Search tips
Search criteria 


Logo of pubhealthrepPublic Health Reports
Public Health Rep. 2005 Mar-Apr; 120(2): 124–132.
PMCID: PMC1497695

Influence of cigarette smoking on the overall perception of dental health among adults aged 20-79 years, United States, 1988-1994.


OBJECTIVE: Investigation into the relationship between lifestyle factors (particularly cigarette smoking) and perceived oral health has been limited. Data from the third National Health and Nutrition Examination Survey (NHANES II), 1988-1994, were used to explore this relationship in a large sample of U.S. adults. METHODS: This study used data on 13,357 dentate participants in NHANES III aged 20-79 years. In NHANES III, information on perceived dental health, sociodemographic attributes, smoking status, frequency of dental visits, dental insurance, and general health perception were collected during a home interview, and oral health status was assessed at a mobile examination center. RESULTS: Overall, 34.4% of individuals in the study sample reported having an unfavorable perception of their dental health by qualifying it as "fair" or "poor." Furthermore, 46.6% of smokers had an unfavorable dental health perception, compared to 28.3% of non-smokers. An interaction between smoking and race/ethnicity was found in logistic regression modeling. Stratified results show that cigarette smoking was not a significant predictor for an unfavorable dental health perception among individuals who self-identified as Mexican American, but smoking was a significant predictor for an unfavorable dental health perception among those who identified as non-Hispanic black or non-Hispanic white. CONCLUSIONS: This is the first study to describe the effects of smoking on dental health perception while controlling for examined oral health status. Because perceived dental health is a potential indicator for dental care utilization, a better knowledge of the factors that influence dental health perception is not only important for dental services planning, but also for understanding oral health-related quality of life issues. Additionally, given that smoking may negatively affect dental health perception, these findings have potential implications for smoking cessation activities conducted by dental care providers.

