Relationship of bone mineral density with panoramic radiomorphometric indices in tobacco users in India

Abstract

Background: Osteoporosis is a crippling disease that can eventually culminate in fracture. Smoking and smokeless tobacco (SLT) use are important contributors to this disease. Decreased bone mineral density (BMD) which marks osteoporotic bone changes are assessed using dual energy X-ray absorptiometry (DXA). Panoramic radiomorphometric indices (RI) which are inexpensive and widely used in dentistry also provide architectural details of jawbones. Hence the study was attempted to find the relationship between BMD and panoramic RI in tobacco users in the Indian Population. Materials and Methods: The hundred subjects were divided into study groups comprising 25 smokers, 25 SLT users, 25 subjects with a combination of habits, and 25 healthy controls were subjected to BMD assessment using DXA scan and digital panoramic radiographs for calculation of mandibular cortical index (MCI), mental index (MI), and panoramic mandibular index (PMI). Results: SLT users had the least values of BMD (P <0.05). Both MI and PMI were markedly reduced in SLT users and had a strong positive correlation to BMD (r=0.600, P- value -0.002 for MI and r= 0.428, P value -0.033 for PMI). A strong negative correlation of MCI to BMD (rs= -0.510, P- value 0.009), MI (rs= -0.632, P- value-0.001),and PMI (rs= -0.432, P- value 0.031) was noted in SLT users with a maximum number of C3 found among them. However, no significant correlation of BMD with RI was obtained in smokers. The practise of both smoking and SLT showed a significant positive correlation of BMD to MI and PMI. Conclusion: Tobacco was found to have detrimental effects on BMD, well reflected in RI of MCI, MI, and PMI, thus, oral physicians must screen and educate tobacco users, particularly, SLT users for impaired bone health and refer them promptly for suitable treatment.