QUESTION: Does vaping (E-cigarette use) increase the risk of periodontal disease or dental

caries?

1) What is the exact research question?

Is there an association between the prevalence of periodontal disease and e-cigarette
use?
P: Adults with periodontitis in the United States
I/E: E-cigarette use
C: Never-smokers
O: Prevalence and severity (risk) of periodontal disease

2) What is the null hypothesis?

There is no association between the use of e-cigarettes and prevalence of periodontal
disease.

3) Target versus study population? Where/how to find them?

Target: Adults that are e-cigarette users or never-smokers
Study: Adults with periodontitis that self-identify/report as e-cigarette users or never-
smokers
Can utilize public national self-reported questionnaires from NHANES/CDC

4) What are the selection criteria?

Inclusion: Users and non-users with periodontitis, self-reported status
Exclusion: Never-smokers with second hand smoking exposure, previous smokers,
missing periodontal data

5) What is the exposure/explanatory variable and how will it be defined and assessed?
Exposure variable is the use of e-cigarettes. The inclusion is dependent on the
questionnaire to self-identity as a smoker. “Use of e-cigarette is the last 30
days?” “What is the frequency of e-cig use?”

6) What is the outcome of interest? How will I define and assess my outcome? What addi-
tional potential risk factors could be included in my study?
Outcome to be measured is the prevalence of periodontal disease across e-cig users and
never smokers. Periodontal assessment will be pooled from self-report. If
measured in the field then periodontal clinical parameters should be measured (PD, radio-
graphic bone loss, BOP, CAL) and categorized.

7) What potential confounders should be considered? How can the effects of these con-
founders be minimized?
Patients that self-report as e-cigarette users may also utilize other forms of tobacco or
alcohol consumption which may affect risk of periodontal disease, other
common risk factors may become confounders within the e-cigarette users
(stress, SES)
8) What type of effect measure/measure of association is appropriate for the study? What is
the equation for this type of measure?
Odds ratio (OR) is a measure of association between exposure and an outcome. The OR

represents the odds that an outcome will occur given a particular exposure,
compared to the odds of the outcome occurring in the absence of that exposure.

OR >1 indicates increased occurrence of an event

OR <1 indicates decreased occurrence of an event

9) What are the advantages of this study design? Disadvantages?

Advantages:
Conducted relatively faster and inexpensive when compared to cohort studies
Conducted as a baseline in a cohort study, this study gives us information about
the prevalence of outcomes or exposures, useful in the design of
cohort study
Cross-sectional useful for public health planning, monitoring and evaluation

Disadvantages:
A one-time measurement of exposure and outcome, difficult to derive causal
relationship
Doesn’t take into account different incidence of periodontal disease in a particular
community, just one snapshot of a larger population, cumulative analysis that may
not be sufficient to understand disease trends

10) What potential biases will I have to consider when designing this type of study and in-
terpreting the results?
Hard to derive a causal relationship due to one-time measurement that introduces
the bias that individuals have began to alter habits. There may have
been e-cig users that reported lower than personal average of usage as
they are attempting to quit.