Title	Tobacco Users Are Not More Susceptible To Dental Caries Than Non-Users
Clinical Question	Among healthy individuals, are tobacco users more susceptible to dental caries than non-users?
Clinical Bottom Line	Two randomized Controlled Trials (RCT) and one study of three cross-sectional studies indicate that tobacco users are not more susceptible to dental caries than non-users. Nagarajappa (2010) RCT study indicated 61.9% of users were affected by caries compared to 90.5% of non-users.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 22339319 Hugoson/2012 Smokers (345), smokeless tobacco users (104) and non-tobacco users (1142) Cross-sectional studies (3) Key results Three cross sectional studies were conducted in 1983, 1993 and 2003 in Jönköping, Sweden. 130 individuals were selected from each of the 20, 30, 40, 50, 60 and 70-year age groups. The subjects were examined clinically and radiographically. According to the mean Decayed Filled Surfaces (DFS) index, there was no significant difference between non-users and smokers in the 1983 and 1993 studies, but compared to snuff users, there was a significantly higher mean DFS. In 2003, there were no significant differences. These findings suggest that neither snuff use nor daily smoking increase the risk of dental caries. 20847998 Nagarajappa/2010 Smokeless tobacco users (42) and non-chewers (42) RCT Key results 42 smokeless tobacco chewers and 42 non-chewers (age 20-60 years) were evaluated for the prevalence of periodontal disease and dental caries using the Decayed Missing Filled Surface (DMFS) index, Community Periodontal Index (CPI), and Loss of Attachment (LA) index. 20 different types of oral microorganisms were collected and cultured from subgingival plaque and stimulated saliva samples. 61.9% of the chewing tobacco users were affected by caries (26 of 42) (mean DMFS = 3.5) compared to 90.5% of non-chewers (38 of 42) (mean DMFS = 5.5) (P<0.05). Lactobacillus species were significantly higher in non-chewers leading to a higher percentage of dental caries compared to chewers (P<0.05). 3920367 Offenbacher/1985 Smokers, smokeless tobacco users and non-tobacco users (565 Males) RCT Key results 565 males (mean age of 13.8 years) filled out a tobacco usage questionnaire and were examined intraorally. Pairwise chi square analysis was used to determine correlations. A 1.6-fold elevation in mean DMF was observed in smokeless tobacco users with gingivitis (P<0.01). However, an increase in caries was not seen in smokeless tobacco users that were free of gingivitis. This may indicate that the cause of caries in those with gingivitis was poor oral hygiene, which is also causing the gingivitis.
Evidence Search	("Tobacco Products"[Mesh]) AND ( "Dental Caries"[Mesh] OR "Dental Caries Susceptibility"[Mesh])
Comments on The Evidence	The Hugoson 2012 study performed three separate cross-sectional studies over three decades. Subjects were treated the same, greater than 80% completed the study and there was adequate follow-up. There were no competing interest, recall bias was unlikely and compliance was adequate. A double-blind study was not indicated and the groups were not similar at the start. In the Nagarajappa 2010 study, the groups were not similar at the start and the study does not specify if it was double-blind. Subjects were treated the same, greater than 80% completed the study and there was adequate follow-up as well. Recall bias was unlikely, there were no competing interests and compliance was adequate. The last study, Offenbacher 1985 was a RCT and the groups were similar at the start. This study also did not specify if it was double-blind. Greater than 80% completed the study and there was adequate follow-up. There was no competing interest, recall bias was unlikely and compliance was adequate. In overall, the result of the studies, demonstrated the multifactorial nature of dental caries. Many confounding factors are playing more active roles in caries development than tobacco in both tobacco users and non-users.
Applicability	These results are applicable in health education setting for all patients irrespective of the age. Although the studies show that users are not more susceptible to dental caries other studies have shown that they are more susceptible to periodontal disease and oral cancer.
Specialty	(Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Pediatric Dentistry) (Periodontics) (Dental Hygiene)
Keywords	Dental caries, Tobacco, Smoking
ID#	2369
Date of submission	02/26/2013
E-mail	Hannan@livemail.uthscsa.edu
Author	Matt Hannan
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Bennett T. Amaechi, BDS, MSc, PhD
Faculty mentor e-mail	amaechi@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available