Individually and collectively, lifestyle factors such as smoking, excessive alcohol consumption and depression can significantly affect the risk of developing periodontitis, according to the study.
In people suffering from depression, smoking significantly increases the likelihood of developing periodontitis. In addition, according to the study, when smoking and excessive alcohol consumption are combined, the prevalence of periodontitis may increase significantly.
“There is an association between smoking, alcohol consumption, and depression in relation to the risk of developing periodontitis, and policies aimed at promoting healthy lifestyles and mental health may be beneficial for oral health,” write the authors, led by Yu.K. Huana from Shanghai Jiao Tong University School of Medicine in China.
The study analyzed data from 6,816 people who took part in the US National Health and Nutrition Examination Survey from 2009 to 2014. Participants underwent an oral health assessment, including a periodontal examination, and provided information on smoking, alcohol consumption, and general health through a questionnaire.
Periodontitis was identified by clinical loss of tooth attachment of 3 mm or more, while depression was assessed using the Patient Health Questionnaire (PHQ-9) with a score of 10 or higher. Alcohol consumption was categorized as light (one drink or less), moderate (one to three drinks), or heavy (four drinks or more) based on daily consumption over the past year. Smoking was defined as smoking at least 100 cigarettes in one's lifetime.
Of the participants, about half were current or former smokers, about 15% were light drinkers, about 70% were moderate drinkers, and 15% were heavy alcoholics. Of the general population, the prevalence of periodontitis was about 39% and depression was about 8%.
According to the study results, logistic regression, along with interaction models, was used to assess how smoking, alcohol consumption, and depression individually and together affect the risk of developing periodontitis.
The findings showed a significant association between smoking and depression, indicating that their combined exposure increases the risk of developing periodontitis, especially among men. Among people with depression, smoking significantly increased the odds of developing periodontitis in young adults by 1.29 times compared with nonsmokers (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.10–4.76).
In addition, a dose-dependent relationship was identified between the frequency of alcohol consumption and smoking, and the incidence of gum disease. Among those who smoked, occasional drinking (OR 1.70; 95% CI 1.22 to 2.37) and regular drinking (OR 2.28; 95% CI 1.68 to 3.11) were significantly increased the prevalence of periodontitis.
However, the study had limitations. The study was cross-sectional, so it may not establish cause and effect or the sequence of events between long-term factors such as periodontitis and smoking and short-term factors such as alcohol use and depression.
“Thus, there is a significant multiplicative relationship between smoking and depression, as well as smoking and alcohol consumption, and promoting healthy lifestyles and mental well-being may play a critical role in the prevention of periodontitis,” concluded Huang et al.