Association of smokeless tobacco with periodontal health of patients seeking treatment at a Dental Hospital setting in Sri Lanka.

Introduction: Betel chewing has indeed been an integral part of many cultures in South Asia and beyond for centuries. The practice involves the combination of various ingredients, including areca nut (also known as betel nut), slaked lime, and often tobacco, all wrapped in a betel leaf. This mixture is chewed for its stimulating and psychoactive effects. In addition to its widespread cultural significance, betel chewing has been linked to social rituals, celebrations, and even medical practices in some regions. Despite its cultural importance, it's important to note the health concerns associated with betel chewing. The use of areca nut has been linked to an increased risk of oral cancers, gum disease, and other health issues. Some studies also indicate that the combination of areca nut and tobacco significantly raises the risk of developing these conditions. Main objective: To assess any association of smokeless tobacco (SLT) with periodontal health of patients seeking dental treatment. Specific objectives: To assess the association of periodontal status with oral hygiene habits of patients seeking dental treatment.To assess the association between smokeless tobacco use with plaque score, bleeding score, BPE (Basic Periodontal Examination) scores and pocket depth measurements. Materials and method: This was a cross sectional descriptive study, conducted among adult patients above the age of 18 years, randomly selected from the daily diagnostic clinic of the Dental (Teaching) Hospital, Peradeniya (DTHP), Sri Lanka. The sample size was calculated by using Lawanga and Lamshow sample size calculation method (Lwanga & Lemeshow, 1991) ensuring a 95 % confidence level and 80 % power and a systematic sampling technique. The study instrument was a check-list to obtain socio demographic information and periodontal health status. Results: A total of 355 adult patients were included in the study, with a mean age of 38 (SD ± 15.2 years) and the age range between 18 and75 years. Out of the total study sample, 120 (34 %) were male and 235 (66 %) were female.It was identified that age is significantly associated with severe periodontal disease (p < 0.001, OR = 1.043 per year increase) and Plaque score percentile is a strong predictor (p < 0.001, OR = 1.87), indicating a higher plaque score is linked to severe periodontal destruction.The inferential statistics revealed that there was a statistically significant increase in the plaque scores (P = 0.007), bleeding scores (P = 0.007) and BPE scores (P = 0.003) in smokeless tobacco users when compared with those who do not use smokeless tobacco. Moreover, the periodontal pocket depths (PPD) of smokeless tobacco (SLT) users were significantly greater (P = 0.023) than those of tobacco nonusers (NSLT). Among the SLT users, and those who had good oral health habits which was assessed in related to their brushing frequency, showed no significant association across their periodontal (PDD) pocket depths resembling their PDD health. Conclusion: The results indicated that smokeless tobacco is detrimental to periodontal health. Habit intervention and reduction in the consumption of smokeless tobacco may significantly reduce periodontal disease, and therefore, these preventive measures should be encouraged in SLT users.