Impact of Smoking on the Anatomical Distribution of Periapical Bone Rarefactions: A Brazilian Retrospective Cross-sectional Study
Luiz Carlos Trevia Morais Correia Viana
*
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, 587 Dr. Valmir Pontes Avenue, Edson Queiroz, Fortaleza, Ceará, 60812-020, Brazil and Postgraduate Program in Public Health, University of Fortaleza, Block B – Room 07, 587 Dr. Valmir Pontes Avenue, Edson Queiroz District, 1st Floor, Fortaleza, Ceará, 60812-020, Brazil.
José Evando da Silva-Filho
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, 587 Dr. Valmir Pontes Avenue, Edson Queiroz, Fortaleza, Ceará, 60812-020, Brazil and Department of Dental Radiology and Imaging, Faculty of Dentistry, University of Fortaleza, 587 Dr. Valmir Pontes Avenue, Edson Queiroz, Fortaleza, Ceará, 60812-020, Brazil.
Alinne Patierry Oliveira Pacífico Feitosa
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, 587 Dr. Valmir Pontes Avenue, Edson Queiroz, Fortaleza, Ceará, 60812-020, Brazil.
Thiago Colares Castelo Branco
Department of Endodontics, Faculty of Dentistry, University of Fortaleza, 587 Dr. Valmir Pontes Avenue, Edson Queiroz, Fortaleza, Ceará, 60812-020, Brazil.
Renata Cordeiro Teixeira
Radiograf Clinic, BS Design – South Tower, 1300 Desembargador Moreira Avenue, Room 613, Aldeota, Fortaleza, Ceará, 60170-002, Brazil.
Christina César Praça-Brasil
Postgraduate Program in Public Health, University of Fortaleza, Block B – Room 07, 587 Dr. Valmir Pontes Avenue, Edson Queiroz District, 1st Floor, Fortaleza, Ceará, 60812-020, Brazil.
*Author to whom correspondence should be addressed.
Abstract
Objective: To investigate the prevalence and distribution of periapical bone rarefactions (PBRs) in smokers and non-smokers using panoramic radiographs (PRs), and to assess the influence of tobacco use on lesion distribution.
Methods: A retrospective cross-sectional analysis was conducted on 212 PRs from adult patients (18–78 years). Patients were classified as active smokers, former smokers, or non-smokers. Radiographs were examined for the presence, location, and distribution of PBRs by calibrated examiners. Associations with smoking history and duration were tested using chi-square and t-tests (two-sided), with a significance level of p<0.05.
Results: PBRs were identified in 74.5% of patients. Unexpectedly, non-smokers showed a higher prevalence (66%) than smokers (33%), which may reflect sample characteristics or confounding factors. In smokers, lesions were predominantly concentrated in maxillary anterior teeth, particularly central incisors, and prevalence increased with longer smoking duration (>10 years). No significant differences were observed between smokers and non-smokers regarding arch distribution. Conclusions: Smoking was not associated with a higher overall prevalence of PBRs but appeared to influence their anatomical distribution and their relationship with tobacco exposure time. These findings emphasize the importance of considering lesion patterns alongside patient history and acknowledge the limitations of panoramic radiographs in establishing causality. Further multicenter and prospective studies using advanced imaging are warranted.
Keywords: Periapical bone rarefactions, tobacco use, panoramic radiography, smoking, oral health