Variation in tobacco use profiles obtained from periodontal maintenance patients

Objectives To compare methods of tobacco use profiling in patients undergoing maintenance treatment for periodontitis. Methods The smoking status of 108 subjects attending a university-based specialist periodontics clinic was assessed by examination of referring records, patient-completed questionnaires, clinician-administered interviews and by salivary cotinine and expired-air carbon monoxide (ECO) measurement. Results Ten percent of the detected smokers (salivary cotinine > 14.2 ng ml−1) reported to be non-smokers in the clinician-administered interview. 4.2% of the smokers detected by ECO analysis (ECO > 8 ppm) reported to be non-smokers in the clinician-administered interview. Systematic under reporting of tobacco use was also apparent in patient-completed questionnaires from the periodontics clinic and, to a larger degree, in the referring clinic records when compared to the clinician-administered interview. Conclusions By biochemically analyzing recent cigarette smoke exposure, our data show that clinician assessment is the most accurate means by which to obtain anamnestic data concerning tobacco use. ECO analysis using portable CO monitors is inexpensive and simple with no requirement for laboratory support. The combination of ECO measurement and clinician-administered tobacco use interview represents a clinically applicable method to improve the detection of an important, periodontally susceptible population—regular smokers who deny smoking.