北京某社区35岁以上居民吸烟与牙周健康状况关系的调查

doi:10.19723/j.issn.1671-167X.2019.06.029

摘要/Abstract

摘要：

目的在北京某社区人群中调查吸烟对牙周健康状况的影响。方法牙周组织健康状况通过自觉症状和临床指标来评价。对北京某社区35岁以上人群进行问卷调查(一般情况、吸烟情况及刷牙出血等牙周自我评价),记录其探诊深度(probing depth,PD)、出血指数(bleeding index,BI)、临床附着丧失(attachment loss,AL)、菌斑指数及缺牙数,最终974名个体纳入统计分析。按吸烟与否分组,对牙周自我评价及临床指标进行分析。结果吸烟者主述刷牙出血与非吸烟者相比显著减少,而自觉牙齿松动则显著增多(P<0.05);吸烟者与非吸烟者自觉牙龈肿胀与口腔异味情况差异无统计学意义。Logistic回归分析调整混杂因素后得到吸烟者中有刷牙出血的为非吸烟者的0.565倍,自觉牙齿松动为非吸烟者的1.572倍,PD均值大于3 mm,AL均值大于3 mm及缺牙数大于8颗的风险分别为非吸烟者的2.129倍、1.698倍和1.933倍(P<0.05)。结论北京该社区人群中,吸烟者与非吸烟者相比虽然自觉刷牙出血更少,但BI均值差异无统计学意义,吸烟者自觉牙齿松动更多,临床检查中吸烟者比非吸烟者牙周组织破坏更加严重

关键词: 吸烟, 牙周指数, 诊断性自我评价, 牙周疾病, 社区人群

Abstract:

Objective: To survey the cigarette smoking status and periodontal status, and to study the correlation between cigarette smoking and periodontal status.Methods: Questionnaires were distributed (including self-assessed periodontal status, such as bleeding while brushing teeth, oral odor, tooth loosen-ing, gum swelling, etc.) and clinical periodontal examinations performed for parameters including probing depth (PD), bleeding index (BI), attachment loss (AL), plaque index (PLI) and amount of teeth loss, which was recorded in the population above 35 years of a community in Beijing. A total of 974 subjects were recruited in the study. The population was divided into current smokers and non-smokers, and the differences of self-assessed periodontal status and periodontal parameters between the groups analyzed.Results: The smokers had significantly less bleeding during toothbrushing, and in the meantime, had significantly more self-reported tooth loosening compared with the non-smokers. The smokers brushed their teeth less than the non-smokers (P<0.05). The self-reported gum swelling and oral odor had no significant difference between the smokers and non-smokers. The smokers had 0.565 times and 1.572 times the risk of bleeding during toothbrushing, self-reported tooth loosening and from Logistic regression analyses, respectively (P<0.05). The mean PD, AL, PLI and the amount of tooth loss of the smokers were significant higher than the non-smokers (P<0.05). However, the mean BI of the smokers was slightly less than the non-smokers’ (1.93±0.540 vs. 1.94±0.512, P=0.707). The smokers had 2.129 times, 1.698 times and 1.933 times the risk of the mean PD>3 mm, the mean AL>3 mm, and the amount of tooth loss above 8, respectively compared with the non-smokers (P<0.05) from Logistic regression analyses.Conclusion: The self-assessed periodontal status is different between smokers and non-smokers in the population of a community in Beijing. Smokers have less bleeding during toothbrushing but no significant difference with BI. Smokers also have more self-reported tooth loosening. Compared with non-smokers, smokers have more severe periodontal destruction.

Key words: Smoking, Periodontal index, Diagnostic self evaluation, Periodontal diseases, Community population

中图分类号:

R781.4

杨一帆,栾庆先. 北京某社区35岁以上居民吸烟与牙周健康状况关系的调查[J]. 北京大学学报（医学版）, 2019, 51(6): 1144-1149.

Yi-fan YANG,Qing-xian LUAN. Correlation between cigarette smoking and periodontal status: A survey on the population of a community above 35-year-old in Beijing[J]. Journal of Peking University(Health Sciences), 2019, 51(6): 1144-1149.

