Oral Health Status Among Rural and Urban Inhabitants of Zambia-a Community Cross-Sectional Study

Oral Health Status Among Rural and Urban Inhabitants of Zambia-a Community Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Oral Health Status Among Rural and Urban Inhabitants of Zambia-a Community Cross-Sectional Study Chrispinus Hakimu Mumena, Göran Kjeller, Bengt Hasséus, Daniel Giglio This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6673703/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Oct, 2025 Read the published version in Scientific Reports → Version 1 posted 17 You are reading this latest preprint version Abstract The knowledge of the prevalence of oral diseases in Africa is poor. In this cross-sectional study we assessed the oral health status in adults living in urban Ndola (N=188) and rural Mansa (N=211) where participants were interviewed on oral health followed by an oral examination. The chi-square test and logistic regression analysis were used to examine associations between socio-demographic factors, oral disease risk factors, and oral disease presence across urban and rural participants. Dental caries occurred in 72.9% of urban and 47.9% of rural participants (p<0.0001). DMFT was 4.0 in urban participants compared to 2.2 in rural participants (p<0.0001). Gingivitis occurred in 84.5% and 88.1% of urban and rural participants, respectively (p=0.297). Age and habitat were factors significantly associated with dental caries, DMFT, and gingivitis. Smoking and alcohol use was significantly associated with gingivitis, while age, education, smoking, and alcohol use were factors significantly associated with periodontal disease. Only three study participants in the rural population were diagnosed with leukoplakia. In conclusion, dental caries was particularly common in the urban population in Zambia, while gingivitis was high in both the urban and rural population. Unmet dental care calls for broad interventions to address oral diseases in Zambia. Health sciences/Diseases/Dental diseases Health sciences/Diseases/Oral diseases/Gingivitis Health sciences/Diseases/Oral diseases/Periodontitis Health sciences/Health care/Dentistry Health sciences/Health care/Public health/Epidemiology Health sciences/Health care/Public health/Population screening Oral health caries gingivitis oral potentially malignant disorder periodontal disease Zambia Figures Figure 1 Introduction Oral diseases are a global public health concern affecting 3.9 billion people in the world with an increase in incidence by almost 21% between 1990 to 2010 1 . Caries of the permanent teeth is the current major public health problem among the non-communicable diseases 2 . Oral health is, however, a neglected problem, especially in African countries, despite that oral diseases share risk factors with other non-communicable diseases such as diabetes and hypertension 2 . Poor oral health is also among the risk factors associated with the development of oral cancer 3 . Other risk factors for oral cancer include tobacco, alcohol, betel quid use and diet 4 . Oral cancer is in many cases preceded by oral potentially malignant disorders (OPMDs), which include leukoplakia, erythroplakia, oral lichen planus and submucous fibrosis 5 . The population in Zambia living below the poverty line is approximately 64.3% 6 . In 2023, Zambia had a GDP per capita of 1331 USD, while Burundi (lowest GDP per capita in the world), Zimbabwe, Botswana (highest GDP per capita on the African continent) and South Africa had a GDP per capita of 193 USD, 2156 USD, 7820 USD and 6023 USD, respectively 7 . In 2018, there was only one dentist per 100,000 inhabitants working in Zambia 8 . Few studies exist on oral health status in the adult population of Zambia as well as elsewhere in Africa. A systematic review showed a prevalence of dental caries of 36% in the permanent dentition among 12-year-old children in Africa, where Zambia was reported to have the lowest prevalence of 11% 9 . Severine et. al. showed that almost half of secondary school adolescents in the Copperbelt province, Zambia, had pre-morbidity stage of dental caries or worse 10 . A population-based study on oral health in Zambia´s eastern neighboring country Malawi showed that 49% of people older than 35 had caries, and, decayed, missing, and filled teeth (DMFT) index in 12, 15, 35–44, 65–74-year-olds was 0.67, 0.71, 3.11 and 6.87, respectively 11 . Population-based studies on the prevalence of oral health, oral cancer and OPMDs in sub-Saharan African populations are only few. Still the use of tobacco and alcohol abuse are common in sub-Saharan Africa including Zambia, particularly in uneducated men 12 , constituting significant risk factors for the development of OPMDs and oral cancer 5 . The sale of tobacco product has also increased in Africa 13 . No studies, to our knowledge, have been conducted on the prevalence of OPMDs in the general or clinic-based populations in Zambia. The present cross-sectional epidemiological study was conducted to assess oral health in rural and urban Zambia. The prevalence of dental caries, gingivitis, periodontal disease, OPMDs and other oral diseases in the general population were assessed and compared between the rural and urban population and factors associated with oral health were assessed. Methods Ethical approval was obtained from the Tropical Disease Research Centre (TDRC) Institution Review Board (IRB), followed by recommendation from the National Health Research Authority (NHRA). The present cross-sectional study was conducted in the Mansa rural area (Luapula Province) and Ndola urban area (Copperbelt Province) in Zambia. Mansa has a population of 205,000 inhabitants whereas 127,000 live in the rural area (for further details on patient selection and recruitment see supplemental methods). The study population consisted of 399 adults aged 21 years and above, who came to the outreach sites/centers. After obtaining informed consent, 188 participants were recruited from Ndola and 211 participants from Mansa. Participants were interviewed and a questionnaire was filled out. Confidentiality was assured during the interview process. The registered variables were age, sex, residential area, marital status, education status, employment status, dental status, oral hygiene status, gingival and periodontal status, medical diseases suffered in the past, tobacco use and alcohol intake habit. The interview was followed by an oral examination. The oral examination was performed by calibrated dentists with the patient sitting in an ordinary office chair, primary school benches and using a flashlight, wooden tongue depressor, dental mirror and a dental explorer. The oral health form was adapted from WHO and structured by improving some of the questions in the language acceptable in the community. Dental caries was graded for clinically visible and for untreated cavities. The DMFT index was used in this study to estimate the caries status (for further details see supplemental methods) 14 . Gingivitis was scored and graded as absent (0) or presence (1) of bleeding on probing in the gingival sulcus of index teeth (#16, 11, 26, 36, 31, 46). Conventional tooth pocket probing was not possible due to the meagre examination facilities and lack of possibility to inform the study subjects about the procedure. Periodontal disease was defined as a tooth mobility with associated gingival recession and registered and scored grade 1–3, where grade 1 mobility indicated tooth mobility of 1 mm in buccolingual direction, grade 2 was tooth mobility of greater than 1 mm without vertical movement of the tooth, and grade 3 was scored when tooth mobility was present in all planes as well as vertically movement 15 . Oral cancer and OPMDs were assessed and distinguished from each other (for further details see supplemental methods). Data management Bivariate logistic regression analysis was performed to assess the relationship between different oral diseases and related variables (sex, age, education, living with a partner, habitat, presence of serious disease, HIV status, smoking, use of smokeless tobacco and alcohol use) and crude odds ratios (COR) and adjusted odds ratios (AOR) were calculated. Statistical significance was set at a p-value less than 0.05. Mean value ± standard error of the mean (SEM) is given in the text. IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA) and GraphPad Prism program 9.1.0 (GraphPad Software, Inc., San Diego, USA) were used to analyze the data. Results Sociodemographic data The sociodemographic data of the cohort has been presented previously 16 . In brief, there was an overweight of women (56%) and of young adults (59%) in the cohort and the average age was 39 ± 0.7 years (n = 399). It was more common in rural participants than in urban participants to not have finished primary school (45.5% vs. 28.2%, respectively; p < 0.0001). Among urban and rural participants, 11.2% and 8.5%, respectively, reported being HIV-positive, while 11.7% of urban participants and 16.6% of rural participants reported not knowing their HIV status (= 0.296) 16 . Chronic disease occurred in about one third of the participants (Supplemental table 1 ). Oral health status Table 1, figure and supplemental tables 2-3 show the frequency distribution of oral health status among the rural and urban population. Table 1 Distribution of the study participants according to oral health status. Variables Urban, N (%) Rural, N (%) Significance Dental Caries Status < 0.0001 No Dental Caries 51 (27.1) 110 (52.1) Dental caries 137 (72.9) 101 (47.9) DMFT 0.001 Low (< 4.5) 129 (68.6) 175 (82.9) High (≥ 4.5) 59 (31.4) 36 (17.1) Periodontal disease 0.634 No 159 (84.6) 182 (86.3) Yes 29 (15.4) 29 (13.8) Gingivitis 0.297 No 29 (15.4) 25 (11.8) Yes 159 (84.5) 186 (88.1) Mucosa lesions 0.048 No 181 (96.3) 206 (97.0) Leukoplakia 0 (0.0) 3 (1.4) Other lesions 7 (3.7) 2 (0.9) Dental caries was more prevalent among urban than rural participants (72.9% and 