Is the use of tobacco products, especially electronic nicotine delivery systems (ENDS), associated with the incidence of oral health outcomes among US adults?

Abstract

Design: Cohort study.

Sample selection: Data were pooled from wave (W) 1 to W5 (2013-2019) of the Population Assessment of Tobacco and Health Study Restricted-Use Files. The W1 cohort respondents were interviewed at all five waves who were aged 18 years and older without a lifetime history of each of the six oral health outcomes (gum disease, precancerous oral lesions, bone loss around teeth, bleeding after brushing or flossing, loose teeth, number of teeth removed because of tooth decay or gum disease).

Data analysis: Data analysis was performed from October 2021 to September 2022. To assess associations between current established tobacco use and incidence of adverse oral health outcomes at the next wave, adjusted hazard ratios (AHRs) and 95% CIs were calculated using Cox proportional hazards models.

Results: Cigarette smoking was positively associated with incidence of gum disease diagnosis (AHR, 1.33; 95% CI, 1.11-1.60), loose teeth (AHR, 1.35; 95% CI, 1.05-1.75), and one or more teeth removed (AHR, 1.43; 95% CI, 1.18-1.74). Smoking any cigars was positively associated with incidence of precancerous oral lesions (AHR, 2.18; 95% CI, 1.38-3.43). Hookah smoking was positively associated with incidence of gum disease diagnosis (AHR, 1.78; 95% CI, 1.20-2.63). Use of electronic nicotine delivery systems (ENDS) was positively associated with incidence of bleeding after brushing or flossing (AHR, 1.27; 95% CI, 1.04-1.54). Snus and smokeless tobacco (excluding snus) were not significantly associated with incidence of gum disease diagnosis or precancerous oral lesions.

Conclusions: This cohort study confirmed associations of current combustible tobacco use with incidence of adverse oral health outcomes. It also showed an association between current ENDS use and incidence of bleeding after brushing or flossing.