The effect of cigarette and e-cigarette use on periodontal health: A cross-sectional study in Eastern Province, Saudi Arabia

INTRODUCTION: Periodontal disease is a prevalent inflammatory condition influenced by various risk factors, including tobacco use. With the rising popularity of electronic cigarettes (e-cigarettes), their potential impact on periodontal health warrants investigation. The aim was to assess the association between e-cigarette use and periodontal disease compared to traditional cigarette smokers and non-smokers in a Saudi adult population. METHODS: This cross-sectional study included 169 adults in the Eastern Province of Saudi Arabia. Participants completed questionnaires on demographics, tobacco use, and oral hygiene practices. Periodontal status was clinically assessed. Logistic regression was used to evaluate the association between tobacco type and periodontal disease, adjusting for confounders. RESULTS: Periodontal disease was diagnosed in 66.9% of participants. Tobacco use was reported by 88%, with 37.3% using e-cigarettes exclusively. Cigarette and mixed users had the highest prevalence of disease, followed by e-cigarette users, with non-smokers showing the lowest rates. Logistic regression revealed significantly increased odds of periodontal disease in cigarette smokers (adjusted odds ratio, AOR=16.31; 95% CI: 2.16-123.18; p=0.0071), and elevated odds in e-cigarette users (AOR=4.74; 95% CI: 0.84-26.80; p=0.0784) compared to non-smokers. Poor oral hygiene, defined as visible plaque and calculus on multiple tooth surfaces with gingival inflammation, was the strongest independent factor associated with disease (AOR=38.98; 95% CI: 4.79-317.11; p=0.0012). CONCLUSIONS: Both cigarette and e-cigarette use were associated with worse periodontal health compared to non-smokers. The elevated odds for e-cigarette users, although accompanied by wide confidence intervals, indicate a potential harmful effect that warrants cautious interpretation. Dental professionals should recognize all forms of tobacco use, including e-cigarettes, as potential risk factors for periodontal disease and emphasize preventive care.