47.9%, respectively, p < 0.0001). The average DMFT was 3.1 (range 1–32). The DMFT score was significantly higher in urban participants than in rural participants (4.0 and 2.2., respectively; p < 0.0001). Likewise, high DMFT (≥ 4.5) was more common among urban participants than rural participants (31.4% and 17.1%, respectively, p < 0.001). Decayed teeth ranged from 1–17 in urban participants and 1–11 in rural participants. Only 27.1% of urban participants and 52.1% of rural participants had no decayed teeth, and, among participants 43.5% had missing teeth. The number of missing teeth ranged from 1 to 26 per person and on average each study participant missed 1.3 teeth. Filled teeth were not encountered in the examined cohort. No participant with missing teeth was found with a dental prosthesis (neither removable nor fixed denture was observed). Gingivitis was common and equally common in urban and rural participants (84.5% and 88.1%, respectively, p = 0.297). Urban and rural participants were also equally affected by the increased tooth mobility grade 2 and 3, i.e ., in 15.4% and 13.8%, respectively, of the participants (p = 0.634). Three rural participants (1.4%) had leukoplakia, while seven urban participants (3.7%) and two rural participants (0.9%) had other mucosal lesions such as swelling on the lip, epulis and oral warts (p = 0.048; Table 1 ). In a few participants from the rural cohort, it was found during oral examination that they had discolored black nasal mucus probably caused by snuffing tobacco. Table 2 Regression analysis of dental caries with socio-demographic variables Univariate analysis Multivariate analysis OR (95% CI) OR (95% CI) Significance OR (95% CI) Significance Gender Man Reference Reference Woman 0.95 (0.64–1.42) 0.803 0.94 (0.52–1.70) 0.843 Age 0.001 < 0.0001 Young adults < 40 years Reference Reference Middle adult 40–59 years 2.28 (1.42–3.67) 0.001 2.26 (1.35–3.78) 0.002 Old adult 60 + years 3.03 (1.51–6.51) 0.002 3.43 (1.61–7.31) 0.001 Education Incomplete primary school or less Reference Reference Completed primary school or more 1.19 (0.79–1.79) 0.414 0.75 (0.46–1.21) 0.232 Living with partner Yes Reference Reference No 1.03 (0.64–1.66) 0.899 1.12 (0.65–1.90) 0.690 Habitat Urban Reference Reference Rural 0.34 (0.23–0.52) < 0.0001 0.32 (0.21–0.51) < 0.0001 Serious disease No Reference Reference Yes 0.64 (0.41-1.00) 0.051 0.71 (0.43–1.17) 0.180 Smoking 0.807 0.798 No Reference Reference Yes 1.16 (0.73–1.84) 0.533 1.31 (0.53–3.25) 0.565 Ex-smoker 1.09 (0.52–2.29) 0.819 1.06 (0.42–2.64) 0.906 Smokeless tobacco No Reference Reference Yes 1.29 (0.65–2.55) 0.468 0.62 (0.22–1.72) 0.356 Alcohol use 0.565 0.728 Never/seldom Reference Reference Once a month 1.02 (0.50–2.06) 0.966 1.15 (0.51–2.60) 0.736 Once a week 1.59 (0.84–3.01) 0.157 1.17 (0.42–0.66) 0.768 Several times a week 1.38 (0.59–2.08) 0.750 1.65 (0.66–4.11) 0.285 CI = confidence interval; OR = odds ratio. Logistic regression analysis was performed to identify sociodemographic factors that predicted untreated oral diseases. In univariate and multivariate analysis, old age (60 + years) was a strong predictor for dental caries [Crude Odds Ratio (COR): 3.03 (1.51–6.51), p = 0.002, Adjusted Odds Ratio (AOR): 3.43 (1.61–7.31), p = 0.001], high DMFT [COR: 8.63 (4.33–17.17), p < 0.0001, AOR: 10.03 (4.66–21.56), p < 0.0001], gingivitis [COR: 3.90 (1.70–8.93), p = 0.001, AOR: 2.92 (1.21–7.02), p = 0.017], and periodontal disease [COR: 7.63 (3.54–16.46), p < 0.0001, AOR: 5.06 (2.20-11.66), p < 0.0001] (Table 2 – 4 and Supplemental table 4). Living in rural area was a protective predictor for dental caries [COR: 0.34 (0.23–0.52), < 0.0001, AOR: 0.32 (0.21–0.51), < 0.0001] and for DMFT [COR: 0.45 (0.28–0.72), p < 0.0001, AOR: 0.39 (0.22–0.67), < 0.0001; Table 2 and Supplemental table 4]. Table 3 Regression analysis of gingivitis with socio-demographic variables Univariate analysis Multivariate analysis OR (95% CI) OR (95% CI) Significance OR (95% CI) Significance Gender Man Reference Reference Woman 0.29 (0.14–0.57) < 0.0001 0.56 (0.24–1.30) 0.174 Age 0.006 0.058 Young adults < 40 years Reference Reference Middle adult 40–59 years 3.90 (1.70–8.93) 0.001 2.92 (1.21–7.02) 0.017 Old adult 60 + years N/A* N/A* N/A* N/A* Education Incomplete primary school or less Reference Reference Completed primary school or more 0.25 (0.12–0.55) 0.001 0.30 (0.13–0.69) 0.005 Living with partner Yes Reference Reference No 0.95 (0.49–1.87) 0.886 0.78 (0.36–1.67) 0.517 Habitat Urban Reference Reference Rural 1.36 (0.76–2.41) 0.298 1.40 (0.74–2.68) 0.304 Serious disease No Reference Reference Yes 0.36 (0.16–0.78) 0.010 0.57 (0.24–1.36) 0.205 Smoking 0.001 0.116 No Reference Reference Yes 6.10 (2.14–17.35) 0.001 6.48 (0.97–43.52) 0.054 Ex-smoker 7.50 (1.00-56.25) 0.050 4.52 (0.49–42.09) 0.185 Smokeless tobacco No Reference Reference Yes 2.04 (0.61–6.87) 0.249 0.24 (0.03–2.13) 0.200 Alcohol use 0.044 0.496 Never/seldom Reference Reference Once a month 1.00 (0.39–2.55) 1.000 0.55 (0.18–1.71) 0.304 Once a week 3.20 (0.95–10.74) 0.060 1.36 (0.35–5.29) 0.660 Several times a week 9.40 (1.26–69.94) 0.029 2.87 (0.32–25.52) 0.345 *All participants in the old adult populations were found to have gingivitis. CI = confidence interval; N/A = not applicable; OR = odds ratio. Smoking was a predictor for gingivitis [COR: 6.10 (2.14–17.35), p < 0.001; AOR 6.48 (0.97–43.52, p = 0.054; Table 3 ). Moreover, the use of smokeless tobacco was associated with high DMFT in univariate [COR: 2.36 (1.20–4.66), p = 0.013] but not in multivariate analysis [AOR: 0.40 (0.13–1.20), p = 0.103, Supplemental table 4]. To have completed primary school was a protective predictor for gingivitis [COR 0.25 (0.12–0.55), p = 0.001; AOR 0.30 (0.13–0.69), p = 0.005; Table 3 ] and periodontal disease [COR: 0.33 (0.19–0.59), p < 0.0001; AOR: 0.40 (0.20–0.78), p = 0.008; Table 4 ]. Alcohol use several times a week was in univariate analysis associated with gingivitis [COR: 9.40 (1.26–69.94), p = 0.029] and periodontal disease [COR: 2.51 (1.15–5.46), p = 0.021] but not in multivariate analysis [AOR: 2.87 (0.32–25.52), p = 0.345 and AOR: 2.31 (0.82–6.51), p = 0.113, respectively, Table 3 – 4 ]. Table 4 Regression analysis of socio-demographic variables with periodontal disease Univariate analysis Multivariate analysis OR (95% CI) OR (95% CI) Significance OR (95% CI) Significance Gender Man Reference Reference Woman 0.74 (0.42–1.29) 0.290 1.11 (0.45–2.73) 0.829 Age < 0.0001 < 0.0001 Young adults < 40 years Reference Reference Middle adult 40–59 years 3.39 (1.71–6.71) < 0.0001 2.83 (1.37–5.85) 0.005 Old adult 60 + years 7.63 (3.54–16.46) < 0.0001 5.06 (2.20-11.66) < 0.0001 Education Incomplete primary school or less Reference Reference Completed primary school or more 0.33 (0.19–0.59) < 0.0001 0.40 (0.20–0.78) 0.008 Living with partner Yes Reference Reference No 1.45 (0.78–2.69) 0.244 0.88 (0.41–1.90) 0.752 Habitat Urban Reference Reference Rural 0.87 (0.50–1.53) 0.634 0.76 (0.39–1.45) 0.398 Serious disease No Reference Reference Yes 0.44 (0.25–0.77) 0.004 0.66 (0.34–4.38) 0.214 Smoking 0.012 0.751 No Reference Reference Yes 2.47 (1.37–4.49) 0.003 1.46 (0.55–3.86) 0.451 Ex-smoker 1.47 (0.52–4.11) 0.466 1.28 (0.37–4.38) 0.698 Smokeless tobacco No Reference Reference Yes 2.52 (1.18–5.38) 0.017 1.01 (0.82–6.51) 0.992 Alcohol use 0.006 0.060 Never/seldom Reference Reference Once a month 3.71 (1.65–8.34) 0.002 3.18 (1.25–8.09) 0.015 Once a week 1.57 (0.67–3.67) 0.300 1.12 (0.40–3.15) 0.828 Several times a week 2.51 (1.15–5.46) 0.021 2.31 (0.82–6.51) 0.113 CI = confidence interval; OR = odds ratio Discussion The present study demonstrated a generally poor oral health including untreated dental caries, gingivitis, and periodontal disease in the Zambian population. Gingivitis occurred predominantly among the elderly. Several of the sociodemographic variables such as age, habitat, tobacco use, and alcohol intake were confirmed to predict oral diseases. The findings of this study are in agreement with the WHO report showing that more than half of the African population are suffering from oral disease 17 . This is a unique study for the African continent where information was collected among all adult age groups and among urban and rural inhabitants representative for the Zambian population. Alcohol use was more prevalent among the urban cohort than the rural cohort, which could be related to favorable socioeconomic status in the urban cohort compared to the rural cohort 18 . Speculatively, low income is associated with drinking heavily, while high income is associated with drinking frequency 18 . Tobacco use was similarly common in the rural and urban populations. The urban cohort was more educated than the rural cohort and education was an independent factor associated with less gingivitis and periodontal disease. Education is associated with better socioeconomic status, and high socioeconomic status is associated with better oral health as demonstrated in previous studies 19 . However, it was observed that dental caries and high DMFT were more common in the urban cohort than the rural cohort in agreement with previous reports 20 . The prevalence of 47.9% of dental caries in the rural cohort is somewhat higher than the prevalence of 33.9% of dental caries earlier reported in the rural areas of southern Zambia 21 . Since close to half of the Zambian population live in urban areas, the prevalence of untreated caries in the country is estimated to be around 60%. This prevalence is less than among adults in Sudan (87%), similar to the prevalence reported from Eritrea (65%), Malawi (49%) and Rwanda (54–72%) but higher than Tanzania (31%) and higher than the estimation made by WHO for Zambia in 2020 1,11,22–25 . The 2022 to 2026 National Health Strategic Plan estimated that prevalence of dental caries in Zambia is around 80%, and the findings of this study are in support of this plan showing that existing oral health outreaches are inadequate and confined to selected parts