Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample
1
Department of Neuroscience, College of Graduate Studies, SUNY Upstate Medical University, Syracuse, NY 13210, USA
2
Department of Otolaryngology and Communication Sciences, SUNY Upstate Medical University, Syracuse, NY 13210, USA
3
Department of Public Health and Preventive Medicine, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
4
Department of Geriatrics, Norton College of Medicine, SUNY Upstate Medical University, Syracuse, NY 13210, USA
*
Author to whom correspondence should be addressed.
Sci 2025, 7(2), 55; https://doi.org/10.3390/sci7020055
Submission received: 19 February 2025
/
Revised: 5 April 2025
/
Accepted: 27 April 2025
/
Published: 6 May 2025
(This article belongs to the Special Issue Feature Papers—Multidisciplinary Sciences 2025)
Abstract
:The role of smoking in the development of periodontal disease has been well explored. However, this study aims to explore the relationship between intensity of smoking history and permanent tooth removal. We utilized the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative sample of 107,859 US adults, to explore this association. Smoking history intensity was a BRFSS-derived measure of pack-year smoking history. Permanent tooth removal was binarized as the presence or absence of a history of permanent tooth removal. A binary logistic regression was conducted to analyze this association after adjusting for a variety of sociodemographic, health, and substance-use covariates. There was a dose-dependent relationship in which increasing smoking history intensity was associated with increased odds for removal of one or more permanent teeth. For example, those who reported a pack-year history of 30 or more years had a 6.4 times significantly higher odds of reporting a history of permanent tooth removal when compared to those with a 0 pack-year history (adjusted odds ratio = 6.37, 95% CI = 3.80–10.69, p < 0.001). These findings can be used to promote smoking reduction or cessation as a means of decreasing risk of permanent tooth removal due to tooth decay or gum disease.
Keywords:
cigarette; dental health; dentistry; health behavior; oral health; smoking; substance use; tobacco; tooth removal; tooth decay1. Introduction
Cigarette smoking remains prevalent in the US, with the CDC estimating that, as of 2021, nearly 28.3 million Americans continue to smoke [1]. Cigarette smoking is a well-established risk factor for tooth loss, due to increased risk for periodontal disease and loss of tissue support [2,3,4,5]. Periodontal disease and resultant dental caries can progress to periapical abscesses, in which cases the associated tooth is often removed to prevent complications such as odontogenic sinusitis or deep neck space infections [6,7]. Tooth loss and periodontal disease, among other oral pathologies, like cancers of the mouth and lips, represent critical public health concerns [8]. According to the World Health Organization (WHO), untreated dental caries in permanent teeth is the most common health condition globally [9]. This is significant given that tooth loss may result in a myriad of complications, including but not limited to social isolation, impaired chewing and swallowing, and poor nutritional status [10,11]. Further, one prospective study identified a nearly 10% 5-year mortality rate amongst patients who underwent removal of all of their permanent teeth [12].
Despite the well-understood link between smoking and poor oral health, evidence is still scarce to prove the dose-dependent effects of smoking on the incidence of tooth loss because the sample population of most studies was limited to specific age groups, genders, and regions. More evidence is still needed to validate the dose-dependent effects between smoking and tooth loss using nationally representative samples of different countries. This is particularly important given the demonstrated role of smoking cessation in reducing the risk for permanent tooth loss [13,14]. Thus, the WHO continues to promote smoking cessation as one of the primary mechanisms to improve oral health globally [9].
The purpose of the present study was to examine the relationship between extent of smoking history with the history of tooth removal among adults in the United States.
2. Materials and Methods
2.1. Data Source
Data in this cross-sectional study were retrieved from the 2022 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative US sample of 107,859 non-institutionalized adults aged 18 years and older. Our sample included respondents who provided responses both on pack-year smoking history and history of permanent tooth removal.
2.2. Smoking History Intensity
The primary independent variable in this study was pack-year smoking history, which we label as the construct “smoking history intensity”. This variable was calculated by the BRFSS by multiplying self-reported packs smoked per day by the number of years smoked. Respondents were split into BRFSS-derived categories based on quartiles of the pack-year data: 0, 1–5, 6–13, 14–29, or ≥30.
