A natural experiment for inferring causal association between smoking and tooth loss: a study of a workplace contemporary cohort

Takashi Hanioka, Satoru Haresaku, Nao Suzuki, Kaoru Shimada, Takeshi Watanabe, Miki Ojima, Keiko Fujiie, Masako Watanabe


Background: Natural experiments in former smokers are an important criterion for inferring causality between smoking and tooth loss. We examined how former smoking influenced risk estimate of tooth loss incidence.

Methods:Records of dental check-ups of the work cohort were examined. The sample consisted of data from 1,724 workers recorded at the ages of 40 years and 50 years, and this was analyzed for tooth loss incidence during a 10-year period. Former smokers were categorized into two groups based on whether they quit smoking before or during the observational period. Variables used for adjustment were age, sex, oral and overall health behavior, dental visit, and number of existing teeth immediately prior to observation.

Results: The prevalence of tooth loss incidence and number of teeth lost during the observational period were both higher in current smokers than in never smokers (33.7% vs. 23.9% and 0.83 vs. 0.42, respectively). Incident odds ratio of tooth loss in long-term quitters relative to never smokers was not significant and less than one (incident odds ratio 0.85, 95% confidence interval 0.56–1.29). Incident odds ratios of short-term quitters and current smokers were both significant, though short-term quitters exhibited higher values (1.72, 1.15–2.55) than current smokers (1.48, 1.10–2.00).

Conclusions: The causal interpretation is strengthened by attenuation of the risk in long-term quitters. However, additional factors may influence the risk estimates of former smokers, suggesting potential limitations of a natural experiment for inferring causal association between smoking and tooth loss.


Natural experiment, Smoking, Tooth loss, Cohort study, Causal inference

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ISSN: 1929-6029