title: Tobacco smoking and radiographic periapical status: a retrospective case-control study.
abstract: BACKGROUND
  The aim of this study was to investigate radiographically the relationship of tobacco smoking and periapical status by using a retrospective case-control study design.
  
  
  METHODS
  The records of 79 controls and 79 age- and sex-matched cases were examined. Case was defined as a patient who has at least 1 radiographically detectable periapical lesion in a tooth. Control was defined as a patient who has no radiographically detectable periapical lesion in any teeth. Periapical status was assessed by using panoramic radiographs and the periapical index score. The history of smoking and diabetes, the number of teeth and root-filled teeth, and the quality of root fillings were recorded. Statistical analyses were conducted by using the Cohen kappa test, χ(2) test, Student's t test, and logistic regression analysis.
  
  
  RESULTS
  Among the case subjects, 75% had antecedents of smoking, whereas in the control group only 13% had been smokers (odds ratio, 20.4; 95% confidence interval, 8.8-46.9; P = .0000). After multivariate logistic regression analysis adjusting for covariates (age, gender, number of teeth, root-filled teeth, root-filled teeth with a root filling technically unsatisfactory, and diabetes), a strong association was observed between the presence of at least 1 radiographically detectable periapical lesion and antecedents of smoking (odds ratio, 32.4; 95% confidence interval, 11.7-89.8; P = .0000).
  
  
  CONCLUSIONS
  After adjusting for age, gender, number of teeth, endodontic status, quality of root filling, and diabetic status, tobacco smoking is strongly associated with the presence of radiographically diagnosed periapical lesions.
authors.affiliation: Department of Odontostomatology, School of Dentistry, University of Barcelona, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: López-López
authors.forename: Enric
authors.initials: E
authors.lastname: Jané-Salas
authors.forename: Jenifer
authors.initials: J
authors.lastname: Martín-González
authors.forename: Lizett
authors.initials: L
authors.lastname: Castellanos-Cosano
authors.forename: José María
authors.initials: JM
authors.lastname: Llamas-Carreras
authors.forename: Eugenio
authors.initials: E
authors.lastname: Velasco-Ortega
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Segura-Egea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010483:Periapical Diseases / Q000000981:diagnostic imaging*; D010486:Periapical Tissue / Q000000981:diagnostic imaging; D019252:Radiography, Dental, Digital / Q000379:methods; D011862:Radiography, Panoramic / Q000379:methods; D012189:Retrospective Studies; D012390:Root Canal Therapy / Q000592:standards; D012907:Smoking / Q000009:adverse effects; D019553:Tooth, Nonvital / Q000145:classification; D055815:Young Adult