University of Oulu

Shweta Goswami, Pekka Ylöstalo, Sohaib Khan, Matti Knuuttila, Eduardo Bernabe & Anna Liisa Suominen (2021) Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels, Acta Odontologica Scandinavica, 79:8, 573-581, DOI: 10.1080/00016357.2021.1917655

Effect of smoking on periodontal health and validation of self-reported smoking status with serum cotinine levels

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Author: Goswami, Shweta1,2; Ylöstalo, Pekka2,3,4,5; Khan, Sohaib1;
Organizations: 1Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
2Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
3Department of Oral and Maxillofacial Diseases, Kuopio University Hospital, Kuopio, Finland
4Department of Oral and Maxillofacial Surgery, Oulu University Hospital, Oulu, Finland
5Unit of Oral Health Sciences, Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
6Division of Population and Patient Health, King’s College London Dental Institute, London, United Kingdom
7Public Health Evaluation and Projection Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 1.6 MB)
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Language: English
Published: Informa, 2021
Publish Date: 2022-03-08


Objectives: To investigate whether self-reported smoking and serum cotinine levels associate with periodontal pocket development and to determine the accuracy of self-reported smoking using serum cotinine.

Materials and methods: This 4-year prospective cohort study included data from 294 dentate adults, aged ≥30 years, who participated in both the Health 2000 Survey and the Follow-up Study of Finnish Adults’ Oral Health. Subjectively reported smoking status (daily smokers n = 62, occasional smokers n = 12, quitters n = 49, and never-smokers n = 171), serum cotinine levels, demographic factors, education level, dental behaviours and medical history were collected at baseline. The outcome measure was the number of teeth with periodontal pocketing ≥4 mm over 4 years.

Results: Self-reported daily smokers had 1.82 (95% CI: 1.32–2.50) higher incidence of deepened periodontal pockets than never-smokers. A positive association was observed between serum cotinine (≥42.0 μg/L) and the development of periodontal pockets. The misclassification rate of self-reported smoking was 6%.

Conclusions: Both self-reported daily smoking and higher serum cotinine were associated with periodontal pocket development. Self-reported smoking was fairly accurate in this study. However, higher cotinine levels among a few self-reported never-smokers indicated misreporting or passive smoking. Thus, self-reports alone are not enough to assess the smoking-attributable disease burden.

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Series: Acta odontologica Scandinavica
ISSN: 0001-6357
ISSN-E: 1502-3850
ISSN-L: 0001-6357
Volume: 79
Issue: 8
Pages: 573 - 581
DOI: 10.1080/00016357.2021.1917655
Type of Publication: A1 Journal article – refereed
Field of Science: 313 Dentistry
Funding: This study is a part of the Health 2000 Survey organized by the Finnish Institute for Health and Welfare (THL) (formerly the National Public Health Institute [KTL] of Finland), and partly supported by the Finnish Dental Society Apollonia and the Finnish Dental Association. The Follow-Up Study on Finnish Adults’ Oral Health was organized and funded by the National Institute for Health and Welfare and the Social Insurance Institution of Finland (KELA).
Copyright information: © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of Acta Odontologica Scandinavica Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.