title: Cigarette Smoking, Tooth Loss, and Chronic Obstructive Pulmonary Disease: Findings From the Behavioral Risk Factor Surveillance System.
abstract: BACKGROUND
  Cigarette smoking and tooth loss are seldom considered concurrently as determinants of chronic obstructive pulmonary disease (COPD). This study examines the multiplicative effect of self-reported tooth loss and cigarette smoking on COPD among United States adults aged ≥18 years.
  
  
  METHODS
  Data were taken from the 2012 Behavioral Risk Factor Surveillance System (n = 439,637). Log-linear regression-estimated prevalence ratios (PRs) are reported for the interaction of combinations of tooth loss (0, 1 to 5, 6 to 31, or all) and cigarettes smoking status (never, former, or current) with COPD after adjusting for age, sex, race/ethnicity, marital status, educational attainment, employment, health insurance coverage, dental care utilization, and diabetes.
  
  
  RESULTS
  Overall, 45.7% respondents reported having ≥1 teeth removed from tooth decay or gum disease, 18.9% reported being current cigarette smokers, and 6.3% reported having COPD. Smoking and tooth loss from tooth decay or gum disease were associated with an increased likelihood of COPD. Compared with never smokers with no teeth removed, all combinations of smoking status categories and tooth loss had a higher likelihood of COPD, with adjusted PRs ranging from 1.5 (never smoker with 1 to 5 teeth removed) to 6.5 (current smoker with all teeth removed) (all P <0.05).
  
  
  CONCLUSIONS
  Tooth loss status significantly modifies the association between cigarette smoking and COPD. An increased understanding of causal mechanisms linking cigarette smoking, oral health, and COPD, particularly the role of tooth loss, infection, and subsequent inflammation, is essential to reduce the burden of COPD. Health providers should counsel their patients about cigarette smoking, preventive dental care, and COPD risk.
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Cunningham
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Paul I
authors.initials: PI
authors.lastname: Eke
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Earl S
authors.initials: ES
authors.lastname: Ford
authors.affiliation: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention.
authors.forename: Israel T
authors.initials: IT
authors.lastname: Agaku
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Anne G
authors.initials: AG
authors.lastname: Wheaton
authors.affiliation: Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
mesh_terms: D040343:Behavioral Risk Factor Surveillance System; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D016540:Smoking Cessation; D016388:Tooth Loss / Q000453:epidemiology; D014481:United States
keywords: Epidemiology; inflammation; oral health; pulmonary disease, chronic obstructive; tobacco; tooth loss