2.3. Permanent Tooth Removal
The dependent variable for this study was the history of permanent tooth removal because of tooth decay or gum disease. Responses included “none”, “1 to 5”, “6 or more, but not all”, and “all”. For the purposes of our initial bivariate analysis and final regression model, we developed a binary variable, in which those who responded “1 to 5”, “6 or more, but not all”, and “all” were included as having a history of permanent tooth removal, whereas those who responded “none” were included as having no history of permanent tooth loss.
2.4. Covariates
In the regression model, we adjusted for multiple covariates which were selected based on their potential role in confounding the association between smoking and tooth loss. For each covariate, all responses were self-reported based on a list of provided options by the BRFSS interviewers. Respondents who refused to respond or answered “don’t know/not sure” were excluded from analysis. Sex was included as “male” or “female”. Race and ethnicity were self-reported and included “non-Hispanic White”, “non-Hispanic Black”, “Hispanic or Latino”, “Asian”, “Native Hawaiian or Other Pacific Islander”, “American Indian or Alaska Native”, “Mixed”, or “Other”. Those who identified as “Native Hawaiian or Other Pacific Islander”, “American Indian or Alaska Native”, “Mixed”, or “Other” were grouped in the analysis as other. Age was assessed through 14 discrete categories, starting with 18 to 24 years and ending with 80 years or older. To protect respondent identity, those who were 65 years or older were collapsed into one category. Options for self-reported general health included “excellent”, “very good”, “good”, “fair”, or “poor”. Income was assessed as annual household income from all sources and included options ranging from less than USD 10,000 to USD 200,000 or more. Health insurance status was assessed as the current, primary source of health insurance. Health insurance options included plan purchased through employer or union, private nongovernmental plan, Medicare, Medigap, Medicaid, Children’s Health Insurance Program, Military related healthcare, Indian Health Services, State-sponsored, other government program, or no coverage of any kind. Alcohol, marijuana, and e-cigarette use were assessed by self-reported consumption within the past 30 days. E-cigarette use was further categorized into never, former, current some-day used, and current everyday use. Options for time since last dental visit included within 1 year, between 1 and 2 years, between 2 and 5 years, greater than 5 years, or never.
2.5. Data Analysis
Our unadjusted bivariate analysis explored the relationship between pack-year history and any history of permanent tooth removal. To further explore this relationship, we conducted a second bivariate analysis stratified by the number of teeth lost. For the bivariate analyses, Pearson’s chi-square tests were utilized. Finally, in the multiple logistic regression model, we regressed the history of permanent tooth removal on smoking history intensity after adjusting for all sociodemographic, health, and substance-use variables that were available in the dataset and factors we identified as potential confounders based on our review of the literature. The average variance inflation factor (VIF) was about 1.6, indicating that there is no harmful multicollinearity. All statistical analyses were conducted using SPSS 28.0 with two-tailed tests at a 0.05 significance level.
3. Results
3.1. Sample Characteristics
Within our sample, 55,486 (51.4%) respondents denied having one or more permanent teeth removed due to tooth decay or gum disease (Table 1). Of the remaining respondents, 12.9% reported loss of 1-to-5 teeth; 21.7% reported loss of greater than 6, but not all teeth; and 13.9% reported loss of all teeth. Our sample comprised 27,372 respondents who had a history of 30 or more pack-years, while only 3422 respondents had a history of 0 pack-years. Male and female respondents were represented about equally, at 51.6% and 48.4%, respectively. The majority of our sample (79.6%) identified themselves as non-Hispanic White. Our sample included adults aged 18 years and older, with those older than 65 years comprising 37.3% of the group. Most of the respondents (33.9%) indicated that they were in good overall health, followed by those who indicated that they were in very good health (29.2%). The most common income level in our sample was USD 50,001 to USD 100,000, with 29.1% of the sample reporting this income level. The most common insurance type among our respondents was private (38.8%), followed by Medicare or Medigap (34.0%). Over 6% of our respondents reported having no insurance coverage. Nearly 80% of respondents denied using marijuana and nearly 60% denied ever having used an e-cigarette. Roughly half (45.2%) of respondents denied using alcohol within the past 30 days. Most respondents (56.0%) reported seeing a dentist within the last year, but 17.3% reported not having seen a dentist in greater than 5 years and 0.8% reported never seeing a dentist.
