246 American Academic Scientific Research Journal for Engineering, Technology, and Sciences ISSN (Print) 2313-4410, ISSN (Online) 2313-4402 http://asrjetsjournal.org/ The Impact of Tobacco Smoking on Oral Health - An Ob- servational Study Mimoza Canga a *, Irene Malagnino b , Edit Xhajanka c , Ruzhdie Qafmolla d , Vito Antonio Malagnino e a Department of Nursing, Faculty of Public Health, University "Ismail Qemali",Vlora, 9401, Albania b Malagnino Associated Medical Clinic, Rome, 00144, Italy c,d Department of Dental Prosthesis, University of Medicine Tirana, Nr. 183 Tirana, 1001, Albania e Endodontic Chair, University "Gabriele D’Annunzio" Chieti, 66100, Italy a Email: mimoza-canga@hotmail.com Abstract Cigarette smoking is a major cause of a high number of diseases including oral diseases. The aim of the present study was to evaluate the impact of smoking on oral health. This is an observational study. In the present re- search were taken into consideration 200 young adults with an age range of 18 to 25 years old, of which 58% were males and 42% were females. The study found a strong correlation between smoking and very bad gingi- val status (P= .001; 95% CI 0.42-0.53), missing teeth (P= .001; 95% CI 0.35-0.45), dental caries (P= .001; 95% CI 0.36-0.43), and inflammation of the lips (P= .001; 95% CI 0.33-0.57). Keywords: Cigarette smoking; dental caries; gingival status; lip inflammation; missing teeth; young adults. 1. Introduction Cigarette smoking is a risk factor for the development of many illnesses such as cardiovascular diseases, chronic obstructive lung diseases, cancers of the mouth, and esophagus. Tobacco smoking rates among adults and chil- dren in developing countries have been increasing significantly [1]. According to a study conducted by Nazir MA et al, the prevalence of tobacco use in adolescents in 133 countries was 19.33%, and it ranged from 1.5% to 65.5% [2]. Tobacco smoking use is recognized as the most noteworthy risk factor for oral diseases [3].Moreover, studies conducted by Papapanou PN et al, and Chapple IL, found that smoking increased the risk of gingival inflamma- tion [4-6]. Likewise, a study conducted by Tanaka K et al, proved that smoking was the cause of various diseas- es, including dental caries [7, 8]. ------------------------------------------------------------------------ * Corresponding author. American Academic Scientific Research Journal for Engineering, Technology, and Sciences(ASRJETS) (2022) Volume 90, No 1, pp 246-252 247 Other clinicians found a direct correlation between smoking and lips pigmentation [9, 10]. The recent literature states that young people who lived with members of their family who were daily smokers had serious problems with their health [11]. Corsi DJ et al, declared that 12% of Canadian youth aged 15 to 19 years old were smokers, meanwhile Wood- gate RL et al, demonstrated that adolescent females by observing their parents who smoked had easier access to buy and consume tobacco [12, 13]. In Pierce and his colleagues study, it is observed that the number of young adult smokers aged 18 to 29 years old who consumed less than 5 cigarettes per day is increased from 4.7% to 6.0% [14]. The present study sets out to assess the impact of tobacco smoking on oral health. 2. Material and method This is an observational study.The current study was conducted in the period from 2019 to 2021, in Albania. In the present research were taken into consideration 200 young adults with an age range of 18 to 25 years old, of which 58% were males and 42% were females. Data collection was done using questionnaires. The question- naire contained information about gender, age range, current smokers, and the number of smokers in the family. The questionnaire included the habits of tobacco consumption in the participants and the characteristics of the sample such as gingivitis, dental caries, missing teeth, and diseases of the lips smoking-related. The question- naire was designed based on the resolution of the Albanian National Committee no. 9, dated 11.11.2011. The duration of the questionnaire lasted 20 minutes and the anonymity of the participants was preserved. The origi- nal research was conducted according to the guidelines of the Helsinki statement [15]. Based on the Helsinki Declaration approved by the World Medical Association the present study participants were current smokers or former smokers. The participants had the right to withdraw at any time. There was no withdrawal of the patients from the study. The inclusion criteria were the age of participants over 18 years old. Participant exclusion crite- ria were diabetic patients. The present study is an attempt to demonstrate the impact of smoking on oral health, assessing the association of smoking with gingivitis, dental caries, missing teeth, and lips inflammation. De- scriptive analysis was performed using percentages for qualitative variables such as gender, age range, smok- ing, number of smokers in the family, daily routine, smoking over time, number of cigarettes per day, gingival status, missing teeth, dental caries, and diseases of the lips smoking-related. Statistical analysis was performed using IBM SPSS 23.0 statistics, Microsoft Windows Linux, Chicago, IL, USA. Data were analyzed by Post Hoc LSD test in variance analysis (ANOVA). The significance level (α) was set at 0.05, with a confidence interval (CI) of 95%. 