Association of Tobacco Exposure Patterns with Periodontal Health: A Cross-Sectional Analysis of NHANES Data

Introduction Periodontitis is an inflammatory disease and a leading cause of adult tooth loss. While the effects of traditional tobacco use on periodontal health are well documented, research on electronic cigarette (e-cigarette) use and secondhand smoke exposure is limited. This study evaluated whether active smoking, passive smoking, e-cigarette use, and combined exposures were associated with periodontitis severity using 2013-2014 National Health and Nutrition Examination Survey (NHANES) data. Materials and Methods A total of 3,618 adults were included. Periodontal staging followed the 2017 American Academy of Periodontology Classification. Associations between smoking status and periodontal staging were examined using multivariable ordinal logistic regression, adjusting for age, gender, diabetes status, socioeconomic status, race/ethnicity, and education level. Results Current tobacco-only smokers had 2.95 times higher odds of more severe periodontitis compared with never smokers ( P<0.001 ). Current e-cigarette-only users had 2.70 times higher odds ( P= 0.011), and dual users had 2.51 times higher odds ( P= 0.010) of more severe periodontitis. Past tobacco smokers had 1.27 times higher odds ( P= 0.003 ), and participants exposed to secondhand smoke had 1.54 times higher odds ( P= 0.028). Discussion All tobacco exposure groups, including e-cigarette-only users and dual users, were significantly associated with greater odds of periodontitis severity. The results emphasize the emerging concern of newer nicotine delivery products. Conclusion All tobacco exposure groups were significantly associated with increased odds of periodontitis severity, including e-cigarette-only users and dual users. Dental professionals should educate patients on the established oral health risks of tobacco use in all forms, including e-cigarettes and secondhand smoke exposure.