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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 15  |  Page : 7-11

Dental caries, missing teeth, and oral health behavior among smokers


Department of Periodontics, University of Benin, Benin-City, Edo State, Nigeria

Date of Submission23-Apr-2019
Date of Acceptance27-Dec-2019
Date of Web Publication11-May-2020

Correspondence Address:
Dr. Clement Chinedu Azodo
Room 21, 2nd Floor, Department of Periodontics, Prof. Ejide Dental Complex, University of Benin Teaching Hospital, P.M.B. 1111 Ugbowo, Benin-City, Edo State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_22_19

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  Abstract 


Objective: To determine dental caries, missing teeth, and oral health behavior among smokers and to correlate same with nicotine dependence. Materials and Methods: The study was carried out among smokers and age-matched nonsmokers in Benin-City, Edo State Nigeria. Nicotine dependence, periodontal knowledge, subjectively rated periodontal status, and oral self-care were assessed with questionnaire while carious, missing, and filled teeth were recorded during oral examination. Results: The mean periodontal health knowledge was 1.65 for smokers and 2.75 for nonsmokers. The mean subjectively rated periodontal status was 4.25 for smokers and 3.40 for nonsmokers. The mean oral health behavior was 9.05 for smokers and 10.50 for nonsmokers. The mean carious teeth was 2.10 for smokers and was 1.00 for nonsmokers. Nicotine addiction was negative correlated with periodontal knowledge, oral behavior, carious teeth, filled teeth, and abrasion teeth but positively correlated with subjectively rated periodontal status and missing teeth. Conclusion: Smokers had lower periodontal knowledge, poorer subjectively rated periodontal health, poorer oral self-care behavior and more carious teeth than nonsmokers. Further studies to include smokers with high nicotine dependence are recommended.

Keywords: Carious teeth, missing teeth oral health behavior, nonsmokers, smokers


How to cite this article:
Azodo CC, Umoh AO. Dental caries, missing teeth, and oral health behavior among smokers. N Niger J Clin Res 2020;9:7-11

How to cite this URL:
Azodo CC, Umoh AO. Dental caries, missing teeth, and oral health behavior among smokers. N Niger J Clin Res [serial online] 2020 [cited 2020 Aug 9];9:7-11. Available from: http://www.mdcan-uath.org/text.asp?2020/9/15/7/284083




  Introduction Top


Tobacco is a global cause of morbidity and mortality in mankind by affecting almost all human tissues and organs. The oral consequences vary from oral and pharyngeal cancer, periodontal diseases, dental caries, teeth and soft tissue discoloration, mucosal conditions, and mouth odor. However, poor knowledge and level of awareness of adverse effect of tobacco on general and oral health have also been reported among dental patients.[1],[2] Although majority of undergraduate exhibited high awareness of the negative impact of smoking on general health, they were ignorant of the effect on oral health.[3] Singh et al.[4] reported an alarmingly low awareness of the effects of smoking on oral health among college students. However, it has been documented that tobacco users attach less importance and engage less in preventive health behaviors which may be related to lower perception of oral health problems than nonsmokers.[5] Studies documented low prevalence of tobacco use among dental patients in comparison with the overall prevalence in Nigeria.[1],[2] The poor preventive health behaviors among smokers worsens their morbidity. There is paucity of studies on dental health status and oral health behavior among smokers. The objective of this study was to examine the dental caries, missing teeth, and oral health behavior in Benin-City.


  Materials and Methods Top


This cross-sectional study was conducted among smokers in Benin-City between December, 2016 and February, 2017. The smokers aged 18–60 years were approached at varied locations in Benin-City and invited to University of Benin Teaching Hospital outpatient dental clinic for the research. Smokers who came to hospital and gave consent were included while those who had any known systemic conditions that could influence oral health and did not give informed consent were excluded from the study. Age- and sex-matched nonsmokers were recruited from the same population. Data collection was done through interviewer-administered questionnaire and clinical examination. The questionnaire elicited information on age and nicotine dependence, periodontal knowledge, subjectively rated periodontal status, oral self-care, and dental attendance.

Nicotine dependence of the smokers was assessed using Fagerstrom's test. The index used to determine periodontal health knowledge consisted of 4 items, namely “gum inflammation can disappear by itself,” “gum bleeding is a sign of a periodontal disease,” “When brushing one's teeth it is important to put little pressure on the toothbrush” and “The more often I brush my teeth on a day, the better it is for my teeth”. All items were scored with 1 = correct or 0 = incorrect, and a sum score was computed so that a total periodontal health knowledge score was formed for each participant ranging from 0 to 4. The higher the total score, the better the periodontal health knowledge.

The index used to determine subjectively rated periodontal health status consisted of 8 questions curled from Hiroshima University-Dental Behavioral Inventory, namely “my gums tend to bleed when I clean my teeth,” “I have noticed some white sticky deposits on my teeth,” “I am bothered by the colour of my gums,” “I clean each of my teeth carefully,” “I have never been taught professionally how to clean,” “I often check my teeth in a mirror after brushing,” “I worry about having bad breath,” and “I use hard toothbrush to clean my teeth” All items were scored with 1 = poor outcome or 0 = good outcome and a sum score was computed, so that a total subjectively rated periodontal health status score was formed for each participant ranging from 0 to 8. The higher the total score, the worse subjectively rated periodontal health status.

