Objective: The aim of the study was to elucidate the association between smoking and apical periodontitis on the basis of cross-sectional as well as longitudinal data. Methods: The study population included 230 individuals in the age range 20-65 years. 10-year longitudinal trends were evaluated from 94 individuals who had participated in an earlier study. Risk assessment was performed by means of logistic regression, the relative risk being estimated from odds ratio (OR) and the 95% confidence intervals (CI). Results: The cross-sectional observations suggested that apical periodontitis was associated with age (OR = 1.8, 95% CI 1.1; 3.3, P = 0.046), gingival bleeding (OR = 4.7, 95% CI 2.0; 11.2, P = 0.000), periodontal bone height (OR = 2.2, 95% CI 1.1; 4.4, P = 0.017), and, in particular, endodontic treatment (OR = 7.9, 95% CI 2.7; 23.4, P = 0.000), but not with smoking. According to the longitudinal observations, endodontic treatment was the only factor that was significantly associated with apical periodontitis (OR = 6.8, 95% CI 1.9; 24.6, P = 0.003). The cross-sectional as well as longitudinal observations did not disclose any influence of smoking on the occurrence or development of apical periodontitis. Conclusions: The influence of smoking on the occurrence and development of apical periodontitis seems to be limited, if any. The different responses to smoking exposure of apical periodontitis and marginal periodontitis as a part of chronic periodontal disease suggest that the two conditions are causally dissimilar. Whereas apical periodontitis typically is an infectious process, chronic periodontal disease in smokers is a destructive process primarily driven by toxic products in tobacco smoke.

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