3.2. Bivariate Analysis
Our bivariate analysis revealed a significant association between pack-year history and history of permanent tooth removal (X2(4) = 11,269, p < 0.001) (Table 2). Among those who reported permanent tooth removal, 38.6% had a pack-year history of 30 or greater, whereas among those who denied permanent tooth removal, only 12.9% had a pack-year history of 30 or greater. We then identified a significant association between pack-year history and number of teeth lost (X2(12) = 18,084, p < 0.001) (Table 3). Respondents with pack-year histories of 30 or greater were the most represented among those who had lost >6 teeth but not all and those who had lost all teeth, at 37.9% and 50.7%, respectively.
3.3. Multiple Logistic Regression
We conducted a multiple logistic regression model to examine the association between smoking history intensity and history of permanent tooth removal. Our model was statistically significant (X2(34) = 1474, p < 0.001), with a good model fit of 74.6% of cases correctly classified. After adjusting for sociodemographic, health, and substance use covariates, respondents who had a 1-to-5 pack-year history were not significantly more likely to report a history of permanent tooth removal (Table 4). However, those with a pack-year history between 6 and 13 years were 2.77 times significantly more likely to report a history of permanent tooth loss when compared to their counterparts with 0 pack-year histories (adjusted odds ratio [aOR] = 2.77, 95% confidence interval [CI] 1.68, 4.57, p < 0.001). With each subsequent increase in pack-year history category, there was a significantly higher adjusted odds for permanent tooth removal. The adjusted odds ratio for permanent tooth removal increased to 4.55 and 6.37 for those with a history of 14 to 29 pack-years and history of 30 or more pack-years, respectively.
Many of the covariates in our regression model also indicated a significant association with tooth loss. Respondents aged 18 to 24 years had an 85.9% significantly lower odds of reporting a history of permanent tooth removal when compared to their counterparts aged 65 years or older (aOR = 0.141; 95% CI, 0.085; 0.234; p < 0.001). Compared to those who reported excellent general health status, those with fair general health had a 2.08 times higher odds of reporting history of permanent tooth removal and those with poor general health had a 1.63 times higher odds of reporting history of permanent tooth removal. Higher income was associated with significantly lower odds of permanent tooth removal. Compared to their counterparts who reported an income of less than USD 25,000, those who reported an income from USD 25,001 to USD 50,000 had 32.8% lower odds of reporting a history of permanent tooth removal (aOR = 0.672; 95% CI, 0.553; 0.816; p < 0.001). Those with no insurance coverage had 1.54-times higher odds of reporting a history of permanent tooth removal (aOR = 1.54; 95% CI, 1.18; 2.00; p < 0.001).
Those who reported marijuana use had 1.71-times higher odds of reporting a history of permanent tooth removal when compared to their counterparts who do not use marijuana (aOR = 1.71; 95% CI, 1.40; 2.07; p < 0.001). Those who reported alcohol use within the past 30 days had 1.20-times higher odds of reporting a history of permanent tooth removal when compared with those who denied using alcohol within the past 30 days (aOR = 1.20; 95% CI, 1.08; 1.34; p < 0.01). Respondents who had seen a dentist within 1 to 2 years had 1.36-times higher odds of reporting a history of permanent tooth removal when compared with those who had seen a dentist within 1 year (aOR = 1.36; 95% CI, 1.11; 1.67; p < 0.001).
