Comparison of gingival phenotype among adult male naswar users, cigarette smokers and non-tobacco users: a cross-sectional study

The impact of nicotine on the gingiva induces morphologic and histopathological changes, including gingival thickness. These changes can affect the esthetic and practical results of periodontal, restorative and orthodontic therapies. The objective of this study was to determine and compare the effects of smoked and smokeless tobacco products (cigarette, naswar) on gingival thickness. This cross-sectional study was carried out at Sardar Begum Dental College & Hospital, Peshawar, Pakistan, from January 2022 to July 2023 on 380 voluntary participants, using a convenience sampling technique. The participants were categorized as cigarette smokers, naswar users and non-tobacco users, after initial screening. Participants were interviewed using a structured interview to document sociodemographic information, oral hygiene behaviors, and tobacco consumption characteristics. Gingival thickness was then measured by a single calibrated examiner in the anterior sextants (maxillary and mandibular). SPSS version 25 was used for data analysis. Apart from descriptive statistical analysis, one-way ANOVA and General Linear Model (GLM) were used to find the statistical significance and association. Out of 380 adult male participants, 126 (33.2%) were cigarette smokers, 132 (34.7%) were naswar users and 122 (32.1%) were non-tobacco users. Tobacco users (Cigarette smokers and naswar users) showed a transparent difference in estimated marginal means, [1.49 mm (95% CI: 1.44-1.54, p < 0.001) and 1.48 mm (95% 1.41-1.56, p < 0.001) respectively], compared to non-tobacco users 1.04 mm (95% CI: 0.90-1.19, p < 0.001. Additionally, the age-wise difference in gingival thickness was non-significant in adults of 18 to 35 years. Tobacco consumption (both smoked and smokeless forms) is associated with increased gingival thickness compared to non-tobacco users, with naswar showing effects comparable to smoking. These findings indicate that tobacco exposure influences gingival phenotype, with brushing technique acting as a secondary modifier.