of the country leading to oral health services disparity 26 . Notably, old age and living in a rural area were independent factors significantly associated with dental caries. The urban cohort had a mean DMFT of 4.0, which is twice as much as the rural cohort of 2.2. While decayed and missing teeth were common, no study participants had filled teeth. This indicates a long-term neglect in dental care such that patients are reporting when the disease is advanced and restorative treatment cannot be offered or lack of knowledge on the available treatment option for a carious tooth and lack of access to restorative dental care/interventions at an early stage of the disease. In most cases in Zambia reporting to the dental clinic for treatment is because of pain when the dental diseases often are advanced 21 . The DMFT in the rural cohort was less than the DMFT reported in rural Uganda 27 . The high prevalence of dental caries observed among the rural participants could be an example of the effects of nutritional transition to a western diet in African countries, which is linked to an increased prevalence of dental caries 17 . The difference between dental caries in urban and rural cohorts could be explained by availability, and accessibility to cariogenic foods in urban areas compared to rural areas. The study did, however, not explore the intake of cariogenic food or examine the degree of use of toothbrush and toothpaste in the rural and urban cohorts. In the current study more than three quarter of both the rural and urban cohort had gingivitis. Gingivitis is an indicator of poor oral hygiene practices 28 . Inaccessibility to oral hygiene devices such as toothbrush and toothpaste or poor knowledge of prevention of oral diseases could be factors contributing to poor oral health among the rural participants. Male gender and incompletion of primary school were also factors associated with gingivitis. The findings of more men than women with periodontal disease are in line with a cross-sectional study conducted in adults in South Africa 29 . Increasing age was associated with increased prevalence of gingivitis and all adults above the age of 60 had gingivitis. The prevalence of severe periodontal disease was found to be low. The prevalence was similar to the prevalence of severe periodontal disease in Zambia reported by WHO and from Ghana but lower than the prevalence of 31.8% of severe periodontitis reported from a general outpatient clinic of a large tertiary hospital in Lagos, Nigeria 30 – 32 . Age was strongly associated with the presence of periodontal disease. It is important to notice that our cohort constituted predominantly by young individuals (median age 36.5) from a non-hospitalized based cohort, which could have contributed to the low prevalence of periodontal disease compared to aforementioned African studies 30 – 32 . Participants with a higher education level were also less affected by periodontal disease. In the univariate regression analysis, alcohol consumption strongly predicted this condition in the rural and urban cohort. Some reports show that alcohol consumption is associated with periodontal disease 33 , while other studies show no association 34 . OPMDs were rarely encountered in the studied cohorts. Leukoplakia was demonstrated in the rural population in only three participants with an overall prevalence of 0.8% in the rural and urban cohorts. This prevalence is lower than the prevalence of 2.4% observed in a cross-sectional study from South Africa 35 . The strength of this study comes from the fact that information on oral health in the general adult population of Zambia was captured for the first time. Most of the oral health information available is from the studies conducted in children and adolescents. This study has, however, also its limitations. Signs of severe periodontitis were identified by the presence of gingivitis and increased tooth mobility during screening. Assessment of periodontal pocket depth and obtaining radiographs were not feasible to perform due to the lack of proper examination facilities. Thus, this could lead to an underreport of the prevalence of periodontitis. Furthermore, this study had a slight overweight of women in the rural cohort, which is accounted by the fact that the study was conducted during working hours and most of the men were involved in work. The sample size of 399 participants was also relatively small. Several dental conditions are probably missed at health posts and health centres in Zambia. Working at these centres are non-dental health workers who lack the knowledge of the basic interventions for dental diseases 11 . The findings of this study call for minimal intervention dentistry from oral health personnel and stakeholders focusing on risk assessment, early prevention, and interception of oral diseases to protect and retain natural teeth as long as possible. By improving oral health, it may improve general health and longevity in the population. In conclusion, oral diseases were common in the Zambian population particularly among the elderly. The oral diseases encountered indicated an unmet need for dental care. Urban habitat, old age, male gender, alcohol abuse, tobacco use, and poor education were confirmed to be associated with the encountered oral health status of the Zambian population. Declarations Acknowledgements We thank the staff who participated in data collection during the study period. Funding declaration The study was sponsored by the King Gustav V Jubilee Clinic Cancer Research Foundation, Gothenburg, Sweden. Authors' contributions CHM, GK, BH, DG designed the study, CHM and DG collected the data, CHM, BH and DG analyzed and interpreted the results, CHM, BH and DG drafted the manuscript and all authors reviewed the results and approved the final version of the manuscript. Competing Interests Statement DG has served on scientific advisory boards and scientific presentations for Merck, Roche and AstraZeneca. CHM, GK, and BH declare no conflict of interest. Data availability statement Additional data is available upon request from the Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3A SE-413 90 Göteborg, Sweden. Email: [email protected] . Ethics declarations: Ethical approval was obtained from the Tropical Disease Research Centre (TDRC) Institution Review Board (IRB), followed by recommendation from the National Health Research Authority (NHRA). The study adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all participants in the study. References W. H. O. Promoting Oral Health in Africa: prevention and control of oral diseases and noma as part of essential noncommunicable disease interventions. (2016). Jain, N., Dutt, U., Radenkov, I. & Jain, S. WHO's global oral health status report 2022: Actions, discussion and implementation. Oral Dis. 30 , 73–79. 10.1111/odi.14516 (2024). Komlos, G., Csurgay, K., Horvath, F., Pelyhe, L. & Nemeth, Z. 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Caries assessment spectrum treatment: the severity score. Int. Dent. J. 68 , 84–90. 10.1111/idj.12331 (2018). Mumena, C. H. et al. Oral human papillomavirus infections in Zambian Rural and Urban residents-a community cross-sectional study. BMC Oral Health . 24 , 1540. 10.1186/s12903-024-05312-4 (2024). Gallagher, J. E. et al. Oral Health Workforce in Africa: A Scarce Resource. Int. J. Environ. Res. Public. Health . 20 10.3390/ijerph20032328 (2023). Huckle, T., You, R. Q. & Casswell, S. Socio-economic status predicts drinking patterns but not alcohol-related consequences independently. Addiction 105 , 1192–1202. 10.1111/j.1360-0443.2010.02931.x (2010). Singh, A., Peres, M. A. & Watt, R. G. The Relationship between Income and Oral Health: A Critical Review. J. Dent. Res. 98 , 853–860. 10.1177/0022034519849557 (2019). Health, M. Annual Health Statistical Report , (2022). https://www.moh.gov.zm/?wpfb_dl=231 Morgan, J. P., Marino, O. N., Finkelman, M., Mourao, C. F. & Flubinda, F. S. Rural Zambian Oral Health Transition: A Long-Term Retrospective Examination of an Outreach Program's Progress and Impact. Ann. Glob Health . 89 , 68. 10.5334/aogh.4179 (2023). Abbass, M. M. S. et al. The potential impact of age, gender, body mass index, socioeconomic status and dietary habits on the prevalence of dental caries among Egyptian adults: a cross-sectional study. F1000Res 8 , 243. 10.12688/f1000research.17892.1 (2019). Teshome, A., Muche, A. & Girma, B. Prevalence of Dental Caries and Associated Factors in East Africa, 2000–2020: Systematic Review and Meta-Analysis. Front. Public. Health . 9 , 645091. 10.3389/fpubh.2021.645091 (2021). Kanmodi, K. K., Uwambaye, P., Amzat, J. & Salami, A. A. Dental caries in Rwanda: A scoping review. Health Sci. Rep. 6 , e1258. 10.1002/hsr2.1258 (2023). Khalifa, N., Allen, P. F., Abu-bakr, N. H., Abdel-Rahman, M. E. & Abdelghafar, K. O. A survey of oral health in a Sudanese population. BMC Oral Health . 12 , 5. 10.1186/1472-6831-12-5 (2012). Health, M. 2022–2026 Zambia National Health Strategic Plan Towards Attainment of Quality Universal Health Coverage Through Decentralisation. (2022). https://www.moh.gov.zm/?page_id=3553 Kutesa, A. et al. Prevalence and factors associated with dental caries among children and adults in selected districts in Uganda. Afr. Health Sci. 15 , 1302–1307. 10.4314/ahs.v15i4.33 (2015). Chapple, I. L. et al. Primary prevention of periodontitis: managing gingivitis. J. Clin. Periodontol . 42 (Suppl 16), 71–76. 10.1111/jcpe.12366 (2015). Chikte, U. et al. Periodontal Disease Status among Adults from South Africa-Prevalence and Effect of Smoking. Int. J. Environ. Res. Public. Health . 16 10.3390/ijerph16193662 (2019). Hewlett, S. A. et al. Assessment of oral health status in a Ghanaian population: rationale, methods, and population characteristics. BMC Oral Health . 22 , 67. 10.1186/s12903-022-02090-9 (2022). 