Socio-economic position, smoking, and plaque: a pathway to severe chronic periodontitis

To report periodontal status and elucidate the relationship among socio-economic position (SEP), plaque accumulation, tobacco smoking, and periodontitis in a representative sample of adult Jewish people, aged 35-44 years, living in Jerusalem.

This cross-sectional study was conducted using a stratified sample of two hundred and fifty-four 35-44-year-old adults in Jerusalem (limited to the Jewish population). A clinical examination (Community Periodontal Index and Plaque Index) and a self-administered questionnaire were applied.

Two hundred and fifty-four adults, mean age 38.6 (SD=3.3) years, participated. The response rate was 88%; intra-examiner κ values were above 0.87. The average number of healthy sextants was 1.18, while the average number of sextants with bleeding, calculus, shallow periodontal pockets, and deep periodontal pockets was 1.3, 2.6, 0.7, and 0.1, respectively. Lower level of education was associated with severe chronic periodontitis (SCP, p=0.012) and also with smoking (p=0.030) and higher level of plaque (p<0.001). Smoking was associated with higher level of plaque (p<0.001), which in turn was associated with SCP (p=0.020).

This study presented a potential explanatory pathway for the relationship between SEP and SCP. Low level of education was proposed as a distal determinant, leading to tobacco smoking and higher levels of plaque, and finally to SCP.