4. Discussion
We identified a significant association between the extent of cigarette smoking history and self-reported permanent tooth removal. Self-reported number of teeth has been shown to be tightly correlated with number of teeth upon clinical examination [15]. As the number of pack-years increased, respondents were significantly more likely to report permanent tooth removal. Previous work has demonstrated associations between the number of cigarettes smoked per day and number of years smoked with number of teeth lost for any reason [3,5]. The association between smoking and tooth loss is maintained even among cohorts of younger adults [16]. Smoking is known to increase the risk for periodontal disease through vascular, immunologic, and infectious mechanisms [17,18]. Importantly, a systematic review with a meta-analysis demonstrated that former smokers were not at an increased risk of tooth loss compared to never smokers, indicating that smoking cessation can have a profound impact on oral health [13,14].
In our study, 13.9% of respondents reported complete tooth loss. This finding is similar to that presented in the 2024 Oral Health Surveillance Report that found that rates of edentulism to be 11.4% and 19.7% for those aged 65–74 and older than 75, respectively. In the aforementioned report, edentulism was associated with non-Hispanic Black race, poverty, and current smoking status [19]. Our analysis did not reveal disparities in permanent tooth removal by race. However, research shows that children of color are less likely to receive preventative dental care, including fluoride and sealants, when compared to their White counterparts, which may explain disparities in dental health observed later in life [20,21]. For example, non-Hispanic Black and Hispanic Black adults have been observed to have higher rates of untreated tooth decay when compared to their White and non-Hispanic Asian counterparts [21]. The literature has inconsistent findings for those who identify as Asian, with some studies demonstrating lower rates of tooth loss among Asian Americans, despite other literature that shows lower rates of sealant use and higher rates of untreated primary tooth decay among Asian children [21,22].
Our analysis demonstrated increased risk of permanent tooth loss as respondents aged. The literature has shown that even among young people aged 20 to 39, the rate of tooth loss was higher among those who smoked [16]. Work by the National Center for Health Statistics demonstrated 13% of adults aged 65 to 74 years were edentulous, and this percentage rose to 25.8% for those older than 75 years [21]. Our analysis found significant associations between self-reported health status and history of permanent tooth removal. Several studies have identified bidirectional links between oral health and a myriad of health conditions including cardiovascular disease, endocrinopathies, and even mortality [23,24,25].
In our study, the risk of permanent tooth removal significantly decreased as the level of income increased. Dental underserved areas typically overlap with those of low socioeconomic status, which, in part, explains the increase in periodontal disease and subsequent tooth removal among these respondents [26]. Further, respondents in our study who had insurance through Medicaid or government-sponsored programs, or who were uninsured, had increased risk of permanent tooth removal when compared to those with private insurance. Dental benefits as a component of Medicaid are allocated at the level of the state, with some states offering no-to-low coverage [27]. Thus, those who are uninsured or under-insured may struggle to access and utilize both preventative and interventional dental care. These disparities are further amplified in rural or otherwise underserved areas [26,28].
Marijuana use confers risk for periodontal disease through similar mechanisms to traditional cigarette smoking. Those who use marijuana may experience xerostomia, which can lead to dental caries, irritation and inflammation, leukoplakia, or candidiasis [29]. Our study identified marijuana use, via inhalation and other modes of consumption, such as ingesting orally, as a significant risk factor for removal of permanent teeth due to periodontal disease or tooth decay. Additional analysis on mode of consumption could further elucidate the various etiologies of oral disease in the setting of marijuana use. The literature presents both positive and negative associations between alcohol use and tooth loss. In our analysis, those who reported drinking alcohol in the past 30 days were more likely to report a history of permanent tooth removal. This variable, however, does not capture those who have a significant alcohol use history but do not currently drink. Some work has demonstrated a positive association between alcohol dependence and permanent tooth loss, despite finding no evidence that alcohol dependence contributed to severe periodontal disease [30]. Other work found that current alcohol users had significantly fewer missing teeth compared to their counterparts who did not use alcohol [3].
The literature shows that access to and utilization of dental care is a predictor of not only oral health but also of the development of cancers of the head and neck [31]. Concordant with the current literature, we have identified an increased risk for permanent tooth removal among those who had not seen a dental provider within 1 year. Logically, however, those who reported never seeing a dentist were significantly less likely to report a history of permanent tooth loss.