2019., W. O. H. C. P. R., (2019). Ojo, K. O., Odukoya, O. O., Ayanbadejo, P. O. & Akinlawon, D. Prevalence of periodontitis and oral hygiene practices among diabetic and non-diabetic patients in a tertiary hospital in Lagos: a cross-sectional study. Pan Afr. Med. J. 45 , 131. 10.11604/pamj.2023.45.131.37904 (2023). Lee, M. et al. The interactive association of smoking and drinking levels with presence of periodontitis in South Korean adults. BMC Oral Health . 16 10.1186/s12903-016-0268-y (2016). Okamoto, Y. et al. Effects of smoking and drinking habits on the incidence of periodontal disease and tooth loss among Japanese males: a 4-yr longitudinal study. J. Periodontal Res. 41 , 560–566. 10.1111/j.1600-0765.2006.00907.x (2006). Pontes, C. C. et al. Prevalence of Oral Mucosal Lesions and Relation to Serum Cotinine Levels-Findings from a Cross-Sectional Study in South Africa. Int. J. Environ. Res. Public. Health . 17 10.3390/ijerph17031065 (2020). Additional Declarations Competing interest reported. DG has served on scientific advisory boards and scientific presentations for Merck, Roche and AstraZeneca. CHM, GK, and BH declare no conflict of interest. Supplementary Files SupplementaltablesScientificReports.doc Additional data Supplemental methods. Supplemental table 1. Distribution of chronic diseases among study participants. Supplemental table 2. Number of missing teeth among urban and rural participants. Supplemental table 3. DMFT score among urban and rural participants. Supplemental table 4. Relationship assessed by regression analysis of DMFT ≥4.5 with socio-demographic variables. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6673703","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":493365387,"identity":"bb378901-39d2-44ab-bc53-6c0996fcfe6b","order_by":0,"name":"Chrispinus Hakimu Mumena","email":"","orcid":"","institution":"Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Chrispinus","middleName":"Hakimu","lastName":"Mumena","suffix":""},{"id":493365388,"identity":"5f690d84-6bcc-48a2-a3d6-1d96ba520d89","order_by":1,"name":"Göran Kjeller","email":"","orcid":"","institution":"Department of Oral and Maxillofacial Surgery, Institute of Odontology, Sahlgrenska Academy at the University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Göran","middleName":"","lastName":"Kjeller","suffix":""},{"id":493365389,"identity":"9a00a098-519d-4fef-9ac3-bf9fdecd3e3b","order_by":2,"name":"Bengt Hasséus","email":"","orcid":"","institution":"Department of Oral Medicine and Pathology, Institute of Odontology, Sahlgrenska Academy at the University of Gothenburg","correspondingAuthor":false,"prefix":"","firstName":"Bengt","middleName":"","lastName":"Hasséus","suffix":""},{"id":493365390,"identity":"33cbda4f-2284-4069-8e41-5750cbf722fb","order_by":3,"name":"Daniel Giglio","email":"data:image/png;base64,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","orcid":"","institution":"Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg","correspondingAuthor":true,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Giglio","suffix":""}],"badges":[],"createdAt":"2025-05-15 14:38:24","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6673703/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6673703/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-24683-4","type":"published","date":"2025-10-21T16:16:38+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":88094452,"identity":"3afe8ee7-2a59-457b-9747-0bb4752feddf","added_by":"auto","created_at":"2025-08-01 10:48:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":6101,"visible":true,"origin":"","legend":"\u003cp\u003eThe number of missing teeth (a) and the Decayed, Missing, and Filled Teeth (mean DMFT) index (b) in rural and urban Zambian participants.\u003c/p\u003e","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6673703/v1/769c8965a52821758705f068.png"},{"id":94490343,"identity":"b70f2dcb-2edc-436c-a38c-79c0f28cebfa","added_by":"auto","created_at":"2025-10-27 17:09:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1384654,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6673703/v1/a5b35380-6edd-4c5d-8707-a158e7d4c325.pdf"},{"id":88096266,"identity":"48488b85-c43b-4fc7-9f89-e4d4d6feafba","added_by":"auto","created_at":"2025-08-01 10:56:23","extension":"doc","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":285538,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional data\u003cbr\u003e\n\u003c/strong\u003eSupplemental methods.\u003c/p\u003e\n\u003cp\u003eSupplemental table 1. Distribution of chronic diseases among study participants.\u003c/p\u003e\n\u003cp\u003eSupplemental table 2. Number of missing teeth among urban and rural participants.\u003c/p\u003e\n\u003cp\u003eSupplemental table 3. DMFT score among urban and rural participants.\u003c/p\u003e\n\u003cp\u003eSupplemental table 4. Relationship assessed by regression analysis of DMFT ≥4.5 with socio-demographic variables.\u003c/p\u003e","description":"","filename":"SupplementaltablesScientificReports.doc","url":"https://assets-eu.researchsquare.com/files/rs-6673703/v1/5f4b86f5ff8cfeb89a44fdca.doc"},{"id":88093577,"identity":"19f8b70e-83fb-467d-9d4f-fea803aae1ed","added_by":"auto","created_at":"2025-08-01 10:40:23","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":17163,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalmethodsScientificReports2025.docx","url":"https://assets-eu.researchsquare.com/files/rs-6673703/v1/ca5201583655b222a9d88af2.docx"}],"financialInterests":"Competing interest reported. DG has served on scientific advisory boards and scientific presentations for Merck, Roche and AstraZeneca. CHM, GK, and BH declare no conflict of interest.","formattedTitle":"Oral Health Status Among Rural and Urban Inhabitants of Zambia-a Community Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOral diseases are a global public health concern affecting 3.9\u0026nbsp;billion people in the world with an increase in incidence by almost 21% between 1990 to 2010\u003csup\u003e1\u003c/sup\u003e. Caries of the permanent teeth is the current major public health problem among the non-communicable diseases\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Oral health is, however, a neglected problem, especially in African countries, despite that oral diseases share risk factors with other non-communicable diseases such as diabetes and hypertension\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Poor oral health is also among the risk factors associated with the development of oral cancer\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Other risk factors for oral cancer include tobacco, alcohol, betel quid use and diet\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Oral cancer is in many cases preceded by oral potentially malignant disorders (OPMDs), which include leukoplakia, erythroplakia, oral lichen planus and submucous fibrosis\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe population in Zambia living below the poverty line is approximately 64.3%\u003csup\u003e6\u003c/sup\u003e. In 2023, Zambia had a GDP per capita of 1331 USD, while Burundi (lowest GDP per capita in the world), Zimbabwe, Botswana (highest GDP per capita on the African continent) and South Africa had a GDP per capita of 193 USD, 2156 USD, 7820 USD and 6023 USD, respectively\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. In 2018, there was only one dentist per 100,000 inhabitants working in Zambia\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Few studies exist on oral health status in the adult population of Zambia as well as elsewhere in Africa. A systematic review showed a prevalence of dental caries of 36% in the permanent dentition among 12-year-old children in Africa, where Zambia was reported to have the lowest prevalence of 11%\u003csup\u003e9\u003c/sup\u003e. Severine et. al. showed that almost half of secondary school adolescents in the Copperbelt province, Zambia, had pre-morbidity stage of dental caries or worse\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. A population-based study on oral health in Zambia\u0026acute;s eastern neighboring country Malawi showed that 49% of people older than 35 had caries, and, decayed, missing, and filled teeth (DMFT) index in 12, 15, 35\u0026ndash;44, 65\u0026ndash;74-year-olds was 0.67, 0.71, 3.11 and 6.87, respectively\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003ePopulation-based studies on the prevalence of oral health, oral cancer and OPMDs in sub-Saharan African populations are only few. Still the use of tobacco and alcohol abuse are common in sub-Saharan Africa including Zambia, particularly in uneducated men\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e, constituting significant risk factors for the development of OPMDs and oral cancer\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The sale of tobacco product has also increased in Africa\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. No studies, to our knowledge, have been conducted on the prevalence of OPMDs in the general or clinic-based populations in Zambia.\u003c/p\u003e\u003cp\u003eThe present cross-sectional epidemiological study was conducted to assess oral health in rural and urban Zambia. The prevalence of dental caries, gingivitis, periodontal disease, OPMDs and other oral diseases in the general population were assessed and compared between the rural and urban population and factors associated with oral health were assessed.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003ewas obtained from the Tropical Disease Research Centre (TDRC) Institution Review Board (IRB), followed by recommendation from the National Health Research Authority (NHRA). The present cross-sectional study was conducted in the Mansa rural area (Luapula Province) and Ndola urban area (Copperbelt Province) in Zambia. Mansa has a population of 205,000 inhabitants whereas 127,000 live in the rural area (for further details on patient selection and recruitment see supplemental methods).