Cannabis appears protective for teeth, but tobacco use remains major threat

To investigate whether behavioral factors and substance use influence the oral disease burden at 40 years of age in a population-based birth cohort. This longitudinal study drew data from the 1982 Pelotas Birth Cohort, Brazil. At age 40, 453 participants were examined. Oral disease burden was modeled as a latent construct including decayed teeth, periodontal probing depth ≥4 mm, clinical attachment level ≥3 mm, and bleeding on probing. Family income at birth and sex were specified as distal exposures. Behavioral factors, substance use, and common mental disorders across adulthood were modeled as mediators influencing oral disease burden at age 40. Associations were estimated using structural equation modeling. Higher sugar intake (SC = 0.269, 95% CI: 0.168-0.370) and tobacco use (SC = 0.432, 95% CI: 0.336-0.527) were associated with an increased oral disease burden at age 40. Dental flossing (SC = -0.450, 95% CI: -0.605 to -0.294) and regular dental visits (SC = -0.311, 95% CI: -0.426 to -0.197) were protective. Cannabis use showed an apparent protective effect (SC = -0.259, 95% CI: -0.389 to -0.129), likely due to correlation with tobacco. Alcohol use was not associated with the outcome. Behavioral factors and substance use at age 30 significantly influenced oral disease burden at age 40. The long-term impact of behavioral trajectories on oral health is underscored by these findings. Clinical and policy interventions prioritizing the stabilization of healthy habits during early adulthood are essential to mitigate the cumulative burden of chronic oral diseases later in life.