Oral self-care was assessed with index for oral hygiene behavior (OHB) formulated by Buunk-Werkhoven et al.[6] This index has eight items with respect to tooth brushing (frequency, time of brushing, measures of force, duration in minutes, method, and use of fluoride toothpaste), interdental cleaning (use of floss, tooth sticks, and interdental brushes), and tongue cleaning. The item scores were assigned weights, the item values were calculated and a sum score was computed with sum OHB score range from 0 to 16. A high sum score indicated a better oral self-care behaviour.

Clinical examination was done to determine the number of carious, missing, filled teeth and those with abrasion. Each tooth dental caries was scored as 1 and those without scored as 0, the same was applied to missing tooth, filled tooth, and abrasion. A high score indicated worse dental health status.

Informed consent was obtained from the participants. Participation was voluntary. Scaling and root planing were done for the participants after the questionnaire administration and clinical examination as incentive for participation. The obtained data were subjected to Chi-square or Fisher's exact statistics, independent t-test and Pearson correlation statistics using IBM SPSS Statistics for Windows, Version 21.0 (IBM Corp Armonk, NY, USA). The statistically significant association was set at P < 0.05.


  Results Top


All the participants – 40 (100.0%) were male with 65.0% of smokers and nonsmokers aged 21–40 years and 35.0% aged 41–60 years. Three-quarters (75.0%) of smokers reported gingival bleeding when cleaning teeth to compare with 80.0% nonsmokers. The majority (80.0%) of the smokers reported sticky deposit on their teeth as compared to nonsmokers (40.0%). One-quarter (25.0%) of smokers were bothered were bothered about their color of their gum as compared to two-fifths (40.0%) of the nonsmokers. About one-third (35.0%) of smokers reported cleaning each of their teeth carefully as compared with 40.0% of the nonsmokers. Three-tenth (30.0%) of the smokers have been taught professionally how to clean teeth as compared to 60.0% of nonsmokers. Nearly half (45.0%) of the smokers reported checking their teeth in a mirror after brushing as compared to 65.0% of the nonsmokers. Only (15.0%) of the smokers were worried about bad breath as compared to three-quarter (75.0%) of the nonsmokers [Table 1]. The majority (90.0%), of the smokers use hard toothbrush when cleaning teeth, as compared to the nonsmokers (30.0%). A lower proportion of smokers (30.0%) clean their teeth twice a day than nonsmokers (60.0%) clean their teeth twice a day. A lower proportion of smokers (25.0%) cleaned their teeth in the morning after breakfast. Four-tenth (40.0%) of the smokers cleaned their teeth with higher than recommended force in comparison with the nonsmokers (5.0%). A higher proportion (65.0%) of the smokers clean their teeth for more than 3 min as compared to the nonsmokers (45.0%) [Table 2].
Table 1: Self-assessment of oral hygiene status among the respondents

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Table 2: Teeth cleaning frequency, duration and periodicity among the respondents

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A total of 60.0% of the smokers performed up and down teeth brushing method as compared to 80.0% of nonsmokers 12. A higher proportion of smokers use chewing stick in addition to toothbrush in teeth cleaning. A higher proportion of smokers (95.0%) uses toothpaste with fluoride as compared to nonsmokers 18 (90.0%). A higher proportion of smokers 18 (90.0%) have never use interdental brushes more frequently as compared to nonsmokers 15 (75.0%). More smokers (65.0%) have never visited a dentist than nonsmokers (60.0%) [Table 3].
Table 3: Teeth cleaning technique, tongue and interdental cleaning, dental attendance among the respondents

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The mean periodontal health knowledge was 1.65 for smoker and 2.75 for nonsmokers. The mean subjectively rated periodontal status was 4.25 for smokers and 3.40 for nonsmokers. The mean oral health behavior was 9.05 for smokers and 10.50 for nonsmokers. The mean carious teeth was 2.10 for smokers and was 1.00 for nonsmokers [Table 4]. Nicotine addiction was negative correlated with periodontal knowledge, oral behavior, carious teeth, filled teeth, and abrasion teeth but positively correlated with subjectively rated periodontal status and missing teeth [Table 5].
Table 4: Mean subjectively rated periodontal status, oral health behavior and dental health status among the participants

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Table 5: Correlation between nicotine addiction, subjectively rated periodontal status, oral health behavior and dental health status

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  Discussion Top


This study with set objective to determine the oral health behavior among smokers found that the overall oral hygiene and periodontal awareness was worse among smokers compared with nonsmokers. More of the smokers reported hard toothbrush use in teeth cleaning combine it with chewing stick, spend more time brushing and used excessive force than the nonsmokers. This may be as a result of conscious effort to reduce the deposits and stains on the surface of the teeth from tobacco smoking. The higher hard toothbrush use may have resulted in more teeth abrasion among the smokers. This is of importance as smokers have been shown to have more tooth sensitivity than those that do not smoke.[7],[8]