\u003c/p\u003e\u003c/p\u003e\u003cp\u003eThe study population consisted of 399 adults aged 21 years and above, who came to the outreach sites/centers. After obtaining informed consent, 188 participants were recruited from Ndola and 211 participants from Mansa. Participants were interviewed and a questionnaire was filled out. Confidentiality was assured during the interview process. The registered variables were age, sex, residential area, marital status, education status, employment status, dental status, oral hygiene status, gingival and periodontal status, medical diseases suffered in the past, tobacco use and alcohol intake habit. The interview was followed by an oral examination. The oral examination was performed by calibrated dentists with the patient sitting in an ordinary office chair, primary school benches and using a flashlight, wooden tongue depressor, dental mirror and a dental explorer. The oral health form was adapted from WHO and structured by improving some of the questions in the language acceptable in the community.\u003c/p\u003e\u003cp\u003eDental caries was graded for clinically visible and for untreated cavities. The DMFT index was used in this study to estimate the caries status (for further details see supplemental methods)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Gingivitis was scored and graded as absent (0) or presence (1) of bleeding on probing in the gingival sulcus of index teeth (#16, 11, 26, 36, 31, 46). Conventional tooth pocket probing was not possible due to the meagre examination facilities and lack of possibility to inform the study subjects about the procedure. Periodontal disease was defined as a tooth mobility with associated gingival recession and registered and scored grade 1\u0026ndash;3, where grade 1 mobility indicated tooth mobility of 1 mm in buccolingual direction, grade 2 was tooth mobility of greater than 1 mm without vertical movement of the tooth, and grade 3 was scored when tooth mobility was present in all planes as well as vertically movement\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. Oral cancer and OPMDs were assessed and distinguished from each other (for further details see supplemental methods).\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eData management\u003c/h2\u003e\u003cp\u003eBivariate logistic regression analysis was performed to assess the relationship between different oral diseases and related variables (sex, age, education, living with a partner, habitat, presence of serious disease, HIV status, smoking, use of smokeless tobacco and alcohol use) and crude odds ratios (COR) and adjusted odds ratios (AOR) were calculated. Statistical significance was set at a p-value less than 0.05. Mean value\u0026thinsp;\u0026plusmn;\u0026thinsp;standard error of the mean (SEM) is given in the text. IBM SPSS Statistics version 26 (IBM Corp., Armonk, NY, USA) and GraphPad Prism program 9.1.0 (GraphPad Software, Inc., San Diego, USA) were used to analyze the data.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic data\u003c/h2\u003e\u003cp\u003eThe sociodemographic data of the cohort has been presented previously\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In brief, there was an overweight of women (56%) and of young adults (59%) in the cohort and the average age was 39\u0026thinsp;\u0026plusmn;\u0026thinsp;0.7 years (n\u0026thinsp;=\u0026thinsp;399). It was more common in rural participants than in urban participants to not have finished primary school (45.5% vs. 28.2%, respectively; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Among urban and rural participants, 11.2% and 8.5%, respectively, reported being HIV-positive, while 11.7% of urban participants and 16.6% of rural participants reported not knowing their HIV status (=\u0026thinsp;0.296)\u003csup\u003e16\u003c/sup\u003e. Chronic disease occurred in about one third of the participants (Supplemental table \u003cspan refid=\"MOESM1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eOral health status\u003c/h3\u003e\n\u003cp\u003eTable 1, figure and supplemental tables 2-3 show the frequency distribution of oral health status among the rural and urban population.\u0026nbsp;\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDistribution of the study participants according to oral health status.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUrban, N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRural, N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDental Caries Status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.0001\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo Dental Caries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e51 (27.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e110 (52.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDental caries\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e137 (72.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (47.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDMFT\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLow (\u0026lt;\u0026thinsp;4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e129 (68.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175 (82.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHigh (\u0026ge;\u0026thinsp;4.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e59 (31.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36 (17.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePeriodontal disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e159 (84.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182 (86.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e29 (13.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGingivitis\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.297\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29 (15.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (11.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e159 (84.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e186 (88.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMucosa lesions\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e0.048\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e181 (96.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e206 (97.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLeukoplakia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3 (1.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOther lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (3.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (0.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDental caries was more prevalent among urban than rural participants (72.9% and 47.9%, respectively, p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The average DMFT was 3.1 (range 1\u0026ndash;32). The DMFT score was significantly higher in urban participants than in rural participants (4.0 and 2.2., respectively; p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). Likewise, high DMFT (\u0026ge;\u0026thinsp;4.5) was more common among urban participants than rural participants (31.4% and 17.1%, respectively, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Decayed teeth ranged from 1\u0026ndash;17 in urban participants and 1\u0026ndash;11 in rural participants. Only 27.1% of urban participants and 52.1% of rural participants had no decayed teeth, and, among participants 43.5% had missing teeth. The number of missing teeth ranged from 1 to 26 per person and on average each study participant missed 1.3 teeth. Filled teeth were not encountered in the examined cohort. No participant with missing teeth was found with a dental prosthesis (neither removable nor fixed denture was observed).\u003c/p\u003e\u003cp\u003eGingivitis was common and equally common in urban and rural participants (84.5% and 88.1%, respectively, p\u0026thinsp;=\u0026thinsp;0.297). Urban and rural participants were also equally affected by the increased tooth mobility grade 2 and 3, \u003cem\u003ei.e\u003c/em\u003e., in 15.4% and 13.8%, respectively, of the participants (p\u0026thinsp;=\u0026thinsp;0.634). Three rural participants (1.4%) had leukoplakia, while seven urban participants (3.7%) and two rural participants (0.9%) had other mucosal lesions such as swelling on the lip, epulis and oral warts (p\u0026thinsp;=\u0026thinsp;0.048; Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In a few participants from the rural cohort, it was found during oral examination that they had discolored black nasal mucus probably caused by snuffing tobacco.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis of dental caries with socio-demographic variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWoman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95 (0.64\u0026ndash;1.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.803\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.94 (0.52\u0026ndash;1.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.843\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung adults\u0026thinsp;\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle adult 40\u0026ndash;59 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.28 (1.42\u0026ndash;3.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.26 (1.35\u0026ndash;3.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOld adult 60\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.03 (1.51\u0026ndash;6.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.43 (1.61\u0026ndash;7.31)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncomplete primary school or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompleted primary school or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.19 (0.79\u0026ndash;1.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.414\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.75 (0.46\u0026ndash;1.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.232\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving with partner\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.03 (0.64\u0026ndash;1.