title: Periodontal attachment loss attributable to cigarette smoking in an urban Brazilian population.
abstract: OBJECTIVE
  The present study estimated the percentages of cases with severe periodontal attachment loss (PAL) attributable to cigarette smoking in a representative adult urban population in southern Brazil.
  
  
  METHODS
  A representative sample comprising 853 dentate individuals (age: 30-103 years) was selected by a multistage, probability sampling method. A full-mouth clinical examination of six sites per tooth was performed and an interview using a structured written questionnaire was undertaken. Cases were defined as individuals with > or =30% teeth with PAL > or =5 mm. A multivariate logistic regression analysis for complex surveys was performed, and adjusted for age, gender, race, socioeconomic status and dental calculus.
  
  
  RESULTS
  The prevalence of cases in this population was 49.7%, or 739,000 subjects. Overall, 50.9% of this adult population, or approximately 757,000 subjects have had a lifetime exposure to cigarette smoking. Multivariate analysis showed that heavy and moderate smokers had a significantly higher risk for PAL > or =5 mm than non-smokers (odds ratio=3.6, 2.0, respectively) after adjusting for the above covariates. We estimated that the number of moderate and heavy smokers with > or =30% teeth with PAL > or =5 mm might be reduced by approximately 28% and 48%, respectively, had they not smoked cigarettes. We project that a smoking cessation program could result in a reduction in the number of cases by up to 12% in this population, or approximately 90,000 potential cases.
  
  
  CONCLUSIONS
  Cigarette smoking was strongly associated with severe attachment loss in this population. A significant percentage of cases may have been prevented if smoking cessation interventions had been implemented. The results support the implementation of population-based smoking cessation programs to reduce the prevalence of severe attachment loss in populations with high level of smoking exposure.
authors.affiliation: Department of Periodontology, Temple University School of Dentistry, Philadelphia, PA 19140, USA.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Susin
authors.forename: Rui V
authors.initials: RV
authors.lastname: Oppermann
authors.forename: Ola
authors.initials: O
authors.lastname: Haugejorden
authors.forename: Jasim M
authors.initials: JM
authors.lastname: Albandar
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D017622:Periodontal Attachment Loss / Q000453:epidemiology* / Q000209:etiology*; D015995:Prevalence; D018570:Risk Assessment; D017062:Small-Area Analysis; D012907:Smoking / Q000009:adverse effects*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014505:Urban Population