The study revealed that the mean of the number of untreated carious teeth was higher among smokers than nonsmokers and this is in keeping with findings of the study conducted in India which showed that smokers were more likely to have caries.[9] The decrease in the pH and buffering power of saliva of smoker[10],[11] and alteration of the microbial flora[12] portend the etiological link between smoking and dental caries. The thorough cleaning by carefully cleaning teeth and checking the effectiveness of teeth cleaning in the mirror were lower among smokers because the majority of the smokers have never been taught professionally how to brush their teeth. The mean filled teeth was lower in smokers than nonsmokers which may be linked with lower dental attendance reported among the smokers in this study.

The smokers reported less gingival bleeding than nonsmokers which is in keeping with less bleeding in midst of sticky deposit due to the overriding vasoconstrictive effect of nicotine. The smokers also reported lower concern about the color of their gingiva and worried less about having bad breath even when their subjectively rated periodontal status was worse than that of the nonsmokers which are indicative of negative oral health attitude among the smokers.

The higher the nicotine addiction, the higher the missing teeth and poorer the subjectively rated periodontal status could be explained by the lower periodontal health knowledge, oral self-care behavior of the smokers with higher nicotine addiction. The higher the nicotine addiction, the lesser the abrasion teeth and filled teeth because of lower attempt at teeth cleaning and lower dental attendance respectively. Nicotine addiction was negative correlated with carious teeth despite the fact that increased nicotine resulted in more severe caries in an animalin vivo study.[13] However, previous study revealed no correlation between the degree of tobacco dependence and caries prevalence and severity in tobacco smokers.[9]


  Conclusion Top


Smokers had lower periodontal knowledge, poorer subjectively rated periodontal health, poorer oral self-care behavior, and more carious teeth than nonsmokers. Further studies to include smokers with high nicotine dependence are recommended.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Nwhator SO, Ayanbadejo P, Arowojolu MO, Akhionbare O, Oginni AO. Awareness of link between smoking and periodontal disease in Nigeria: A comparative study. Res Rep Trop Med 2010;1:45-51.  Back to cited text no. 1
    
2.
Ehizele AO, Azodo CC, Ojehanon PI, Akhionbare O, Umoh AO, Adeghe HA. Prevalence of tobacco use among dental patients and their knowledge of its health effects. Niger J Clin Pract 2012;15:270-5.  Back to cited text no. 2
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3.
Braimoh BO, Umanah AU. Cigarette smoking and awareness of oral health problems of tobacco use among students at the University of Port Harcourt, South-South Nigeria. World J Dent 2014;5:209-12.  Back to cited text no. 3
    
4.
Singh S, Dagrus K, Bkariya P, Bargale S, Shah S. Knowledge and attitude regarding ILL effects of smoking among college students. EJDTR 2015;4:259-65.  Back to cited text no. 4
    
5.
Shah AH, ElHaddad SA. Oral hygiene behavior, smoking, and perceived oral health problems among university students. J Int Soc Prev Community Dent 2015;5:327-33.  Back to cited text no. 5
    
6.
Buunk-Werkhoven YA, Dijkstra A, van der Schans CP. Determinants of oral hygiene behavior: A study based on the theory of planned behavior. Community Dent Oral Epidemiol 2011;39:250-9.  Back to cited text no. 6
    
7.
Vijaya V, Sanjay V, Varghese RK, Ravuri R, Agarwal A. Association of dentine hypersensitivity with different risk factors: A cross sectional study. J Int Oral Health 2013;5:88-92.  Back to cited text no. 7
    
8.
Mudrakola DP, Turagam N, Deepthi M, Yelamanchi RB, Jeevan MB. A cross sectional study on prevalence of dentine hypersensitivity among adults. Invest Clin 2017;58:235-242.  Back to cited text no. 8
    
9.
Sharma S, Mishra SK, Mittal N. Influence of tobacco dependence on caries development in young male adults: A cross-sectional study. J Conserv Dent 2018;21:597-601.  Back to cited text no. 9
[PUBMED]  [Full text]  
10.
Kanwar A, Sah K, Grover N, Chandra S, Singh RR. Long-term effect of tobacco on resting whole mouth salivary flow rate and pH: An institutional based comparative study. Eur J Gen Dent 2013;2:296-9.  Back to cited text no. 10
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11.
Khan GJ, Javed M, Ishaq M. Effect of smoking on salivary flow rate. Gomal J Med Sci 2010;8:221-4.  Back to cited text no. 11
    
12.
Al-Weheb AM. Smoking and its relation to caries experience and salivary lactobacilli count. J Coll Dent 2005;17:92-5.  Back to cited text no. 12
    
13.
Liu S, Wu T, Zhou X, Zhang B, Huo S, Yang Y, et al. Nicotine is a risk factor for dental caries: Anin vivo study. J Dent Sci 2018;13:30-6.  Back to cited text no. 13
    



 
 
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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