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.899\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12 (0.65\u0026ndash;1.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.690\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHabitat\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.34 (0.23\u0026ndash;0.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.32 (0.21\u0026ndash;0.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerious disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.64 (0.41-1.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.051\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.71 (0.43\u0026ndash;1.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.180\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.807\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.798\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.16 (0.73\u0026ndash;1.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.31 (0.53\u0026ndash;3.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.565\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEx-smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.09 (0.52\u0026ndash;2.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.819\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.06 (0.42\u0026ndash;2.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.906\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmokeless tobacco\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.29 (0.65\u0026ndash;2.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.468\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.62 (0.22\u0026ndash;1.72)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.356\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.565\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.728\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever/seldom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.02 (0.50\u0026ndash;2.06)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.15 (0.51\u0026ndash;2.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.736\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.59 (0.84\u0026ndash;3.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.17 (0.42\u0026ndash;0.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.768\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeveral times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.38 (0.59\u0026ndash;2.08)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.750\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.65 (0.66\u0026ndash;4.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.285\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; OR\u0026thinsp;=\u0026thinsp;odds ratio.\u003c/p\u003e\u003cp\u003eLogistic regression analysis was performed to identify sociodemographic factors that predicted untreated oral diseases. In univariate and multivariate analysis, old age (60\u0026thinsp;+\u0026thinsp;years) was a strong predictor for dental caries [Crude Odds Ratio (COR): 3.03 (1.51\u0026ndash;6.51), p\u0026thinsp;=\u0026thinsp;0.002, Adjusted Odds Ratio (AOR): 3.43 (1.61\u0026ndash;7.31), p\u0026thinsp;=\u0026thinsp;0.001], high DMFT [COR: 8.63 (4.33\u0026ndash;17.17), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, AOR: 10.03 (4.66\u0026ndash;21.56), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001], gingivitis [COR: 3.90 (1.70\u0026ndash;8.93), p\u0026thinsp;=\u0026thinsp;0.001, AOR: 2.92 (1.21\u0026ndash;7.02), p\u0026thinsp;=\u0026thinsp;0.017], and periodontal disease [COR: 7.63 (3.54\u0026ndash;16.46), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, AOR: 5.06 (2.20-11.66), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001] (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e and Supplemental table 4). Living in rural area was a protective predictor for dental caries [COR: 0.34 (0.23\u0026ndash;0.52), \u0026lt;\u0026thinsp;0.0001, AOR: 0.32 (0.21\u0026ndash;0.51), \u0026lt;\u0026thinsp;0.0001] and for DMFT [COR: 0.45 (0.28\u0026ndash;0.72), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, AOR: 0.39 (0.22\u0026ndash;0.67), \u0026lt;\u0026thinsp;0.0001; Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e and Supplemental table 4].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis of gingivitis with socio-demographic variables\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWoman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.29 (0.14\u0026ndash;0.57)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.56 (0.24\u0026ndash;1.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.174\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.058\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung adults\u0026thinsp;\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle adult 40\u0026ndash;59 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.90 (1.70\u0026ndash;8.93)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.92 (1.21\u0026ndash;7.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOld adult 60\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eN/A*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eN/A*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eN/A*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eN/A*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncomplete primary school or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompleted primary school or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.25 (0.12\u0026ndash;0.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.30 (0.13\u0026ndash;0.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving with partner\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.95 (0.49\u0026ndash;1.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.78 (0.36\u0026ndash;1.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.517\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHabitat\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.36 (0.76\u0026ndash;2.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.40 (0.74\u0026ndash;2.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerious disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.36 (0.16\u0026ndash;0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.010\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.57 (0.24\u0026ndash;1.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.205\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.116\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.10 (2.14\u0026ndash;17.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.48 (0.97\u0026ndash;43.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEx-smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.50 (1.00-56.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.52 (0.49\u0026ndash;42.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.185\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmokeless tobacco\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.04 (0.61\u0026ndash;6.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.249\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.24 (0.03\u0026ndash;2.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.200\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.496\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever/seldom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.00 (0.39\u0026ndash;2.55)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.55 (0.18\u0026ndash;1.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.304\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.20 (0.95\u0026ndash;10.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.36 (0.35\u0026ndash;5.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.660\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeveral times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.40 (1.26\u0026ndash;69.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.029\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.87 (0.32\u0026ndash;25.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.345\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e*All participants in the old adult populations were found to have gingivitis. CI\u0026thinsp;=\u0026thinsp;confidence interval; N/A\u0026thinsp;=\u0026thinsp;not applicable; OR\u0026thinsp;=\u0026thinsp;odds ratio.\u003c/p\u003e\u003cp\u003eSmoking was a predictor for gingivitis [COR: 6.10 (2.14\u0026ndash;17.35), p\u0026thinsp;\u0026lt;\u0026thinsp;0.001; AOR 6.48 (0.97\u0026ndash;43.52, p\u0026thinsp;=\u0026thinsp;0.054; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Moreover, the use of smokeless tobacco was associated with high DMFT in univariate [COR: 2.36 (1.20\u0026ndash;4.66), p\u0026thinsp;=\u0026thinsp;0.013] but not in multivariate analysis [AOR: 0.40 (0.13\u0026ndash;1.20), p\u0026thinsp;=\u0026thinsp;0.103, Supplemental table 4]. To have completed primary school was a protective predictor for gingivitis [COR 0.25 (0.12\u0026ndash;0.55), p\u0026thinsp;=\u0026thinsp;0.001; AOR 0.30 (0.13\u0026ndash;0.69), p\u0026thinsp;=\u0026thinsp;0.005; Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e] and periodontal disease [COR: 0.33 (0.19\u0026ndash;0.59), p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; AOR: 0.40 (0.20\u0026ndash;0.78), p\u0026thinsp;=\u0026thinsp;0.008; Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e]. Alcohol use several times a week was in univariate analysis associated with gingivitis [COR: 9.40 (1.26\u0026ndash;69.94), p\u0026thinsp;=\u0026thinsp;0.029] and periodontal disease [COR: 2.51 (1.15\u0026ndash;5.46), p\u0026thinsp;=\u0026thinsp;0.021] but not in multivariate analysis [AOR: 2.87 (0.32\u0026ndash;25.52), p\u0026thinsp;=\u0026thinsp;0.345 and AOR: 2.31 (0.82\u0026ndash;6.51), p\u0026thinsp;=\u0026thinsp;0.113, respectively, Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRegression analysis of socio-demographic variables with periodontal disease\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003eUnivariate analysis\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003eMultivariate analysis\u003c/p\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSignificance\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWoman\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.74 (0.42\u0026ndash;1.