3. Results The majority of the participants in the study belonged to the age range from 21 to 25 years old, respectively 70.5% of them, while 12% of the participants were from 19 to 20 years old. The results of our study showed that 70% of the participants were current smokers. Based on the present research it resulted that 51% of the partici- pants had one smoker in the family, whereas 31 % of the patients had two smokers in the family. American Academic Scientific Research Journal for Engineering, Technology, and Sciences(ASRJETS) (2022) Volume 90, No 1, pp 246-252 248 The results were detailed in Table 1. Table 1: Socio-demographic characteristics of the sample. Variables Percentage Female 42% Male 58% Age range 18-19 9.5% 19-20 12% 20-21 8% 21-25 70.5% Smoking Current smokers 70% Former smokers 30% Number of smokers in the family 1 smoker 51% 2 smokers 31% 3 smokers 18% A high percentage of the participants reported smoking in the morning 31% of them, and 28% of the participants reported smoking after lunch. In this study, 51% of the participants declared, that they smoking for more than 5+ years. It resulted that 43% of the sample smoked 10-20 cigarettes per day. The results were presented in Ta- ble 2. Table 2: The habits of tobacco consumption among participants. Variables Percentage Smokers - Daily Routines In the morning 31% After lunch 28% Smoking associated with coffee consumption 21% Before bedtime 8.5% Night smokers 11.5% Smoking use over time 1-2 years 17% 3-4 years 20% 4-5 years 12% 5+ years 51% Number of cigarettes smoked per day 3-5 22% 5-10 35% 10-20 43% Based on the results of the current study it was observed that 43.5% of participants had bad gingival status, and 34.5% of them had very bad gingival status. The findings of the study show that 46.5% of the participants had lost 1-2 teeth and 44% of them had lost 2-3 teeth. The current study showed that 55% of patients had 2-3 teeth with dental caries, 27% of the patients had more than 3 teeth with caries and 18% of them had 1-2 dental caries. According to study data, 34% of the partic- ipants declared, that they had lips pathology. The results were presented in Table 3. American Academic Scientific Research Journal for Engineering, Technology, and Sciences(ASRJETS) (2022) Volume 90, No 1, pp 246-252 249 Table 3: Oral health status related to cigarette smoking. Gingival status Percentage Good 22% Bad 43.5% Very bad 34.5% Missing teeth 1-2 46.5% 2-3 44% 3+ 9.5% Dental caries 1-2 18% 2-3 55% 3+ 27% Smoking-related to lips inflammation Yes 34% No 66% According to the ANOVA test, smoking was strongly correlated with very bad gingival status (P= .001; 95% CI 0.42-0.53), missing teeth (P= .001; 95% CI 0.35-0.45), and dental caries (P= .001; 95% CI 0.36-0.43). This study showed that there is a statistically significant correlation between smoking and lips inflammation (P= .001; 95% CI 0.33-0.57). The results were detailed in Table 4. Table 4: The correlation between cigarette smoking and oral health. Smoking Variables P-value 95% Confidence Interval Gingival status Missing teeth Dental caries Smoking-related to lips inflamma- tion .001 .001 .001 .001 .42 .53 .35 .45 .36 .43 .33 .57 4. Discussions The aim of this observational study was to show the impact of smoking on oral health diseases. According to the data from the study conducted by Toljamo T et al, it was demonstrated that young male smokers aged from 18 to 26 years old were nicotine-dependent, 95.3% of them [16]. On the other hand, as reported by the present study, most of the participants, 58% of them were young male smokers. Some studies suggest that that smoking in young adults is influenced by family members [17-19]. Similarly, the current study demonstrated that almost half of the participants, 51% of them had in the family at least one smoker. The results of the cross-sectional analysis carried out by Barrington-Trimis JL et al, demonstrated that among young adults in the US in 2018, 42.6% began smoking at the age of 18 years or older [20]. According to the latest data published by the Institute of Public Health in Albania, the prevalence of adult smokers (18 years and older) is higher, especially for men, 58.8%. American Academic Scientific Research Journal for Engineering, Technology, and Sciences(ASRJETS) (2022) Volume 90, No 1, pp 246-252 250 In this study, 31% of the participants stated that they smoke in the morning. Our results are similar to the findings of the study conducted by Haberstick et al, who also noticed that smoking the first cigarette in the morning may be the most highly encountered habit among young adults [21]. The present study, reports that 43.5% of the participants had bad gingival status and 34.5% of them had very bad gingival status and is in agreement with studies conducted by Rösing CK et al, and Holde GE et al, who proved that smoking was associated with increased gingival complications [22,23]. On the basis of our data, exists a significant correlation between smoking and dental caries, and our results are supported by the study carried out by Wagenknecht DR and his colleagues [8]. The current study demonstrated that smoking has a significant impact on the manifestation of lips inflammation P-value= .001. Other studies have had similar findings [9,24]. Smoking is a serious risk factor for missing teeth. During analyze of data, we found that 46.5% of the participants had 1-2 missing teeth. Similarly, a systematic review conducted by Hanioka T et al, has confirmed that smoking is associated with tooth loss [25]. We emphasize that, one of the main objectives of the Albanian government is the implementation of the anti-tobacco law, which aims through an information and awareness campaign to control and monitor measures to protect health from tobacco smoking. Data from the current study do support the idea that dentists have an important role in encouraging patients to stop smoking in order to improve their health status. Participants in the study claimed that they had a need for smoking as routine, and that has developed a social environment among them. The limitation of this study was the age range from 18 to 25 years and did not include adolescents younger than 18 years and adults over 25 years old. The recommendation of this study is quitting cigarette smoking is beneficial for smokers of any age, especially among young people. 5. Conclusions The study found a strong correlation between smoking and very bad gingival status, missing teeth, dental caries, and lip inflammation. 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