Associations among smoking status, including the use of cigarettes, electronic cigarettes, and heated cigarettes, periodontal condition, and tooth loss in employed Japanese adults: a cross-sectional study.

Background: Information on the effects of the use of electronic cigarettes and heated cigarettes on oral health status is sparse. In addition, few studies have reported the oral health behaviours of the users of such products. We examined the associations among smoking status (including the use of cigarettes and electronic/heated cigarettes), oral health behaviours, periodontal condition, and tooth loss in employed Japanese adults.

Methods: The participants were 512 employees of 20 business offices of 19 companies that are members of the Aichi Branch of the Japan Health Insurance Association. Between December 2019 and March 2020, we performed dental examinations and asked the participants to complete self-administered questionnaires. We obtained the results of specific health check-ups from the Japan Health Insurance Association. Periodontal status was evaluated using the Community Periodontal Index and the loss of attachment. Multivariable linear regression analysis and structural equation modelling were performed to examine the relationship between periodontal condition/tooth loss and other factors.

Results: In multivariable linear regression analysis, smokers had 1.38 fewer teeth on average compared to nonsmokers. Compared to nonsmokers, those who smoked cigarettes, electronic/heated cigarettes, or both had 15.4%, 17.9%, and 12.1% greater proportions of teeth with probing depth (PD) ≥ 4 mm and had 16.6%, 19.2%, and 9.99% greater proportions of teeth with attachment loss (AL) ≥ 4 mm, respectively. In structural equation modelling, cigarette smokers and participants who had no interest in oral health had fewer teeth. Cigarette smokers, electronic/heated cigarette smokers, and those who did not make an effort to care for their teeth still had more teeth with ≥ 4 mm PD and teeth with ≥ 4 mm AL.

Conclusion: The use of all cigarette types was significantly associated with poor oral health status. Smokers tended to pay less attention to their oral health, leading to poorer oral hygiene habits and worsening periodontal status. Providing smoking cessation support in workplaces and dental offices is important for maintaining the oral health of occupational adults. Because cross-sectional studies cannot clarify causality or the direction of the association between smoking and oral health status, further longitudinal studies are needed.