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.290\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.11 (0.45\u0026ndash;2.73)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.829\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYoung adults\u0026thinsp;\u0026lt;\u0026thinsp;40 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMiddle adult 40\u0026ndash;59 years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.39 (1.71\u0026ndash;6.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.83 (1.37\u0026ndash;5.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOld adult 60\u0026thinsp;+\u0026thinsp;years\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.63 (3.54\u0026ndash;16.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5.06 (2.20-11.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncomplete primary school or less\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCompleted primary school or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.33 (0.19\u0026ndash;0.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.0001\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.40 (0.20\u0026ndash;0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.008\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eLiving with partner\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.45 (0.78\u0026ndash;2.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.244\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.88 (0.41\u0026ndash;1.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.752\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHabitat\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.87 (0.50\u0026ndash;1.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.634\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.76 (0.39\u0026ndash;1.45)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.398\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSerious disease\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0.44 (0.25\u0026ndash;0.77)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0.66 (0.34\u0026ndash;4.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmoking\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.012\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.751\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.47 (1.37\u0026ndash;4.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.003\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.46 (0.55\u0026ndash;3.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.451\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEx-smoker\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.47 (0.52\u0026ndash;4.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.466\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.28 (0.37\u0026ndash;4.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.698\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSmokeless tobacco\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.52 (1.18\u0026ndash;5.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.017\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.01 (0.82\u0026ndash;6.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.992\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAlcohol use\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.060\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNever/seldom\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a month\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.71 (1.65\u0026ndash;8.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.18 (1.25\u0026ndash;8.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u003cb\u003e0.015\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOnce a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.57 (0.67\u0026ndash;3.67)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.300\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.12 (0.40\u0026ndash;3.15)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.828\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSeveral times a week\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.51 (1.15\u0026ndash;5.46)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.31 (0.82\u0026ndash;6.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.113\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003eCI\u0026thinsp;=\u0026thinsp;confidence interval; OR\u0026thinsp;=\u0026thinsp;odds ratio\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study demonstrated a generally poor oral health including untreated dental caries, gingivitis, and periodontal disease in the Zambian population. Gingivitis occurred predominantly among the elderly. Several of the sociodemographic variables such as age, habitat, tobacco use, and alcohol intake were confirmed to predict oral diseases. The findings of this study are in agreement with the WHO report showing that more than half of the African population are suffering from oral disease\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis is a unique study for the African continent where information was collected among all adult age groups and among urban and rural inhabitants representative for the Zambian population. Alcohol use was more prevalent among the urban cohort than the rural cohort, which could be related to favorable socioeconomic status in the urban cohort compared to the rural cohort\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Speculatively, low income is associated with drinking heavily, while high income is associated with drinking frequency\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Tobacco use was similarly common in the rural and urban populations.\u003c/p\u003e\u003cp\u003eThe urban cohort was more educated than the rural cohort and education was an independent factor associated with less gingivitis and periodontal disease. Education is associated with better socioeconomic status, and high socioeconomic status is associated with better oral health as demonstrated in previous studies\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. However, it was observed that dental caries and high DMFT were more common in the urban cohort than the rural cohort in agreement with previous reports\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The prevalence of 47.9% of dental caries in the rural cohort is somewhat higher than the prevalence of 33.9% of dental caries earlier reported in the rural areas of southern Zambia\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Since close to half of the Zambian population live in urban areas, the prevalence of untreated caries in the country is estimated to be around 60%. This prevalence is less than among adults in Sudan (87%), similar to the prevalence reported from Eritrea (65%), Malawi (49%) and Rwanda (54\u0026ndash;72%) but higher than Tanzania (31%) and higher than the estimation made by WHO for Zambia in 2020\u003csup\u003e1,11,22\u0026ndash;25\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe 2022 to 2026 National Health Strategic Plan estimated that prevalence of dental caries in Zambia is around 80%, and the findings of this study are in support of this plan showing that existing oral health outreaches are inadequate and confined to selected parts of the country leading to oral health services disparity\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Notably, old age and living in a rural area were independent factors significantly associated with dental caries. The urban cohort had a mean DMFT of 4.0, which is twice as much as the rural cohort of 2.2. While decayed and missing teeth were common, no study participants had filled teeth. This indicates a long-term neglect in dental care such that patients are reporting when the disease is advanced and restorative treatment cannot be offered or lack of knowledge on the available treatment option for a carious tooth and lack of access to restorative dental care/interventions at an early stage of the disease. In most cases in Zambia reporting to the dental clinic for treatment is because of pain when the dental diseases often are advanced\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe DMFT in the rural cohort was less than the DMFT reported in rural Uganda\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. The high prevalence of dental caries observed among the rural participants could be an example of the effects of nutritional transition to a western diet in African countries, which is linked to an increased prevalence of dental caries\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The difference between dental caries in urban and rural cohorts could be explained by availability, and accessibility to cariogenic foods in urban areas compared to rural areas. The study did, however, not explore the intake of cariogenic food or examine the degree of use of toothbrush and toothpaste in the rural and urban cohorts.\u003c/p\u003e\u003cp\u003eIn the current study more than three quarter of both the rural and urban cohort had gingivitis. Gingivitis is an indicator of poor oral hygiene practices\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. Inaccessibility to oral hygiene devices such as toothbrush and toothpaste or poor knowledge of prevention of oral diseases could be factors contributing to poor oral health among the rural participants. Male gender and incompletion of primary school were also factors associated with gingivitis. The findings of more men than women with periodontal disease are in line with a cross-sectional study conducted in adults in South Africa\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. Increasing age was associated with increased prevalence of gingivitis and all adults above the age of 60 had gingivitis.