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Table 7 Snuff use and endpoints relevant to periodontal and gingival disease – evidence from Sweden

From: Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States

Study

Endpoint

Time of exposure

Statistic

Exposeda

Unexposeda

Nb

Summary of statistical testsc

Wickholm 2004 [10]

Plaque index

Ever

% ≥ 2.0

2.6

2.0

4

OR 1.29 (0.45–3.70)d

Montén 2006 [12]

Plaque

Current

%

59.0

64.0

19

OR 0.75 (0.32–1.76)

Wickholm 2004 [10]

Calculus index

Ever

% ≥ 2.0

5.9

3.8

9

OR 1.57 (0.76–3.23)d

Montén 2006 [12]

Gingivitis

Current

%

47.0

50.0e

16

OR 0.94 (0.41–2.15)

Modeer 1980 [6]

Gingival index

Not known

mean

1.10

0.89

-

p < 0.001f

Rolandsson 2005 [20]

Gingival index

Current

mean

12.4

13.1

-

Difference not significant

Wickhol m 2004 [10]

Gingival index

Ever

% ≥ 2.0

8.5

12.0

13

OR 0.68 (0.38–1.22)d

Rolandsson 2005 [20]

Gingival bleeding

Current

%

10.0

20.0

4

OR 0.44 (0.12–1.62)

Bergström 2006 [11]

Gingival bleeding

Current

-

-

-e

-

No significant difference

  

Former

-

-

-e

-

No significant difference

Frithiof 1983 [17]

Gingival recession

Current

%

9.5

-

2

-

Andersson 1989 [18]

Gingival recession

Currentg

%

17.8

-

44

Prevalence higher in loose snuff users (23.5%) than in portion-bag users (2.9%), p < 0.05

Wickholm 2004 [10]

Gingival recession

Ever

%

64.7

59.9

99

OR 1.22 (0.87–1.73)d

Rolandsson 2005 [20]

Gingival recession

Current

%

17.5

-

-

-

Montén 2006 [12]

Gingival recession

Current

%

42.0

17.0

14

OR 3.72 (1.40–9.99)h

Wickholm 2004 [10]

Pocket depth

Ever

%≥ 5 mm

10.5

9.5

16

OR 1.11 (0.64–1.92)d

Bergström 2006 [11]

Pocket depth

Current

-

-

-e

-

No significant difference

  

Former

-

-

-e

-

No significant difference

Montén 2006 [12]

Pocket depth

Currentg

mean

2.3

2.4

-

No significant difference

Montén 2006 [12]

Attachment loss

Currentg

mean

0.2

0.1

-

No significant difference

Montén 2006 [12]

Alveolar bone level

Currentg

mean

1.3

1.3

-

No significant difference

Bergström 2006 [11]

Bone Heightj

Current

mean

1.0

1.06e

-

No significant differencei

  

Former

mean

1.12

1.06e

-

No significant differencei

Wickholm 2004 [10]

Periodontal diseasel

Current

-

-

-

-

OR 0.66 (0.30–1.32)k

  

Former

-

-

-

-

OR 2.55 (0.80–6.80)k

  1. a Exposure is always to snuff and is classified, where possible, as current or former. The corresponding unexposed group is never for ever, and non-current for current, except where indicated
  2. b Number of exposed subjects with endpoint (where available)
  3. c Tests are unadjusted for any potential confounding variable, except where stated. Where necessary ORs and 95% CIs are calculated from the data provided in the source paper
  4. d The source paper presented results separately for four groups: A = never used tobacco, B = smoked only, C = snuff only, D = smoked and snuff. The ORs given in Table 7 are based on combining ORs for nonsmokers (C vs A) and smokers (D vs B) using fixed-effects meta-analysis [87], and are thus adjusted for smoking. ORs (CIs) specifically for nonsmokers are plaque index 1.13 (0.14–9.11), calculus index 3.53 (0.93–13.45), gingival index 1.14 (0.39–3.33), gingival recessions 1.43 (0.80–2.55) and pocket depth 1.61 (0.54–4.80)
  5. e Unexposed is never snuff
  6. f Adjusted for plaque index
  7. g Snuff only, no smoking
  8. h The ORs and CIs are adjusted for plaque, gingivitis and toothbrushing
  9. i Adjusted for age
  10. j Distance from the cement-enamel junction to the periodontal bone crest
  11. k Adjusted for smoking and plaque index
  12. l Three or more teeth with pocket depth ≥ 5 mm
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BMC Oral Health

ISSN: 1472-6831

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