title: Socio-economic position, smoking, and plaque: a pathway to severe chronic periodontitis.
abstract: OBJECTIVE
  To report periodontal status and elucidate the relationship among socio-economic position (SEP), plaque accumulation, tobacco smoking, and periodontitis in a representative sample of adult Jewish people, aged 35-44 years, living in Jerusalem.
  
  
  METHODS
  This cross-sectional study was conducted using a stratified sample of two hundred and fifty-four 35-44-year-old adults in Jerusalem (limited to the Jewish population). A clinical examination (Community Periodontal Index and Plaque Index) and a self-administered questionnaire were applied.
  
  
  RESULTS
  Two hundred and fifty-four adults, mean age 38.6 (SD=3.3) years, participated. The response rate was 88%; intra-examiner κ values were above 0.87. The average number of healthy sextants was 1.18, while the average number of sextants with bleeding, calculus, shallow periodontal pockets, and deep periodontal pockets was 1.3, 2.6, 0.7, and 0.1, respectively. Lower level of education was associated with severe chronic periodontitis (SCP, p=0.012) and also with smoking (p=0.030) and higher level of plaque (p<0.001). Smoking was associated with higher level of plaque (p<0.001), which in turn was associated with SCP (p=0.020).
  
  
  CONCLUSIONS
  This study presented a potential explanatory pathway for the relationship between SEP and SCP. Low level of education was proposed as a distal determinant, leading to tobacco smoking and higher levels of plaque, and finally to SCP.
authors.affiliation: Department of Community Dentistry, Hadassah School of Dental Medicine, Hebrew University, Jerusalem, Israel. aviz@hadassah.org.il
authors.forename: Avraham
authors.initials: A
authors.lastname: Zini
authors.forename: Harold D
authors.initials: HD
authors.lastname: Sgan-Cohen
authors.forename: Wagner
authors.initials: W
authors.lastname: Marcenes
mesh_terms: D000328:Adult; D055113:Chronic Periodontitis / Q000145:classification*; D003430:Cross-Sectional Studies; D003728:Dental Calculus / Q000145:classification; D003742:Dental Devices, Home Care; D003774:Dental Plaque Index; D004522:Educational Status; D004651:Employment; D005191:Family Characteristics; D005260:Female; D005884:Gingival Hemorrhage / Q000145:classification; D015438:Health Behavior; D006801:Humans; D007557:Israel; D007585:Jews; D008297:Male; D009911:Oral Hygiene Index; D010512:Periodontal Index; D010514:Periodontal Pocket / Q000145:classification; D012907:Smoking; D012923:Social Class; D014099:Toothbrushing