\u003c/p\u003e\u003cp\u003eThe prevalence of severe periodontal disease was found to be low. The prevalence was similar to the prevalence of severe periodontal disease in Zambia reported by WHO and from Ghana but lower than the prevalence of 31.8% of severe periodontitis reported from a general outpatient clinic of a large tertiary hospital in Lagos, Nigeria\u003csup\u003e\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Age was strongly associated with the presence of periodontal disease. It is important to notice that our cohort constituted predominantly by young individuals (median age 36.5) from a non-hospitalized based cohort, which could have contributed to the low prevalence of periodontal disease compared to aforementioned African studies\u003csup\u003e\u003cspan additionalcitationids=\"CR31\" citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Participants with a higher education level were also less affected by periodontal disease. In the univariate regression analysis, alcohol consumption strongly predicted this condition in the rural and urban cohort. Some reports show that alcohol consumption is associated with periodontal disease\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e, while other studies show no association\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eOPMDs were rarely encountered in the studied cohorts. Leukoplakia was demonstrated in the rural population in only three participants with an overall prevalence of 0.8% in the rural and urban cohorts. This prevalence is lower than the prevalence of 2.4% observed in a cross-sectional study from South Africa\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe strength of this study comes from the fact that information on oral health in the general adult population of Zambia was captured for the first time. Most of the oral health information available is from the studies conducted in children and adolescents. This study has, however, also its limitations. Signs of severe periodontitis were identified by the presence of gingivitis and increased tooth mobility during screening. Assessment of periodontal pocket depth and obtaining radiographs were not feasible to perform due to the lack of proper examination facilities. Thus, this could lead to an underreport of the prevalence of periodontitis. Furthermore, this study had a slight overweight of women in the rural cohort, which is accounted by the fact that the study was conducted during working hours and most of the men were involved in work. The sample size of 399 participants was also relatively small.\u003c/p\u003e\u003cp\u003eSeveral dental conditions are probably missed at health posts and health centres in Zambia. Working at these centres are non-dental health workers who lack the knowledge of the basic interventions for dental diseases\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. The findings of this study call for minimal intervention dentistry from oral health personnel and stakeholders focusing on risk assessment, early prevention, and interception of oral diseases to protect and retain natural teeth as long as possible. By improving oral health, it may improve general health and longevity in the population.\u003c/p\u003e\u003cp\u003eIn conclusion, oral diseases were common in the Zambian population particularly among the elderly. The oral diseases encountered indicated an unmet need for dental care. Urban habitat, old age, male gender, alcohol abuse, tobacco use, and poor education were confirmed to be associated with the encountered oral health status of the Zambian population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the staff who participated in data collection during the study period.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding declaration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was sponsored by the King Gustav V Jubilee Clinic Cancer Research Foundation, Gothenburg, Sweden.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCHM, GK, BH, DG designed the study, CHM and DG collected the data, CHM, BH and DG analyzed and interpreted the results, CHM, BH and DG drafted the manuscript and all authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDG has served on scientific advisory boards and scientific presentations for Merck, Roche and AstraZeneca. CHM, GK, and BH declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAdditional data is available upon request from the Institute of Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Medicinaregatan 3A SE-413 90 G\u0026ouml;teborg, Sweden. Email: [email protected].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations:\u0026nbsp;\u003c/strong\u003eEthical approval was obtained from the Tropical Disease Research Centre (TDRC) Institution Review Board (IRB), followed by recommendation from the National Health Research Authority (NHRA). The study adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all participants in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eW. H. O. 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Health\u003c/em\u003e. \u003cb\u003e17\u003c/b\u003e \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph17031065\u003c/span\u003e\u003cspan address=\"10.3390/ijerph17031065\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2020).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Oral health, caries, gingivitis, oral potentially malignant disorder, periodontal disease, Zambia","lastPublishedDoi":"10.21203/rs.3.rs-6673703/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6673703/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe knowledge of the prevalence of oral diseases in Africa is poor. In this cross-sectional study we assessed the oral health status in adults living in urban Ndola (N=188) and rural Mansa (N=211) where participants were interviewed on oral health followed by an oral examination. The chi-square test and logistic regression analysis were used to examine associations between socio-demographic factors, oral disease risk factors, and oral disease presence across urban and rural participants. Dental caries occurred in 72.9% of urban and 47.9% of rural participants (p\u0026lt;0.0001). DMFT was 4.0 in urban participants compared to 2.2 in rural participants (p\u0026lt;0.0001). Gingivitis occurred in 84.5% and 88.1% of urban and rural participants, respectively (p=0.297). Age and habitat were factors significantly associated with dental caries, DMFT, and gingivitis. Smoking and alcohol use was significantly associated with gingivitis, while age, education, smoking, and alcohol use were factors significantly associated with periodontal disease. Only three study participants in the rural population were diagnosed with leukoplakia. In conclusion, dental caries was particularly common in the urban population in Zambia, while gingivitis was high in both the urban and rural population. Unmet dental care calls for broad interventions to address oral diseases in Zambia.\u003c/p\u003e","manuscriptTitle":"Oral Health Status Among Rural and Urban Inhabitants of Zambia-a Community Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-01 10:40:18","doi":"10.21203/rs.3.rs-6673703/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-08-14T15:45:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-06T19:00:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164920542230185079667640903815633424730","date":"2025-08-04T14:34:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-03T21:28:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78804022671701290251640609436605524064","date":"2025-08-02T11:46:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"210391017779186290171858711352454230751","date":"2025-07-31T15:19:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T19:10:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-30T12:06:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"75559631106429961530876754961490862900","date":"2025-07-30T11:39:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"130116999351568207834950437791095153477","date":"2025-07-30T11:06:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"128455201679998814727922823814583180753","date":"2025-07-30T10:30:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"117072951054568077353452733237052146388","date":"2025-07-28T12:13:24+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-07-28T10:50:06+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-07-28T10:34:08+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-06-04T17:41:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-02T10:25:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-06-02T10:22:38+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e784534f-32e7-4128-9775-c21b6cf97332","owner":[],"postedDate":"August 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":52394031,"name":"Health sciences/Diseases/Dental diseases"},{"id":52394032,"name":"Health sciences/Diseases/Oral diseases/Gingivitis"},{"id":52394033,"name":"Health sciences/Diseases/Oral diseases/Periodontitis"},{"id":52394034,"name":"Health sciences/Health care/Dentistry"},{"id":52394035,"name":"Health sciences/Health care/Public health/Epidemiology"},{"id":52394036,"name":"Health sciences/Health care/Public health/Population screening"}],"tags":[],"updatedAt":"2025-10-27T16:26:08+00:00","versionOfRecord":{"articleIdentity":"rs-6673703","link":"https://doi.org/10.1038/s41598-025-24683-4","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-10-21 16:16:38","publishedOnDateReadable":"October 21st, 2025"},"versionCreatedAt":"2025-08-01 10:40:18","video":"","vorDoi":"10.1038/s41598-025-24683-4","vorDoiUrl":"https://doi.org/10.1038/s41598-025-24683-4","workflowStages":[]},"version":"v1","identity":"rs-6673703","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6673703","identity":"rs-6673703","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}