Association between smoking, betel chewing and gingival bleeding in rural Sri Lanka

Objective: To ascertain the association between tobacco use and gingival bleeding in a rural community in Sri Lanka. Material and methods: A cross-sectional field-based study was carried out in 2178 rural males aged 20-60 years, employing a multistage cluster sampling technique. The levels of plaque and gingivitis were recorded on four sites of all teeth present excluding third molars, using the plaque index (PLI) and gingival index (GI). Information pertaining to sociodemographic variables, oral hygiene practices and tobacco consumption habits was obtained from all subjects. Results: One-way anova combined with the Bonferroni test disclosed that betel chewers had a significantly higher mean number of sites with gingival bleeding (22.6+/-21.8) than smokers (10.8+/-11.2) and nontobacco users (8.7+/-6.8) (p <0.0001). A higher proportion of betel chewers (55.1%) showed greater than or equal to12 bleeding sites compared to smokers (27.6%). Logistic regression analysis revealed that the association between betel chewing and gingival bleeding was positive (OR=2.41; p <0.0001) whereas that of smoking and gingival bleeding was negative (OR=0.75; p <0.05). Oral hygiene had the strongest relationship with gingival bleeding (OR=18.11). Conclusion: While confirming the masking effect of smoking on gingival bleeding, these findings indicate that betel chewing might significantly enhance gingival bleeding in the population studied.