Impact of Smoking on the Anatomical Distribution of Periapical Bone Rarefactions: A Brazilian Retrospective Cross-sectional Study

Abstract

Objective: To investigate the prevalence and distribution of periapical bone rarefactions (PBRs) in smokers and non-smokers using panoramic radiographs (PRs), and to assess the influence of tobacco use on lesion distribution. Methods: A retrospective cross-sectional analysis was conducted on 212 PRs from adult patients (18–78 years). Patients were classified as active smokers, former smokers, or non-smokers. Radiographs were examined for the presence, location, and distribution of PBRs by calibrated examiners. Associations with smoking history and duration were tested using chi-square and t-tests (two-sided), with a significance level of p<0.05. Results: PBRs were identified in 74.5% of patients. Unexpectedly, non-smokers showed a higher prevalence (66%) than smokers (33%), which may reflect sample characteristics or confounding factors. In smokers, lesions were predominantly concentrated in maxillary anterior teeth, particularly central incisors, and prevalence increased with longer smoking duration (>10 years). No significant differences were observed between smokers and non-smokers regarding arch distribution. Conclusions: Smoking was not associated with a higher overall prevalence of PBRs but appeared to influence their anatomical distribution and their relationship with tobacco exposure time. These findings emphasize the importance of considering lesion patterns alongside patient history and acknowledge the limitations of panoramic radiographs in establishing causality. Further multicenter and prospective studies using advanced imaging are warranted.