Association Between Tobacco and Periodontal Disease in Latin America from 2000 to 2024: Cross-Sectional Analysis of Global Burden of Disease Study

<b>Objectives:</b> This study aims to examine the ecological-level association between active and passive tobacco use and periodontal disease in Latin America from 2000 to 2024. <b>Methods:</b> A cross-sectional ecological study was conducted using secondary data from the Global Burden of Disease Study. Data from 20 Latin American countries were analyzed, stratified by country, sex, and age group. Multiple regression models were used to assess the relationship between tobacco consumption and periodontal disease prevalence, adjusted for age and sex. <b>Results:</b> The prevalence of periodontal disease was high in both sexes, particularly among individuals older than 55 years. The countries with the highest age-standardized rates were Colombia, Panama, and Costa Rica, with nearly 35,000 cases per 100,000 population. Regression models indicated that passive tobacco exposure explained 90.4% of the variability in women (R² = 0.9041) and 92.5% in men (R² = 0.9253). Active tobacco use showed weaker associations, with R² values of 0.3721 in women and 0.4601 in men. Passive exposure demonstrated better predictive accuracy, with lower Root MSE values (3192.8 and 3261.7). <b>Conclusions:</b> There is a significant ecological-level association between tobacco use and periodontal disease in Latin America, particularly for passive exposure. These findings highlight the need to strengthen tobacco control policies and preventive strategies targeting environmental exposure. However, due to the ecological nature of the study, these associations do not imply causality at the individual level. Longitudinal studies with individual-level data are needed to explore the underlying biological and contextual factors.