Volume 23, Issue 2 (June & July 2020)                   J Arak Uni Med Sci 2020, 23(2): 264-277 | Back to browse issues page

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Farhadtoski K, Bayani M, Sarlak H, Salimi Z. Factors Associated With Chronic Periodontitis Risk: A Case-Control Study. J Arak Uni Med Sci 2020; 23 (2) :264-277
URL: http://jams.arakmu.ac.ir/article-1-6203-en.html
1- Department of Periodontology, Faculty of Dentistry, Arak University of Medical Sciences, Arak, Iran.
2- Department of Periodontology, Faculty of Dentistry, Arak University of Medical Sciences, Arak, Iran. , mbayani@gmail.com
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Periodontitis is one of the most common chronic inflammatory diseases that can affect anyone of any age. The cause of periodontitis is the presence of opportunistic bacteria that are naturally present in the mouth [1]. Periodontitis is a multifactorial disease that is affected by various factors [8]. Risk assessment for chronic diseases is very important because it is common in a small group of people who are at higher risk [9]. Various factors have been identified that cause periodontitis, including weakened immune systems, smoking [10], alcohol abuse, and personal oral health [12]. The aim of this study was to evaluate some of the risk factors for periodontitis including smoking, alcohol use, toothbrushing and Socioeconomic Status (SES).

Materials and Methods

This case-control study was conducted on 240 students of Arak University of Medical Sciences (120 periodontitis patients and 120 healthy peers). Two questionnaires were used to collect information; a demographic and risk factors form, and a questionnaire prepared by Garmaroodi et al. to assess the SES of participants. To diagnose periodontitis, the identification of the areas with dental plaque accumulation and clinical examination were used. The criteria for periodontitis included the observation of teeth with any periodontal disease, the observation of bone loss on radiography images, and the probing depth ≥4 mm. Multilevel logistic regression was used to investigate the relationship between periodontitis and other variables. Data were analyzed in Stata 11 software.


Demographic information and risk factors related to study participants are shown in Table 1,


and the relationship between periodontitis and study variables using multilevel logistic regression are presented in Table 2.

According to Odds Ratio (OR) values, the relationship of Periodontitis with age (>30 years vs. <20 years), SES (poor vs. moderate and high), toothbrushing, the average time period to change toothbrush (<3 months vs. >6 months), and cigarette smoking was significant. The dose-response relationship for cigarette smoking and periodontitis was also significant, where the chance of developing periodontitis was OR= 3.05 among patients who smoked 5-10 cigarettes per day, and OR= 3.81 among those who smoked more than 10 cigarettes per day, compared to those who smoked less than 5 cigarettes per day.


In this study, there was a significant relationship between prevalence of periodontitis and smoking, toothbrushing, toothbrush replacement, and SES. There was also a dose-response relationship for cigarette smoking. As the number of smoked cigarettes increased, the risk of periodontitis also increased. Being a former or current smoker also affects periodontitis. In different studies, similar results have been reported for smoking, although the effects of previous and current smoking have not been studied [20-23]. People who smoke more than 10 cigarettes a day are more likely to develop periodontitis [27]. Periodontitis prevalence was highest in current smokers, low in former smokers, and lowest in those who had never smoked [29]. People with high SES had higher periodontal health than people with poor SES [16]. Alcohol consumption increases the risk of periodontitis [31]. On average, people consuming alcohol less than once a week are just as likely to develop periodontitis as those who do not drink alcohol [32]. Alcohol consumption also has a significant effect on clinical attachment level [36]. 


Given the importance of periodontitis, its various complications and high costs, and given the role of its risk factors, it is necessary to plan to reduce cigarette smoking and alcohol consumption and increase oral health and brushing, especially in young people.

Ethical Considerations

Compliance with ethical guidelines

This study obtained its ethical approval from the Research Ethics Committee of Arak University of Medical Sciences (Code: 1397.145).


The present paper was extracted from the PhD thesis of the first author Department of Periodontology, Faculty of Dentistry, Arak University of Medical Sciences.

Authors' contributions

All authors met the writing standards based on the recommendations of the International Committee of Medical Journal Editors (ICMJE).

Conflicts of interest

The authors declared no conflict of interest.

The authors would like to thank the Deputy for Research of Arak University of Medical Sciences for their financial support.


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Type of Study: Original Atricle | Subject: General
Received: 2019/12/8 | Accepted: 2020/02/15

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