Prevalence of Periapical Pathosis in Smokers vs. Nonsmokers: A Cross-Sectional Study

Abstract

Introduction: Tobacco smoking presents a health hazard that negatively affects oral health. The possible link between tobacco smoking and periapical pathosis has been a subject of long debate. However, recent systematic reviews and meta-analyses have indicated that tobacco smokers had an increased prevalence of pulpal and periapical disease. The purpose of this study was to assess the prevalence of periapical pathosis in smokers versus nonsmokers and to examine the differences between males and females and between African American and Caucasian patient populations.Method: Integrated data of hospital patients were used. Data included the corresponding diagnosis code for periapical abscess (PA). History of smoking, including current and past smoking, was retrieved by searching the appropriate query in the database. The relative risk of smoking and its association with gender and race were calculated and analyzed statistically; p < 0.05 was considered statistically significant.Results: Out of 953,741 patients examined, 6,283 were diagnosed with periapical abscesses. The relative risk for the presence of periapical abscesses in African Americans was 3.37 whereas the relative risk in Caucasians was 0.75. The difference was statistically significant for both African Americans and Caucasians (p < 0.0001). The relative risk for the presence of periapical abscesses in the smokers’ groups was 4.14. The relative risk was significantly higher in female smokers than in male smokers (p < 0.0001). The relative risk for the presence of periapical abscesses in African Americans who smoked was 7.13 compared to the relative risk of 2.36 in African Americans who didn’t smoke. The relative risk for the presence of periapical abscesses in Caucasians who smoked was 3.63 compared to the relative risk of 0.68 in Caucasians who didn’t smoke. The differences were statistically significant (p < 0.0001). The relative risk for the presence of periapical abscesses was higher in African Americans than in Caucasians in both smoking and nonsmoking groups.Conclusions: Under the conditions of this study, it appears that a strong correlation exists between tobacco smoking and the presence of periapical pathosis. Gender and race may play a role in the prevalence of such lesions.Practical implications: Smoking cessation and prevention protocols should be adopted and recommended to patients.