title: Comparison of clinical periodontal status among habitual smokeless-tobacco users and cigarette smokers.
abstract: OBJECTIVE
  Investigating the comparative effect of cigarette smoking and smokeless-tobacco use on periodontal health.
  
  
  BACKGROUND
  There is a dearth of studies comparing the effects of smoking and smokeless tobacco on periodontal health. Smokeless tobacco is emerging as a major public health hazard, but is often neglected as a risk factor by many clinicians.
  
  
  METHODS
  A cross-sectional study of 286 subjects was conducted. The participants were divided into mutually exclusive groups (i.e. any subject who had the habit of both smoking as well as smokeless tobacco usage was excluded from the study), as follows: a smoking group (SG; n=121); a smokeless-tobacco group (ST; n=81); and a non-tobacco-consuming group (NT; n=84). Data were obtained using a questionnaire and by clinical examination. The Periodontal Disease Index (PDI) and Oral Hygiene Index-Simplified (OHI-S) were used to clinically evaluate the periodontal and dental health status of the subjects. Multivariate analysis was performed to identify statistical correlations.
  
  
  RESULTS
  The Plaque Index was higher in the ST group than in the SG group and was statistically significantly higher in the ST group than in the NT group. Probing depth and gingival inflammation (components of the PDI) were also higher in the ST group than in the SG and NT groups, but this was not statistically significant.
  
  
  CONCLUSIONS
  Within the limits of the study, and for this study population, the impact on the periodontium as a result of smokeless tobacco use appeared to be comparable with that of smoking tobacco. The results of this study affirm the need to consider smokeless tobacco as a possible contributory factor to periodontal disease, in addition to smoking, and to counsel patients accordingly. Further randomised clinical trials are necessary to validate the long-term impact of smokeless tobacco on periodontal disease.
authors.affiliation: Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Varun
authors.initials: V
authors.lastname: Kulkarni
authors.affiliation: Department of Periodontics, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: Juhi Raju
authors.initials: JR
authors.lastname: Uttamani
authors.affiliation: Clarus Dental Specialities, Pune, India.|University of Texas Health Science Center, Houston, TX, USA.
authors.forename: Neel B
authors.initials: NB
authors.lastname: Bhatavadekar
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009910:Oral Hygiene; D010510:Periodontal Diseases / Q000453:epidemiology / Q000209:etiology*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D011795:Surveys and Questionnaires; D014030:Tobacco, Smokeless / Q000009:adverse effects*
keywords: Smokeless tobacco; oral hygiene status; periodontal disease; rural; smoking