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Table 8 ST use and endpoints relevant to periodontal and gingival disease – evidence from the USA

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

Ernster 1990 [34]

Plaque

Snuff ever

%

25.8

29.7d

154

OR 0.82 (0.65–1.03)

Ernster 1990 [34]

Plaque

CT ever

%

30.2

29.7d

52

OR 1.02 (0.72–1.46)

Wolfe 1987 [30]

Calculus

ST current

%e

21.6

20.5f

-

"Virtually no difference"

Offenbacher 1985 [29]

Gingivitis

ST use

%

72.0

77.1

54

OR 0.76 (0.44–1.32)

Cummings 1989 [31]

Gingivitis

ST current

%

35.3

33.3

6

OR 1.09 (0.15–7.80)

  

ST former

%

50.0

33.3

1

OR 2.00 (0.08–51.6)

  

CT current

%

33.3

33.3d

3

OR 1.00 (0.11–8.95)

  

Snuff current

%

28.6

33.3d

4

OR 0.80 (0.10–6.25)

Robertson 1997 [38]

Severe gingivitis

ST current

%

-

-

-

"Prevalence equally distributed"

  

ST former

%

-

-

-

"Prevalence equally distributed"

Wolfe 1987 [30]

Gingival bleeding

ST current

%e

6.2

7.1f

-

"Virtually no difference"

Ernster 1990 [34]

Gingival bleeding

Snuff ever

%

5.9

8.8d

35

OR 0.64 (0.43–0.96)

Ernster 1990 [34]

Gingival bleeding

CT ever

%

9.9

8.8d

17

OR 1.13 (0.65–1.96)

Offenbacher 1985 [29]

Gingival recession

ST use

%

60.0

14.1

45

OR 9.15 (5.40–15.5)g

Wolfe 1987 [30]

Gingival recession

ST current

mean %e

0.4

0.6f

-

"Virtually no difference"

Creath 1988 [32]

Gingival recession

Snuff ever

%

0.3

0.0

1

No significant difference

Cummings 1989 [31]

Gingival recession

ST current

%

41.2

16.7

7

OR 3.50 (0.33–36.9)

  

ST former

%

50.0

16.7

1

OR 5.00 (0.15–167)

  

CT current

%

55.6

16.7d

5

OR 6.25 (0.50–77.5)

  

Snuff current

%

35.7

16.7d

4

OR 2.78 (0.25–30.9)

Ernster 1990 [34]

Gingival recession

Snuff ever

%

26.4

13.8d

158

OR 2.24 (1.73–2.90)h

Ernster 1990 [34]

Gingival recession

CT ever

%

11.0

13.8d

19

OR 0.77 (0.46–1.29)

Robertson 1997 [38]

Gingival recession

ST use

%

-

-

-

ST users had "significantly more recession"

Christen 1979 [46]

Gingival recession

ST current

%

50.0

-

7

-

Robertson 1997 [38]

Gingival recession increase

ST use

mean (mm)

0.36

No change

-

Not tested

Creath 1988 [32]

Rolled gingival margins

Snuff ever

%

3.1

3.4

9

OR 0.91 (0.42–1.99)

Ernster 1990 [34]

Pocket depth

ST use

% ≥ 4 mm

-

-d

-

No significant difference

Robertson 1997 [38]

Pocket depth

ST use

%

-

-

-

No significant difference

Wolfe 1987 [30]

Attachment loss

ST current

%e

3.9

3.3f

-

"Virtually no difference"

Ernster 1990 [34]

Attachment loss

Snuff ever

%

10.7

4.4d

64

OR 2.63 (1.75–3.93)h

Ernster 1990 [34]

Attachment loss

CT ever

%

4.7

4.4d

8

OR 1.07 (0.49–2.32)

Beck 1995 [24]

Attachment loss (new lesions)i

ST use

%

-

-

-

OR 2.99 (p = 0.001)j

Beck 1995 [24]

Attachment loss (lesion progression)k

ST use

mean

-

-

-

No associationl

Greer 1983 [27]

Periodontal degenerationm

ST use

%

25.6

-

30

-

Poulson 1984 [28]

Periodontal degenerationm

ST use

%

26.8

-

15

-

Sinusas 1992 [36]

Periodontal diseasen

ST use

%

19.3

21.2

17

OR 0.89 (0.42–1.87)

Fisher 2005 [43]

Periodontal diseaseo

ST current

%

9.8

4.3

29

OR 2.1 (1.2–3.7)p

Fisher 2005 [43]

Periodontal diseaseo

ST former

%

9.1

4.3

38

OR 1.5 (0.9–2.6)p

  1. a Where possible exposure is classified as "current" or "former" with exposure given as "use" only where the source paper did not clearly distinguish how former users were considered. The corresponding non-exposure is never or non-use to the same type of ST, 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 Unexposed is ST never
  5. e % of sites affected
  6. f Unexposed is ST non-current
  7. g The OR for gingival recession is 20.7 if gingivitis is present and 1.13 if it is not present
  8. h The authors also reported an increase in snuff users after adjustment for age, race, cigarette smoking, alcohol consumption and dental hygiene practice
  9. i During the whole year follow-up period
  10. j Adjusted for income, soft tissue reaction and history of pain
  11. k Increase in depth over a one year period
  12. l ST did not appear as an independent risk factor, following backward elimination, in a logistic regression model involving multiple sociodemographic, psychological, medical, environmental, behavioural and oral variables
  13. m Defined as gingival recession with apical migration of the gingival to or beyond the cementoenamel junction, with or without clinical evidence of inflammation
  14. n Gingival recession or gingival thickening and erythema
  15. o Severe active periodontal disease, defined as having at least one tooth with 6 mm or more attachment loss, and bleeding in the same tooth
  16. p Adjusted for smoking, age, diabetes, minority status, gender and visiting dentist in the past year. Similar estimates of 2.1 (1.0–4.4) for current ST and 1.5 (0.5–4.3) for former ST are given for never smokers, and of 2.1 (1.0–4.2) for current ST and 1.3 (0.7–2.7) for former ST are given for interproximal severe active periodontal disease
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BMC Oral Health

ISSN: 1472-6831

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