Nicotine Dependence and Periodontal Status among Tobacco Users in a Dental Hospital of Kathmandu Valley


Loss of attachment
nicotine dependence
periodontal pocket


Introduction: Tobacco use in any form (smoking or smokeless) has been recognised to be a significant risk factor for the development and progression of periodontal disease.

Objective: To assess the nicotine dependence and periodontal status among tobacco users of a dental hospital of Kathmandu Valley and determine their association.

Methods: A cross-sectional study was conducted among 164 tobacco users visiting a dental hospital of Kathmandu. Nicotine dependence was assessed using the Fagerstrom Test for Nicotine Dependence-Smokeless Tobacco and the Fagerstrom Test for Nicotine Dependence. Their periodontal status was examined using community periodontal index and loss of attachment. Data were entered in Microsoft excel sheet and analysed in IBM SPSS Statistics for Windows, version 20. Mean, standard deviation, proportion, and percentage were calculated depending upon the nature of data. Chi-square test and Fisher’s exact test were used to determine the association between different variables.

Results: Most of the tobacco smokers (34, 63.0%), chewers (12, 48.0%), and dual users (smoke=55, 64.7%; smokeless= 46, 54.1%) in this study showed low nicotine dependence. Majority of the tobacco users surveyed had periodontal pocket of 4-5 mm (73, 44.5%) and loss of attachment of 6-8 mm (79, 48.2%). Tobacco smokers and chewers having moderate or high nicotine dependence had periodontitis significantly higher than those who had low dependence.

Conclusion: The findings in this study conclude that most of the individuals using tobacco in any form have periodontal diseases. Nicotine dependence is significantly associated with increased periodontal breakdown.



Pallavi P, Amith HV, Garima B, Vani S, Bhanupriya T, Ankita S. Assessment of nicotine dependence among the tobacco users in outreach programs: A questionnaire based survey. Int J Oral Health Med Res. 2015;2(3):34-8.

Malhotra R, Kapoor A, Grover V, Kaushal S. Nicotine and periodontal tissues. J Indian Soc Periodontol. 2010;14(1):72-9.

Chahal GS, Chhina K, Chhabra V, Chahal A. Smoking and its effect on periodontium – Revisited. Indian J Dent Sci. 2017;9(1):44-51.

Divinakumar KJ, Patra P, Prakash J, Daniel A. Prevalence and patterns of tobacco use and nicotine dependence among males industrial workers. Ind Psychiatry J. 2017 Jan;26(1):19-23.

Nepal STEPS survey 2019. Tobacco Fact Sheet. 2019. Available from: Last accessed: 29th October 2020.

Aryal UR, Bhatta DN, Shrestha N, Gautam A. Assessment of nicotine dependence among smokers in Nepal: a community based cross-sectional study. Tob Induc Dis. 2015 Dec 1;13(1):26-34.

Rajkarnikar J, Acharya J. Prevalence and severity of periodontal diseases among Nepalese adults-a hospital based study. J Coll Med Sci. 2014;10(1):11-6.

Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerström test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire. Br J Addict. 1991 Sep;86(9):1119-27.

Ebbert JO, Patten CA, Schroeder DR. The Fagerström test for nicotine dependence-smokeless tobacco (FTND-ST). Addict Behav. 2006 Sep 1;31(9):1716-21.

World Health Organization. WHO basic oral health survey (4th ed). Geneva, Switzerland: World Health Organization. 1997.

Mubeen K, Chandrashekhar H, Kavitha M, Nagarathna S. Effect of tobacco on oral-health an overview. J Evol Med Dent Sci. 2013 May 20;2(20):3523-35.

Khanal GN, Khatri RB. Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence. Int Health. 2020 Sep 11;0:1-12.

Benowitz NL. Nicotine addiction. N Engl J Med. 2010 Jun 17;362(24):2295-303.

Samaha AN, Yau WY, Yang P, Robinson TE. Rapid delivery of nicotine promotes behavioral sensitization and alters its neurobiological impact. Biol Psychiatry. 2005 Feb 15;57(4):351-60.

Goyal J, Menon I, Singh RP, Gupta R, Sharma A, Bhagia P. Prevalence of periodontal status among nicotine dependent individuals of 35-44 years attending community dental camps in Ghaziabad district, Uttar Pradesh. J Family Med Prim Care. 2019 Jul;8(7):2456-62.

Calsina G, Ramon JM, Echeverria JJ. Effects of smoking on periodontal tissues. J Clin Periodontol. 2002;29:771-6.

Pradhan S, Bhat MK. Assessment of periodontal status of rural Nepalese population using the community periodontal index. J Nepal Dent Assoc. 2009;10(2):97-104.

Gupta S, Pradhan S, Sushil KC, Shakya S, Giri M. C-reactive protein in periodontitis and its comparison with body mass index and smoking behaviour. J Nepal Med Assoc. 2017 Apr 1;56(206):226-33.

Gupta S, Maharjan A, Dhami B, Amgain P, Katwal S, Adhikari B, Shukla A. Status of tobacco smoking and diabetes with periodontal disease. J Nepal Med Assoc. 2018 Sep 1;56(213):818-24.

Goel K, Gorkhali RS, Pradhan S, Gupta S. Impact of smoking and smoking cessation on periodontal health: a review. J Nepal Soc Periodontol Oral Implantol. 2017 Dec 4;1(2):65-71.

Bergstrom J, Eliasson S, Dock J. A 10-year prospective study of tobacco smoking and periodontal health. J Periodontol. 2000;71(8):1338-47.

Mullally BH. The influence of tobacco smoking on the onset of periodontitis in young persons. Tobo Induc Dis. 2004 Jun;2(2):1-3.

Dhami B, Shrestha P, Humagain M. Effect of cigarette smoking on periodontal health status in Nepalese population. J Nepal Dent Assoc. 2013;13(2):16-21.

Calsina G, Ramon J-M, Echeverria J-J. Effects of smoking on periodontal tissues. J Clin Periodontol. 2002 Aug; 29(8): 771-6.

Hashim R, Thomson WM, Pack ARC. Smoking in adolescence as a predictor of early loss of periodontal attachment. Community Dent Oral Epidem. 2001; 29(2): 130-5.