Tobacco Smoking and Radiographic Periapical Status: A Retrospective Case-Control Study

doi:10.1016/j.joen.2012.02.011

Journal of Endodontics

Volume 38, Issue 5, May 2012, Pages 584-588

https://doi.org/10.1016/j.joen.2012.02.011 Get rights and content

Abstract

Introduction

The aim of this study was to investigate radiographically the relationship of tobacco smoking and periapical status by using a retrospective case-control study design.

Methods

The records of 79 controls and 79 age- and sex-matched cases were examined. Case was defined as a patient who has at least 1 radiographically detectable periapical lesion in a tooth. Control was defined as a patient who has no radiographically detectable periapical lesion in any teeth. Periapical status was assessed by using panoramic radiographs and the periapical index score. The history of smoking and diabetes, the number of teeth and root-filled teeth, and the quality of root fillings were recorded. Statistical analyses were conducted by using the Cohen kappa test, χ² test, Student's t test, and logistic regression analysis.

Results

Among the case subjects, 75% had antecedents of smoking, whereas in the control group only 13% had been smokers (odds ratio, 20.4; 95% confidence interval, 8.8–46.9; P = .0000). After multivariate logistic regression analysis adjusting for covariates (age, gender, number of teeth, root-filled teeth, root-filled teeth with a root filling technically unsatisfactory, and diabetes), a strong association was observed between the presence of at least 1 radiographically detectable periapical lesion and antecedents of smoking (odds ratio, 32.4; 95% confidence interval, 11.7–89.8; P = .0000).

Conclusions

After adjusting for age, gender, number of teeth, endodontic status, quality of root filling, and diabetic status, tobacco smoking is strongly associated with the presence of radiographically diagnosed periapical lesions.

Section snippets

Subjects

The protocol was approved by the Ethic Committee of the Dental Faculty of Barcelona, Spain, and each subject signed a consent form after being advised of the nature of the study.

Participants were recruited among new patients presenting consecutively seeking routine dental care (not emergency care) at the Dental Clinic of the University of Barcelona Spain. Subjects who met the inclusion/exclusion criteria of this study were asked to voluntarily participate. Inclusion criteria were as follows:

Results

Table 1 shows the distribution of the study factors in both control and case groups. There was no significant difference in age, gender, or number of teeth between control and case groups. The average number of teeth per subject was 23.4 ± 6.0 and 23.0 ± 5.7 in the controls and cases, respectively (P > .05). Root-filled teeth were found more frequently in the case group. The average number of root-filled teeth per subject was 2.1 ± 2.1 in cases and 1.4 ± 1.6 in controls (P < .05). One or more

Discussion

The aim of this study was to investigate the possible association between smoking and the radiographic periapical status by using a case-control study design. Results reveal a statistically significant association between tobacco smoking and the presence of radiographically diagnosed periapical lesions.

Because control subjects were age- and sex-matched with the case patients, there were not significant differences between control and case subjects in age or in gender. Moreover, the average

Acknowledgments

The authors deny any conflicts of interest related to this study.

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Prevalence of periapical lesions in smokers compared to non-smokers has been previously investigated. Some studies found increased prevalence among smokers (Correia-Sousaa et al., 2015; Kirkevang and Wenzel, 2003; Lopez-Lopez et al., 2012; Bukmir et al., 2016; Segura-Egea et al., 2011; Segura-Egea et al., 2008), while others found no significant association between smoking and apical periodontitis (Bahammam, 2012; Bergström et al., 2004; Rodriguez et al., 2013). However, all the aforementioned studies examined the periapical status using periapical or panoramic radiographs, which are both two-dimensional radiographs.
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Clinical ResearchTobacco Smoking and Radiographic Periapical Status: A Retrospective Case-Control Study

Abstract

Introduction

Methods

Results

Conclusions

Section snippets

Subjects

Results

Discussion

Acknowledgments

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Clinical Research
Tobacco Smoking and Radiographic Periapical Status: A Retrospective Case-Control Study