Habits such as tobacco use and high-sugar diets during early adulthood may contribute to an increased risk of chronic oral disease by age 40, according to a study recently published in the Journal of Dentistry.
Improved oral hygiene and regular dental visits may protect against chronic oral disease, making clinical interventions to reinforce healthy habits key to reducing oral health risks, the study’s authors wrote.
“Behavioral factors and substance use at age 30 significantly influenced oral disease burden at age 40,” wrote the authors, led by Rafaela do Carmo Borges of the Federal University of Pelotas School of Medicine in Brazil (J Dent, February 26, 2026, 106589).
The study sought to determine whether behavioral factors and substance use affect oral disease burden at age 40 using data from the 1982 Pelotas Birth Cohort in Brazil. The cohort originally included 5,914 births from urban families and followed participants with oral health assessments at ages 24, 31, and 40, they wrote.
For the study, 453 individuals at age 40 underwent oral examinations conducted between 2022 and 2023. Chronic oral disease burden was measured as a combined outcome, including untreated decay, periodontal pocketing, clinical attachment loss, and bleeding on probing. Researchers evaluated prior sugar intake and alcohol, tobacco, and cannabis use, adjusting for sex, income at birth, mental health, dental visits, and flossing habits.
Several behavioral pathways linked early-life factors to oral health in adulthood. Higher sugar intake (standardized coefficient [SC] = 0.269, 95% confidence interval (CI): 0.168 to 0.37) and tobacco use (SC = 0.432, 95% CI: 0.336 to 0.527) were associated with greater oral disease burden at age 40, whereas flossing (SC = -0.45, 95% CI: -0.605 to -0.294) and regular dental visits (SC = -0.311, 95% CI: -0.426 to -0.197) were protective, they wrote.
Furthermore, cannabis use appeared protective (SC = -0.259, 95% CI: -0.389 to -0.129), likely due to its correlation with tobacco, and alcohol use was not associated with the outcome. When tobacco was removed from the model, cannabis reversed direction and became nonsignificant (SC = 0.032, p = 0.498), whereas excluding cannabis left tobacco as a strong predictor (SC = 0.245, p < 0.001).
The study, however, had limitations. Self-reported behaviors may have been misclassified, as participants could have overreported healthy habits and underreported harmful ones due to social desirability bias, the authors added.
“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,” Borges and colleagues concluded.