Full Text

The Full Text of this article is available as a PDF (94K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • McGrath Colman, Bedi Raman. Understanding the value of oral health to people in Britain--importance to life quality. Community Dent Health. 2002 Dec;19(4):211–214. [PubMed]
  • Locker David, Matear David, Stephens Marlene, Jokovic Aleksandra. Oral health-related quality of life of a population of medically compromised elderly people. Community Dent Health. 2002 Jun;19(2):90–97. [PubMed]
  • Batchelor Paul, Sheiham Aubrey. Does perceived risk of oral problems influence the use of dental services in university entrants? Community Dent Health. 2002 Jun;19(2):116–119. [PubMed]
  • McGrath C, Bedi R. Can dental attendance improve quality of life? Br Dent J. 2001 Mar 10;190(5):262–265. [PubMed]
  • Newton JT, Khan FA, Bhavnani V, Pitt J, Gelbier S, Gibbons DE. Self-assessed oral health status of ethnic minority residents of South London. Community Dent Oral Epidemiol. 2000 Dec;28(6):424–434. [PubMed]
  • Atchison KA, Gift HC. Perceived oral health in a diverse sample. Adv Dent Res. 1997 May;11(2):272–280. [PubMed]
  • Gilbert GH, Stoller EP, Duncan RP, Earls JL, Campbell AM. Dental self-care among dentate adults: contrasting problem-oriented dental attenders and regular dental attenders. Spec Care Dentist. 2000 Jul-Aug;20(4):155–163. [PubMed]
  • Andrews JA, Severson HH, Lichtenstein E, Gordon JS. Relationship between tobacco use and self-reported oral hygiene habits. J Am Dent Assoc. 1998 Mar;129(3):313–320. [PubMed]
  • Gilbert Gregg H, Shelton Brent J, Chavers L Scott, Bradford Edward H., Jr The paradox of dental need in a population-based study of dentate adults. Med Care. 2003 Jan;41(1):119–134. [PubMed]
  • Locker D. Does dental care improve the oral health of older adults? Community Dent Health. 2001 Mar;18(1):7–15. [PubMed]
  • Cruz GD, Galvis DL, Kim M, Le-Geros RZ, Barrow SY, Tavares M, Bachiman R. Self-perceived oral health among three subgroups of Asian-Americans in New York City: a preliminary study. Community Dent Oral Epidemiol. 2001 Apr;29(2):99–106. [PubMed]
  • Jones JA, Kressin NR, Spiro A, 3rd, Randall CW, Miller DR, Hayes C, Kazis L, Garcia RI. Self-reported and clinical oral health in users of VA health care. J Gerontol A Biol Sci Med Sci. 2001 Jan;56(1):M55–M62. [PubMed]
  • Ostberg Anna-Lena, Eriksson Bo, Lindblad Ulf, Halling Arne. Epidemiological dental indices and self-perceived oral health in adolescents: ecological aspects. Acta Odontol Scand. 2003 Feb;61(1):19–24. [PubMed]
  • Chisick MC, Poindexter FR, York AK. Factors influencing perceived need for dental care by United States military recruits. Clin Oral Investig. 1998 Mar;2(1):47–51. [PubMed]
  • Suominen-Taipale AL, Nordblad A, Alanen P, Alha P, Koskinen S. Self-reported dental health, treatment need and attendance among older adults in two areas of Finland. Community Dent Health. 2001 Mar;18(1):20–26. [PubMed]
  • Watson MR, Gibson G, Guo I. Women's oral health awareness and care-seeking characteristics: a pilot study. J Am Dent Assoc. 1998 Dec;129(12):1708–1716. [PubMed]
  • Atchison KA, Matthias RE, Dolan TA, Lubben JE, De Jong F, Schweitzer SO, Mayer-Oakes SA. Comparison of oral health ratings by dentists and dentate elders. J Public Health Dent. 1993 Fall;53(4):223–230. [PubMed]
  • Locker D, Clarke M, Payne B. Self-perceived oral health status, psychological well-being, and life satisfaction in an older adult population. J Dent Res. 2000 Apr;79(4):970–975. [PubMed]
  • Allen PF, Locker D. Do item weights matter? An assessment using the oral health impact profile. Community Dent Health. 1997 Sep;14(3):133–138. [PubMed]
  • Atchison KA, Dolan TA. Development of the Geriatric Oral Health Assessment Index. J Dent Educ. 1990 Nov;54(11):680–687. [PubMed]
  • Slade GD, Spencer AJ. Development and evaluation of the Oral Health Impact Profile. Community Dent Health. 1994 Mar;11(1):3–11. [PubMed]
  • Hyman Jeffrey J, Reid Britt C. Epidemiologic risk factors for periodontal attachment loss among adults in the United States. J Clin Periodontol. 2003 Mar;30(3):230–237. [PubMed]
  • Jansson L, Lavstedt S, Frithiof L, Theobald H. Relationship between oral health and mortality in cardiovascular diseases. J Clin Periodontol. 2001 Aug;28(8):762–768. [PubMed]
  • Johnson NW, Bain CA. Tobacco and oral disease. EU-Working Group on Tobacco and Oral Health. Br Dent J. 2000 Aug 26;189(4):200–206. [PubMed]
  • Lissowska J, Pilarska A, Pilarski P, Samolczyk-Wanyura D, Piekarczyk J, Bardin-Mikolłajczak A, Zatonski W, Herrero R, Munoz N, Franceschi S. Smoking, alcohol, diet, dentition and sexual practices in the epidemiology of oral cancer in Poland. Eur J Cancer Prev. 2003 Feb;12(1):25–33. [PubMed]
  • Locker D. Smoking and oral health in older adults. Can J Public Health. 1992 Nov-Dec;83(6):429–432. [PubMed]
  • Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. National Health and Nutrition Examination Survey. J Periodontol. 2000 May;71(5):743–751. [PubMed]
  • Aligne C Andrew, Moss Mark E, Auinger Peggy, Weitzman Michael. Association of pediatric dental caries with passive smoking. JAMA. 2003 Mar 12;289(10):1258–1264. [PubMed]
  • Drury TF, Winn DM, Snowden CB, Kingman A, Kleinman DV, Lewis B. An overview of the oral health component of the 1988-1991 National Health and Nutrition Examination Survey (NHANES III-Phase 1). J Dent Res. 1996 Feb;75(Spec No):620–630. [PubMed]
  • Winn DM, Johnson CL, Kingman A. Periodontal disease estimates in NHANES III: clinical measurement and complex sample design issues. J Public Health Dent. 1999 Spring;59(2):73–78. [PubMed]
  • Arbes SJ, Jr, Agústsdóttir H, Slade GD. Environmental tobacco smoke and periodontal disease in the United States. Am J Public Health. 2001 Feb;91(2):253–257. [PubMed]
  • Matthias RE, Atchison KA, Lubben JE, De Jong F, Schweitzer SO. Factors affecting self-ratings of oral health. J Public Health Dent. 1995 Fall;55(4):197–204. [PubMed]
  • Payne BJ, Locker D. Relationship between dental and general health behaviors in a Canadian population. J Public Health Dent. 1996 Summer;56(4):198–204. [PubMed]
  • Ylöstalo PV, Ek E, Laitinen J, Knuuttila ML. Optimism and life satisfaction as determinants for dental and general health behavior-oral health habits linked to cardiovascular risk factors. J Dent Res. 2003 Mar;82(3):194–199. [PubMed]
  • McGrath Colman, Bedi Raman. Measuring the impact of oral health on quality of life in Britain using OHQoL-UK(W). J Public Health Dent. 2003 Spring;63(2):73–77. [PubMed]
  • Gift HC, Atchison KA, Dayton CM. Conceptualizing oral health and oral health-related quality of life. Soc Sci Med. 1997 Mar;44(5):601–608. [PubMed]
  • Gooch BF, Dolan TA, Bourque LB. Correlates of self-reported dental health status upon enrollment in the Rand Health Insurance Experiment. J Dent Educ. 1989 Nov;53(11):629–637. [PubMed]
  • Rosenberg D, Kaplan S, Senie R, Badner V. Relationships among dental functional status, clinical dental measures, and generic health measures. J Dent Educ. 1988 Nov;52(11):653–657. [PubMed]
  • Bloom B, Gift HC, Jack SS. Dental services and oral health. Vital Health Stat 10. 1992 Dec;(183):1–95. [PubMed]
  • Gift HC, Atchison KA, Drury TF. Perceptions of the natural dentition in the context of multiple variables. J Dent Res. 1998 Jul;77(7):1529–1538. [PubMed]
  • Andersen RM. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995 Mar;36(1):1–10. [PubMed]
  • Jones RB. Tobacco or oral health: past progress, impending challenge. J Am Dent Assoc. 2000 Aug;131(8):1130–1136. [PubMed]
  • Albert David, Ward Angela, Ahluwalia Kavita, Sadowsky Donald. Addressing tobacco in managed care: a survey of dentists' knowledge, attitudes, and behaviors. Am J Public Health. 2002 Jun;92(6):997–1001. [PubMed]
  • Hastreiter RJ, Bakdash B, Roesch MH, Walseth J. Use of tobacco prevention and cessation strategies and techniques in the dental office. J Am Dent Assoc. 1994 Nov;125(11):1475–1484. [PubMed]
  • Warnakulasuriya Saman. Effectiveness of tobacco counseling in the dental office. J Dent Educ. 2002 Sep;66(9):1079–1087. [PubMed]

Articles from Public Health Reports are provided here courtesy of SAGE Publications