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Variables	Smokers (n=207)	Non-smokers (n=785)	P
Demographic variables, systemic status
Age/years, median (min, max)	63 (36, 83)	65 (37, 85)	<0.001
Gender, n (%)			<0.001
Male	188 (91.3)	297 (38.7)
Female	18 (8.70)	471 (61.3)
Education, n (%)			0.229
Primary school	49 (23.8)	225 (29.4)
Middle school	123 (59.7)	410 (53.6)
College	34 (16.5)	130 (17.0)
Income per month, n (%)			0.054
≤1 000 yuan	56 (27.2)	220 (28.6)
>1 000 yuan, ≤2 000 yuan	124 (60.2)	487 (63.4)
>2 000 yuan, ≤4 000 yuan	25 (12.1)	51 (6.6)
>4 000 yuan	1 (0.50)	10 (1.3)
Diabetes mellitus, n (%)	58 (31.7)	260 (37.4)	0.156
Taking antibiotics in three months, n (%)	28 (13.6)	132 (17.2)	0.216
Self-assessment and behavior
Bleeding while brushing, n (%)	48 (24.6)	248 (33.4)	0.019
Teeth loosening, n (%)	126 (64.0)	406 (54.7)	0.020
Oral odor, n (%)	85 (43.1)	265 (35.8)	0.057
Gum swelling, n (%)	70 (35.5)	236 (31.8)	0.321
Frequency of toothbrushing, n (%)			<0.001
None	14 (7.1)	30 (4.1)
Once per day	104 (52.8)	290 (39.2)
Twice per day	77 (39.1)	389 (52.6)
Three times per day	2 (1.0)	31 (4.2)
Clinical parameters
PD/mm, median (min, max)	2.92 (1.48, 6.19)	2.54 (1.08, 11.50)	<0.001
AL/mm, median (min, max)	2.79 (0.29, 13.00)	2.44 (0.04, 11.00)	<0.001
BI, $x ? ± s$	1.93±0.54	1.94±0.51	0.707
PLI, median (min, max)	1.71 (0.70, 3.58)	1.67 (0.50, 3.38)	0.085
Amount of tooth loss, median (min, max)	5 (0, 28)	4 (0, 28)	0.111

Covariates	Bleeding while brushing	Teeth loosening	Frequency of toothbrushing>1
Smoke	0.565 (0.361, 0.886)^*	1.527 (1.019, 2.289)^*	0.743 (0.496, 1.113)
Age	0.937 (0.917, 0.956)^△	1.019 (1.000, 1.038)	0.987 (0.968, 1.006)
Gender	0.986 (0.694, 1.400)	0.804 (0.580, 1.115)	2.270 (1.614, 3.192)^△
Education (reference: college)
Primary school	1.047 (0.618, 1.774)	1.232 (0.763, 1.988)	0.276 (0.167, 0.455)^△
Middle school	0.982 (0.639, 1.511)	1.247 (0.837, 1.857)	0.791 (0.524, 1.196)
Income per month(reference: >4 000 yuan)
≤1 000 yuan	0.975 (0.237, 4.003)	2.392 (0.567, 10.082)	0.830 (0.193, 3.575)
>1 000 yuan, ≤2 000 yuan	0.838 (0.209, 3.359)	2.074 (0.503, 8.558)	1.064 (0.252, 4.489)
>2 000 yuan, ≤4 000 yuan	0.765 (0.174, 3.368)	1.399 (0.313, 6.263)	1.052 (0.229, 4.825)
Diabetes mellitus	1.478 (1.076, 2.028)^*	1.076 (0.799, 1.448)	1.080 (0.795, 1.468)
Taking antibiotics in 3 months	1.001 (0.669, 1.498)	1.597 (1.088, 2.345)^*	1.198 (0.814, 1.764)

Covariates	PD>3 mm
Smoke	2.129 (1.415, 3.203)^△	1.698 (1.035, 2.784)^*	1.157 (0.791, 1.693)	1.933 (1.234, 3.028)^#
Age	1.004 (0.983, 1.025)	1.075 (1.050, 1.100)^△	1.001 (0.983, 1.019)	1.135 (1.105, 1.166)^△
Gender	0.631 (0.439, 0.908)^*	1.074 (0.736, 1.568)	1.212 (0.884, 1.661)	0.861 (0.596, 1.243)
Education, ref (college)
Primary school	1.410 (0.823, 2.415)	1.200 (0.686, 2.097)	0.894 (0.564, 1.419)	2.014 (1.181, 3.436)^#
Middle school	1.339 (0.849, 2.111)	1.380 (0.875, 2.178)	1.229 (0.833, 1.811)	1.686 (1.028, 2.764)^*
Income per month, ref (>4 000 yuan)
≤1 000 yuan	P>0.999	1.028 (0.237, 4.461)	1.746 (0.417, 7.301)	1.505 (0.150, 15.146)
>1 000 yuan, ≤2 000 yuan	P>0.999	1.082 (0.257, 4.561)	1.688 (0.411, 6.929)	1.497 (0.151, 14.829)
>2 000 yuan, ≤4 000 yuan	P>0.999	1.221 (0.260, 5.735)	1.779 (0.401, 7898)	1.723 (0.159, 18.618)
Diabetes mellitus	1.575 (1.137, 2.180)^#	1.192 (0.836, 1.700)	1.162 (0.874, 1.544)	1.842 (1.321, 2.569)^△
Taking antibiotics in 3 months	0.666 (0.429, 1.034)	1.376 (0.899, 2.104)	0.877 (0.611, 1.259)	0.741 (0.473, 1.161)