Prevalence of use of tobacco and cannabis products among UCSF dental patients with Periodontal Disease: cross sectional assessment
Background: The aims of this study are to assess the prevalence of tobacco and cannabis use among adult patients visiting the UCSF Dental Center between January of 2019 and June of 2020, and to compare the periodontal diagnoses between tobacco/cannabis use groups, while accounting for demographic confounding factors, such as age, gender, race, ethnicity, and insurance.
Methods: Data were derived from UCSF Dental Center student, resident, and faculty clinics. The extracted data fit the inclusion criteria, which included individuals age ≥18 that had dental examinations completed between January 2019 to June 2020. Data analysis was performed to ascertain the relationship between use of tobacco (past and present) and/or cannabis products and periodontitis as defined by AAP/CDC definitions. Covariates included age, gender, and insurance status. Univariable and multivariable logistic regression analyses were carried out to evaluate the relationship between exposure (tobacco/cannabis use) and outcome (periodontitis).
Results: Within the patient population of UCSF Dental Center, that met the inclusion criteria, 6.2% of patients were current tobacco users, 12.0% were former tobaccos users, 6.5% were cannabis users, and 2.3% were both tobacco and cannabis users. Modelling with multiple logistic regression revealed that current and former cigarette users had 1.7x and 1.4x, respectively, the odds as never smokers of having periodontitis (adjusted OR = 1.7; 95% CI 1.4-2.2 and adjusted OR = 1.4; 95% CI 1.2-1.7, respectively). Cannabis users had 1.3x the odds of having periodontitis (adjusted OR = 1.3; 95% CI 1.0-1.5). The odds of having periodontal disease while using both cannabis and tobacco product were statistically significant (adjusted OR = 1.7; 95% CI 1.2-2.4). In addition to looking at the association between tobacco and/or cannabis product use and periodontal disease that included moderate disease, a logistic regression analysis was completed to assess whether there was an association between tobacco products, cannabis products, and tobacco and cannabis products and specifically severe periodontal disease. Compared to tobacco and cannabis non-use, current and former cigarette use was associated with 2.2x and 1.5x, respectively, the odds of a severe form of periodontal disease (adjusted OR = 2.2; 95% CI 1.9-2.7 and adjusted OR = 1.5; 95% CI 1.3-1.7, respectively). Cannabis use did not have a statistically significant association with severe periodontal disease (adjusted OR = 1.1; 95% CI 0.9-1.4). Using both cannabis and tobacco products was associated with approximately twice the odds of severe periodontal disease (adjusted OR = 2.4; 95% CI 1.7-3.2). Finally, an ordered logistic regression analysis was conducted. This analysis revealed that odds of being in a more severe category of periodontal disease increases with use of tobacco or cannabis products. After adjusting for covariates, current and former cigarette users had 2x greater odds of being in a more severe category of periodontal disease than never smokers (adjusted OR = 2.1; 95% CI 1.8-2.4 and adjusted OR = 1.5; 95% CI 1.3-1.7, respectively). Cannabis users had 1.2x greater odds than never smokers of being a more severe category of periodontal disease (adjusted OR = 1.2; 95% CI 1.1-1.4) Using both cannabis and tobacco products was also statistically significantly associated with higher odds of being at a greater severity level of periodontal disease (adjusted OR = 2.1; 95% CI 1.6-2.7).
Conclusion: In this sample of dental patients in a Northern California academic practice tobacco use, with and without cannabis use, was associated with periodontitis and severe periodontitis. In addition, the results of this study showed that cannabis use alone was associated with periodontitis, but not severe periodontal disease. With the recent legalization of medical and recreational cannabis use, there will likely be an increase in prevalence of cannabis use throughout the United States. It is important for health care clinicians to understand its potentials risks. Determining whether an association exists between cannabis and periodontal disease should be a priority for periodontal epidemiological studies. Dental and medical practitioners should take steps to raise awareness of the possibility of regular tobacco and cannabis use as potential risk factors for periodontal disease.