Tobacco Use and Oral Health Status: A Cross-sectional Study among Commercial Motorcycle Riders in a Suburban Community in Nigeria

INTRODUCTION

The usage of tobacco poses one of the biggest risks to public health in history, and tobacco use is an epidemic that is rapidly spreading.¹ With the tobacco pandemic killing over 8 million people every year worldwide, it is one of the biggest threats to public health that the world has ever faced.² More than 7 million of those deaths result from direct tobacco use, while around 1.2 million are from non-smokers exposed to second-hand smoke.² About 16,100 tobacco-related deaths occur in Nigeria annually.³ Due to the nation’s inadequate monitoring and surveillance systems, these numbers may be greatly underestimated.⁴

Approximately, 5.6% (4.7 million) of adult Nigerians use tobacco products currently, and 3.9% (3.1 million) smoke cigarettes.⁵ Tobacco products’ increased use in Nigeria can be attributed to the fact that they serve a variety of functions, including being a surrogate currency, a means of social control, a stress reliever, and a social lubricant.⁶ Furthermore, In most of the Nigeria’s rural and urban communities, smokeless tobacco is consumed in unknown amounts as part of a social gathering custom, for recreational purposes, as a “cure” for specific illnesses, and for other reasons without consideration for the possible health risks.⁷

Motorcycles and tricycles are becoming increasingly popular modes of transportation among Nigerians, particularly in recent years. The use of motorcycles as a means of public transport became famous in 1992 due to the dearth of other means of public transportation.⁸ The country’s sociopolitical situation, which includes widespread poverty, unemployment, and political exploitation, has resulted in a dramatic increase in the need for commercial motorcycle riders.⁷ Most motorcyclists (locally known as “Okada Riders”) are young, male, low-to-medium-income earners with a low educational status.⁷ According to a study conducted among commercial motorcycle riders in Southern Nigeria, a significant percentage (15.30%) consumed tobacco, with approximately 14.70% smoking cigarettes.⁹ Commercial motorcycle riders have increasingly used tobacco products to improve their riding performance, making them a vulnerable population to tobacco use. As a result, there have been detrimental effects on people’s health, endangering drivers, passengers, and other road users and creating a serious public health issue in developing countries.

Tobacco use is associated with several harmful effects that most users are unaware of.¹⁰ Tobacco use has several negative effects on oral health, including tooth and dental restoration staining, hyposmia, and the development of oral diseases, such as smokers’ palate, smokers’ melanosis, and coated tongue.¹¹ Tobacco use has also been linked to oral pre-cancerous lesions, oral cancer, oral candidiasis, periodontal disease, implant failure, and dental caries.^11,12 For example, it has been implicated in the etiology of various forms of cancer, such as lung, bladder, and esophageal cancers. Moreover, it is a prevalent risk factor for a number of chronic illnesses, such as diabetes, heart disease, and respiratory issues.¹³

Despite evidence from various parts of the world showing that tobacco users generally have poor oral health,^14–20 the effects of tobacco use on the oral health of commercial motorcycle riders, a tobacco-vulnerable population in Nigeria, have never been studied to the best of our knowledge. This cross-sectional study aimed to assess the possible relationship between tobacco use and oral health among a disproportionate tobacco population, commercial motorcyclists, in a Nigerian suburban community as a piece of vital information to facilitate planning a context-appropriate cessation program for this population. This study’s objectives were to examine the possible relationship between cigarette smoking and (1) periodontal health, (2) oral hygiene status, (3) gingival health, and extrinsic teeth discoloration among commercial motorcycle riders.

MATERIALS AND METHODS

RESULTS

DISCUSSION

The current study found that the prevalence of smoking among commercial motorcycle riders was 24.7%, which is at least 6.5 times higher than the general population (3.6%).²⁷ This demonstrates that commercial motorcycle riders are a population who are more predisposed to smoking cigarettes and using other tobacco products due to the nature of their job. Increased biking performance and stress relief could be why this population uses tobacco more than the general population.²⁸ Furthermore, our participants’ smoking rates were approximately 1.7 times higher than those reported in a similar population in another part of Nigeria in 2015.⁹ This population should receive special attention in terms of smoking cessation education and services.

The results of this study showed that smokers had periodontal disease at a higher severity than did non-smokers. About half (50.8%) of the smokers scored CPITN maximum codes 3 and 4, signifying shallow and deep periodontal pockets. Our finding was in keeping with other studies where smokers are likelier to have worse periodontal health than non-smokers.^{18–20,29–31} Smoking affects the immune response and impairs the periodontal tissue’s healing capability.¹⁷ Tobacco use slows the rate at which polymorphonuclear leukocytes move, reducing the ability of oral tissues to defend against bacterial attack, resulting in poor healing and periodontal disease.¹⁷ Nicotine can also change fibroblasts’ structure, preventing them from firmly attaching to the tooth root surface, resulting in attachment loss and alveolar bone loss.^15,16

More than 70% of the smokers in our study had mild gingivitis, keeping with the current knowledge of tobacco on the gingiva. Cigarette smoking causes nicotine-induced vasoconstriction, which can exhibit decreased vascular angiogenesis and thus masks clinical features that can be used to monitor periodontal health.^30–32

This study showed that current smokers are more likely to have poor oral hygiene than non-smokers. This finding mirrors that of previous studies,^14,33,34 where it was reported that smokers had an average OHI score that was greater than non-smokers. This can be explained by the fact that cigarette smoking causes tooth staining, which roughens the surface of the teeth and promotes faster plaque accumulation.^35,36

In our study, current smokers were about four times more likely than non-smokers to have externally discolored teeth. Tobacco smoke contains compounds (nicotine and tar) that can be deposited on the teeth’ surface, penetrate the teeth’ hard tissues, and cause tooth discoloration.³⁷ Many studies have shown a 2–4 times increase in teeth discoloration in smokers compared with non-smokers; however, an eight times increase in our population may indicate that commercial motorcycle riders consume a lot more cigarettes than the general population.^38,39

Our study findings are novel in terms of tobacco use and habits, as well as the associated oral health status among commercial motorcycle riders in Nigeria. The results can be used to help plan a context-appropriate cessation program for this population, as well as to improve their oral health.

Because of the cross-sectional nature of our study, establishing a cause–effect relationship between smoking and oral health status is impossible. We encountered difficulty in getting the riders to complete the questionnaires and oral examination due to the busy nature of their job. However, we overcame this by repeatedly visiting the motorcycle parks. Tobacco use was based on respondents’ self-reporting, and it is not impossible that some tobacco users may deny they consume tobacco. Thus, there might be possibility of under-reporting of smoking status which might mask the true strength of the positive relationship we observed between smoking and oral health status. Due to the quick pace of data collection and the participants’ pressure to complete the oral assessments fast, there is the possibility that the oral examinations conducted for this study might not be as thorough as those conducted at dental clinics.

Further research into a large sample of commercial motorcyclists in Nigeria and different parts of the country is recommended.

CONCLUSION

Commercial motorcycle riders in Nigeria are more likely to use tobacco, particularly cigarette smoking. Motorcycle riders who currently smoke have worse oral health than those who do not smoke. As a result, smoking cessation interventions should target this population in order to improve their oral health.

ACKNOWLEDGMENT

The authors want to thank the 255 commercial motorcyclists in the Igbo-Ora community who consented to be part of our study. The Authors also appreciate the chairpersons of the four commercial motorcycle associations in the Igbo-Ora community and the heads of the nine parks where we enrolled participants.

ORCID

Samuel Tobi Tundealao https://orcid.org/0000-0002-1243-0564

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