Immunochromatographic Assessment of Salivary Cotinine and Its Correlation With Nicotine Dependence in Tobacco Chewers

Background: This study assessed the correlation between nicotine dependence and salivary cotinine levels in tobacco chewers and checked the reliability of Fagerstorm test in tobacco cessation programmes.

Methods: The study sample included 75 tobacco chewers aged between 20 to 50 years. Self-reported nicotine dependence was evaluated using Fagerstorm Test for Nicotine dependence-smokeless tobacco questionnaire. Patients were categorized into low, moderate and high dependent chewers based on their answers to the questionnaire. The unstimulated salivary cotinine levels were measured by immunochromatographic assay using the NicAlert saliva test. Data was analysed using the chi-square test for testing intra-group variation, analysis of variance for testing between-groups variation, and the Spearman coefficient for assessing the association between variables.

Results: No statistically significant association was seen between salivary cotinine levels and nicotine dependence. A weak positive correlation was noted between the above variables (r = 0.230). In the group studied, it was evident that the patients were under-reporting the nicotine dependence.

Conclusions: The measurement of salivary cotinine by immunochromatographic assay using NicAlert saliva test is a useful and convenient method for studying the nicotine dependence in tobacco chewers. Immunochromatography-based cotinine test strips are an easy method of detecting salivary cotinine in a dental setup. From this study we are of the opinion that a simple questionnaire like Fagerstorm test can give a less adequate analysis of patient's dependence especially in countries like India, where patients tend to under-report their dependency. Immediate feedback from a chairside test can help both the dentists and patients during a tobacco cessation programme.