Data about dento-alveolar trauma were not available in the BRFSS dataset. However, traumatic dental injuries can lead to permanent tooth loss through several mechanisms, including pulp necrosis and inflammatory root resorption [32]. Further, when maxillomandibular fractures involve the tooth root or existing periodontal disease poses risk for abscess formation, tooth removal may be required [33]. In the cases of tooth root involvement, removal allows for the reduction and fixation required to restore occlusion.
There are a few key limitations to the present study. Foremost, the causal relationship between the extent of smoking history and the history of permanent tooth removal due to tooth decay or gum disease could not be explored due to the cross-sectional nature of the BRFSS data. Our primary dependent variable of history of removal of permanent teeth was limited to those who had teeth removed due to periodontal disease. It is unclear if those who had teeth removed for medical or surgical management of cancers of the head and neck were included in this group. Thus, the adjusted odds ratios presented here may be underrepresenting the true relationship between smoking history and the removal of permanent teeth.
The strength of this study is the analysis of a nationally representative sample spanning a wide age range with varying smoking intensity. In addition, the BRFSS data allow for analysis of some covariates (e.g., income and history of e-cigarette use) which are not typically included in electronic medical records.
There are a few key limitations to the present study. Foremost, the causal relationship between smoking history intensity and the history of tooth permanent tooth removal due to tooth decay or gum disease could not be explored due to the cross-sectional nature of the BRFSS data. Our primary dependent variable of history of removal of permanent teeth was limited to those who had teeth removed due to periodontal disease. It is unclear if those who had teeth removed for medical or surgical management of cancers of the head and neck were included in this group. Thus, the adjusted odds ratios presented here may be underrepresenting the true relationship between smoking history and the removal of permanent teeth. The strength of this study is the analysis of a nationally representative sample spanning a wide age range with varying smoking intensity. In addition, the BRFSS data allow for analysis of many covariates (e.g., income and history of e-cigarette use) which are not typically included in electronic medical records.
5. Conclusions
This study identified a significant association between intensity of cigarette smoking and permanent tooth removal among US adults. These findings have important implications, as they provide evidence for public health and healthcare professionals to promote smoking reduction or cessation as a means of decreasing risk of permanent tooth removal due to tooth decay or gum disease.
Author Contributions
Conceptualization, Y.W.; Methodology, Y.W., N.A.D. and R.W.; Software, Y.W., N.A.D. and R.W.; Formal Analysis, N.A.D. and R.W.; Writing—Original Draft Preparation, Y.W., N.A.D. and R.W.; Writing—Review and Editing, N.A.D. and R.W.; Supervision, R.W. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of SUNY Upstate Medical University (protocol code 2190522-1 on 5 October 2024) for studies involving humans.
Informed Consent Statement
Patient consent was waived due to using de-identified publicly available data.
Data Availability Statement
The data presented in this study are available through the US Centers for Disease Control and Prevention (CDC) in the public domain at https://www.cdc.gov/brfss/annual_data/annual_2022.html (accessed on 26 April 2024).
Conflicts of Interest
The authors declare no conflicts of interest.
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Table 1.
Sample characteristics.
