title: Smokeless tobacco use and periodontal health in a rural male population.
abstract: BACKGROUND
  Despite the reported effects of smokeless tobacco (ST) on the periodontium and high prevalence of ST use in rural populations and in men, studies on this specific topic are limited. The purpose of this cross-sectional investigation is to evaluate the periodontal health status of male ST users from a rural population.
  
  
  METHODS
  Adult male residents of two rural Appalachian Ohio counties and daily ST users, with a unilateral mandibular oral ST keratosis lesion, were recruited. Subjects completed a questionnaire and received oral examination. Teeth present, ST keratosis lesion, plaque and gingival index, probing depth (PD), recession depth (RD), and attachment level were recorded. Statistical analysis compared ST-site mandibular teeth (teeth adjacent to the subject's unilateral ST keratosis lesion) to NST-site teeth (contralateral corresponding teeth).
  
  
  RESULTS
  This study includes 73 ST users. Recession prevalence is much greater in ST-site quadrants (36%) compared to NST-site quadrants (18%; P <0.001). Twice as many teeth had recession on ST-site (approximately 20%) than NST-site (approximately 10%; P = 0.0001). Average buccal RD on ST-site teeth did not differ from that on the NST-site teeth (P = 0.0875). Although average buccal attachment loss is greater on ST-site teeth (P = 0.016), the mean difference is <0.5 mm. When stratified by years of ST use, subjects using ST for 10 to 18 years exhibit the most differences between ST and NST sites, whereas subjects using ST for <10 years show no differences.
  
  
  CONCLUSIONS
  The results indicate that greater gingival recession prevalence and extent are associated with ST placement site in rural male ST users.
authors.affiliation: Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
authors.forename: Yong H
authors.initials: YH
authors.lastname: Chu
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Tatakis
authors.forename: Alvin G
authors.initials: AG
authors.lastname: Wee
mesh_terms: D000328:Adult; D001061:Appalachian Region; D003430:Cross-Sectional Studies; D003774:Dental Plaque Index; D005889:Gingival Recession / Q000209:etiology*; D006801:Humans; D007642:Keratosis / Q000209:etiology*; D008137:Longitudinal Studies; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology*; D017622:Periodontal Attachment Loss / Q000209:etiology*; D010512:Periodontal Index; D012424:Rural Population; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014030:Tobacco, Smokeless / Q000009:adverse effects*; D055815:Young Adult