Introduction:
To improve their performance and alertness, bus drivers are known to abuse alcohol, cigarette, kola nut and other substances that have substantial independent and combined deleterious effects on oral tissues. The study aimed to characterize risk associations between aggregates of alcohol/tobacco use and oral-health outcomes among a group of road transport workers in the Ojota and Berger bus terminals in Lagos State.

Methods:
Data were obtained from a probability sample of 150 commercial drivers from two bus terminals (Ojota and Berger) in Lagos State via face-to-face interviews and oral examination using a validated structured questionnaire. Multistage cluster sampling was conducted through the selection of two clusters from the major registered motor parks at the first stage by simple random sampling; while the selection of drivers was done by simple random sampling (balloting), using the list of registered drivers in the two garages as the sampling frame. Past and present tobacco and alcohol use were self-reported by respondents. Multivariable regression analysis measured the relationship between the outcomes [potentially malignant lesions (Leukoplakia, Erythroplakia, Smokers palate, Lichen planus), periodontal disease (CPITN Scores 3,4) and oral-health-related quality of life, OHRQoL (OHIP-14)] and exposures, controlling for the covariates age, marital status, education status, income level, oral hygiene, dental caries, functional tooth units, and previous treatment.

Results:
All the respondents were male. The prevalence of alcohol ever use was 82%, and 35% were moderate or heavy drinkers (2–4 drinks). Prevalence of tobacco ever use was 71%; while 32% were heavy smokers (>11 cigarettes/ day), 64% had a history of kola nut chewing habit, and 53% ate at least 2 kola nuts daily. Heavy smokers had more potentially malignant lesions (OR=1.89, 95% CI: 1.33–3.27); significantly worse periodontal destruction (OR=3.12, 95% CI: 2.28–5.17); and significantly worse OHRQoL (OR=2.35, 95% CI: 1.42–4.54). For individual OHRQoL domains, Pain 3.03 ( 95% CI: 1.77–4.21], Discomfort 2.89 [ 95% CI: 2.32– 4.17], Speech 3.02 ( 95% CI: 2.32–4.13), Diet 2.77 (95% CI: 1.87–4.28), Embarrassment 1.97 (95% CI: 1.65–3.14) and Self-consciousness 2.34 (95% CI: 1.93–3.48), were significantly associated with heavy smoking, after controlling for covariates.

Conclusions:
This study highlights the role of tobacco and alcohol as modifiable risk factors for periodontal disease and potentially malignant lesions that can impact negatively on OHRQoL. Bus drivers, in Lagos State, Nigeria, are an important target group in controlling tobacco and alcohol use in Nigeria and should receive adequate attention for oral health promotion and other preventive initiatives.