| Frequency | Percent | |
|---|---|---|
| Removal of permanent teeth | ||
| None | 55,486 | 51.4 |
| 1 to 5 | 13,938 | 12.9 |
| 6 or more teeth, but not all | 23,427 | 21.7 |
| All | 15,008 | 13.9 |
| Pack-year smoking history | ||
| 0 | 3422 | 3.2 |
| 1–5 | 25,744 | 23.9 |
| 6–13 | 23,415 | 21.7 |
| 14–29 | 27,906 | 25.8 |
| ≥30 | 27,372 | 25.4 |
| Sex | ||
| Male | 55,702 | 51.6 |
| Female | 52,157 | 48.4 |
| Race and ethnicity | ||
| White, non-Hispanic | 85,835 | 79.6 |
| Hispanic | 7441 | 6.9 |
| Black, non-Hispanic | 6858 | 6.4 |
| Other | 5465 | 5.1 |
| Asian, non-Hispanic | 2260 | 2.1 |
| Age | ||
| 18 to 24 years | 2547 | 2.4 |
| 25 to 34 years | 10,045 | 9.3 |
| 35 to 44 years | 16,302 | 15.1 |
| 45 to 54 years | 16,708 | 15.5 |
| 55 to 64 years | 220,026 | 20.4 |
| ≥65 years | 40,231 | 37.3 |
| General health | ||
| Excellent | 12,525 | 11.7 |
| Very good | 31,460 | 29.2 |
| Good | 36,476 | 33.9 |
| Fair | 19,313 | 17.9 |
| Poor | 7827 | 7.3 |
| Income (in USD) | ||
| 0 to 25,000 | 19,826 | 21.5 |
| 25,001 USD 50,000 | 25,886 | 28.0 |
| 50,001 to 100,000 | 26,853 | 29.1 |
| >100,000 | 19,816 | 21.4 |
| Health insurance | ||
| Private | 40,633 | 38.8 |
| Medicare or Medigap | 35,676 | 34.0 |
| Government-sponsored | 12,146 | 11.6 |
| Medicaid | 9793 | 9.3 |
| No coverage | 6550 | 6.3 |
| Marijuana use | ||
| No | 20,285 | 79.2 |
| Yes | 5328 | 20.8 |
| E-cigarette history | ||
| Never | 64,045 | 59.6 |
| Former | 31,842 | 29.6 |
| Current, some days | 5985 | 5.6 |
| Current, all days | 5597 | 5.2 |
| Alcohol use | ||
| No | 47,684 | 45.2 |
| Yes | 57,851 | 54.8 |
| Time since last dental visit | ||
| Less than 1 year | 59,743 | 56.0 |
| 1 to 2 years | 13,143 | 12.3 |
| 2 to 5 years | 14,513 | 13.6 |
| ≥5 years | 18,421 | 17.3 |
| Never | 877 | 0.8 |
Table 2.
Chi-square analysis of smoking history intensity and any permanent teeth removed.
| Any Permanent Teeth Removed (N, %) | |||
|---|---|---|---|
| Pack-Year History | No | Yes | Chi-Square Test |
| 0 | 2995 (5.4%) | 427 (0.8%) | X2(4) = 11,269, p < 0.001 |
| 1–5 | 19,458 (35.1%) | 6286 (12.0%) | |
| 6–13 | 13,945 (25.1%) | 9470 (18.1%) | |
| 14–29 | 11,944 (21. 5%) | 15,962 (30.5%) | |
| ≥30 | 7144 (12.9%) | 20,228 (38.6%) | |
Table 3.
Chi-square analysis of smoking history intensity and number of permanent teeth removed.
| Number of Permanent Teeth Removed (N, %) | |||||
|---|---|---|---|---|---|
| Pack-Year History | None | 1 to 5 | >6 Teeth, but Not All | All Teeth | Chi-Square Test |
| 0 | 2995 (5.4%) | 120 (0.9%) | 231 (1.0%) | 76 (0.5%) | X2(12) = 18,084, p < 0.001 |
| 1–5 | 19,458 (35.1%) | 2110 (15.1%) | 3006 (12.8%) | 1934 (12.9%) | |
| 6–13 | 13,945 (25.1%) | 3319 (23.8%) | 4217 (18.0%) | 1934 (12.9%) | |
| 14–29 | 11,944 (21.5%) | 4645 (33.3%) | 7094 (30.3%) | 4223 (28.1%) | |
| ≥30 | 7144 (12.9%) | 3744 (26.9%) | 8879 (37.9%) | 7605 (50.7%) | |
Table 4.
Multiple logistic regression of the association between smoking history intensity and permanent teeth removal.
Table 4.
