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Table 7 Snuff use and endpoints relevant to periodontal and gingival disease – evidence from Sweden

From: Systematic review of the relation between smokeless tobacco and non-neoplastic oral diseases in Europe and the United States

Study Endpoint Time of exposure Statistic Exposeda Unexposeda Nb Summary of statistical testsc
Wickholm 2004 [10] Plaque index Ever % ≥ 2.0 2.6 2.0 4 OR 1.29 (0.45–3.70)d
Montén 2006 [12] Plaque Current % 59.0 64.0 19 OR 0.75 (0.32–1.76)
Wickholm 2004 [10] Calculus index Ever % ≥ 2.0 5.9 3.8 9 OR 1.57 (0.76–3.23)d
Montén 2006 [12] Gingivitis Current % 47.0 50.0e 16 OR 0.94 (0.41–2.15)
Modeer 1980 [6] Gingival index Not known mean 1.10 0.89 - p < 0.001f
Rolandsson 2005 [20] Gingival index Current mean 12.4 13.1 - Difference not significant
Wickhol m 2004 [10] Gingival index Ever % ≥ 2.0 8.5 12.0 13 OR 0.68 (0.38–1.22)d
Rolandsson 2005 [20] Gingival bleeding Current % 10.0 20.0 4 OR 0.44 (0.12–1.62)
Bergström 2006 [11] Gingival bleeding Current - - -e - No significant difference
   Former - - -e - No significant difference
Frithiof 1983 [17] Gingival recession Current % 9.5 - 2 -
Andersson 1989 [18] Gingival recession Currentg % 17.8 - 44 Prevalence higher in loose snuff users (23.5%) than in portion-bag users (2.9%), p < 0.05
Wickholm 2004 [10] Gingival recession Ever % 64.7 59.9 99 OR 1.22 (0.87–1.73)d
Rolandsson 2005 [20] Gingival recession Current % 17.5 - - -
Montén 2006 [12] Gingival recession Current % 42.0 17.0 14 OR 3.72 (1.40–9.99)h
Wickholm 2004 [10] Pocket depth Ever %≥ 5 mm 10.5 9.5 16 OR 1.11 (0.64–1.92)d
Bergström 2006 [11] Pocket depth Current - - -e - No significant difference
   Former - - -e - No significant difference
Montén 2006 [12] Pocket depth Currentg mean 2.3 2.4 - No significant difference
Montén 2006 [12] Attachment loss Currentg mean 0.2 0.1 - No significant difference
Montén 2006 [12] Alveolar bone level Currentg mean 1.3 1.3 - No significant difference
Bergström 2006 [11] Bone Heightj Current mean 1.0 1.06e - No significant differencei
   Former mean 1.12 1.06e - No significant differencei
Wickholm 2004 [10] Periodontal diseasel Current - - - - OR 0.66 (0.30–1.32)k
   Former - - - - OR 2.55 (0.80–6.80)k
  1. a Exposure is always to snuff and is classified, where possible, as current or former. The corresponding unexposed group is never for ever, and non-current for current, except where indicated
  2. b Number of exposed subjects with endpoint (where available)
  3. c Tests are unadjusted for any potential confounding variable, except where stated. Where necessary ORs and 95% CIs are calculated from the data provided in the source paper
  4. d The source paper presented results separately for four groups: A = never used tobacco, B = smoked only, C = snuff only, D = smoked and snuff. The ORs given in Table 7 are based on combining ORs for nonsmokers (C vs A) and smokers (D vs B) using fixed-effects meta-analysis [87], and are thus adjusted for smoking. ORs (CIs) specifically for nonsmokers are plaque index 1.13 (0.14–9.11), calculus index 3.53 (0.93–13.45), gingival index 1.14 (0.39–3.33), gingival recessions 1.43 (0.80–2.55) and pocket depth 1.61 (0.54–4.80)
  5. e Unexposed is never snuff
  6. f Adjusted for plaque index
  7. g Snuff only, no smoking
  8. h The ORs and CIs are adjusted for plaque, gingivitis and toothbrushing
  9. i Adjusted for age
  10. j Distance from the cement-enamel junction to the periodontal bone crest
  11. k Adjusted for smoking and plaque index
  12. l Three or more teeth with pocket depth ≥ 5 mm