation.
International Journal of Environmental Research and Public Health · 5 authors, 3 centres
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A key limitation is the cross-sectional design, which cannot establish causation.
Smoking is a major public health threat and is associated with various chronic diseases, including periodontal disease. This study aimed to investigate the relationship between smoking and periodontal disease risk in South Korean adults, with a focus on the impact of smoking cessation in five-year intervals. Methods: The study used data from the 2016-2018 Korea National Health and Nutrition Examination Survey (KNHANES), a nationwide cross-sectional survey. The final study population included 9,178 adults (4,161 males, 5,017 females) after excluding those under 19, unable to perform oral examination, or with missing data. The dependent variable was the Community Periodontal Index (CPI) score, and the independent variable was smoking status (non-smoker, ex-smoker, current smoker). Covariates included socioeconomic factors, health behaviors, and oral health habits. Multivariable logistic regression analysis was used to assess associations, with results presented as odds ratios (ORs) and 95% confidence intervals (CIs). Key Results: Current smokers had a significantly higher risk of periodontal disease than non-smokers (males: OR 1.78, 95% CI 1.43–2.23; females: OR 1.44, 95% CI 1.04–1.99). Age, lower education level, and lack of dental checkups were also associated with higher risk. Subgroup analysis showed that males with higher pack years had increased risk (over 20 pack years: OR 1.84, 95% CI 1.38–2.47). Ex-smokers who quit for less than five years had a lower risk than current smokers but higher than non-smokers (males: OR 1.42, 95% CI 1.04–1.96). Limitations: The cross-sectional design limits causal inference; data were self-reported, potentially introducing recall bias; and the study could not distinguish between types of smoking (e.g., conventional vs. e-cigarettes) or use biological indicators like urine cotinine. Implications: The findings support the association between smoking and periodontal disease and highlight the potential benefits of early smoking cessation, even for periods less than five years, which could motivate smokers to quit and improve public oral health.