Multiple logistic regression of the association between smoking history intensity and permanent teeth removal.
| Adjusted Odds Ratio | 95% Confidence Interval | p-Value | ||
|---|---|---|---|---|
| Pack-year smoking history | ||||
| 0 | REF | REF | REF | REF |
| 1–5 | 1.59 | 0.966 | 2.61 | 0.068 |
| 6–13 | 2.77 | 1.68 | 4.57 | <0.001 |
| 14–29 | 4.55 | 2.75 | 7.54 | <0.001 |
| ≥30 | 6.37 | 3.80 | 10.69 | <0.001 |
| Sex | ||||
| Male | REF | REF | REF | REF |
| Female | 1.06 | 0.919 | 1.23 | 0.419 |
| Race and ethnicity | ||||
| White, non-Hispanic | REF | REF | REF | REF |
| Black, non-Hispanic | 1.30 | 0.981 | 1.72 | 0.068 |
| Hispanic | 1.04 | 0.796 | 1.37 | 0.763 |
| Asian, non-Hispanic | 0.95 | 0.652 | 1.37 | 0.774 |
| Other | 1.10 | 0.845 | 1.43 | 0.486 |
| Age | ||||
| 18 to 24 years | 0.14 | 0.085 | 0.234 | <0.001 |
| 25 to 34 years | 0.27 | 0.196 | 0.362 | <0.001 |
| 35 to 44 years | 0.39 | 0.300 | 0.515 | <0.001 |
| 45 to 64 years | 0.55 | 0.419 | 0.713 | <0.001 |
| 55 to 64 years | 0.84 | 0.653 | 1.08 | 0.164 |
| ≥65 years | REF | REF | REF | REF |
| General health | ||||
| Excellent | REF | REF | REF | REF |
| Very good | 1.21 | 0.946 | 1.56 | 0.128 |
| Good | 1.53 | 1.20 | 1.95 | <0.001 |
| Fair | 2.08 | 1.58 | 2.73 | <0.001 |
| Poor | 1.63 | 1.15 | 2.32 | 0.007 |
| Income (in USD) | ||||
| 0 to 25,000 | REF | REF | REF | REF |
| 25,001 to 50,000 | 0.67 | 0.553 | 0.816 | <0.001 |
| 50,001 to 100,000 | 0.47 | 0.375 | 0.578 | <0.001 |
| >100,000 | 0.21 | 0.164 | 0.281 | <0.001 |
| Insurance | ||||
| Private | REF | REF | REF | REF |
| Medicare or Medigap | 1.25 | 0.99 | 1.58 | 0.060 |
| Medicaid | 1.73 | 1.36 | 2.20 | <0.001 |
| Government-sponsored | 1.28 | 1.03 | 1.59 | 0.027 |
| No coverage | 1.54 | 1.18 | 2.00 | 0.001 |
| Marijuana use | ||||
| No | REF | REF | REF | REF |
| Yes | 1.71 | 1.40 | 2.07 | <0.001 |
| E-cigarette use | ||||
| Never | REF | REF | REF | REF |
| Former | 1.30 | 1.11 | 1.52 | 0.001 |
| Current, someday | 1.44 | 1.13 | 1.84 | 0.003 |
| Current, all days | 0.83 | 0.618 | 1.11 | 0.214 |
| Alcohol use | ||||
| No | REF | REF | REF | REF |
| Yes | 1.20 | 1.08 | 1.34 | 0.001 |
| Time since last dental visit | ||||
| Less than 1 year | REF | REF | REF | REF |
| 1 to 2 years | 1.36 | 1.11 | 1.67 | 0.003 |
| 2 to 5 years | 1.22 | 0.997 | 1.50 | 0.054 |
| ≥5 years | 1.05 | 0.866 | 1.28 | 0.604 |
| Never | 0.42 | 0.214 | 0.812 | 0.011 |
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Wei, Y.; Debick, N.A.; Wong, R. Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample. Sci 2025, 7, 55. https://doi.org/10.3390/sci7020055
AMA Style
Wei Y, Debick NA, Wong R. Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample. Sci. 2025; 7(2):55. https://doi.org/10.3390/sci7020055
Chicago/Turabian StyleWei, Yu, Nadia Alexandra Debick, and Roger Wong. 2025. "Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample" Sci 7, no. 2: 55. https://doi.org/10.3390/sci7020055
APA StyleWei, Y., Debick, N. A., & Wong, R. (2025). Smoking History Intensity and Permanent Tooth Removal: Findings from a National United States Sample. Sci, 7(2), 55. https://doi.org/10.3390/sci7020055
