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January 26, 2000

Blood Lead Level and Dental Caries—Reply

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(4):476-477. doi:10.1001/jama.283.4.475

In Reply: Dr Green and Dr Neiburger suggest confounding of environmental lead exposure with poverty and race is problematic. We have attempted to control for relevant factors that were measured in NHANES-III; however, as we stated in our article, residual confounding is likely to be present. The origin of dental caries is complex, requiring the interaction of key acidogenic bacteria with fermentable carbohydrates in the diet. If these cofactors are not present, even a highly susceptible tooth will not suffer decay. Experimental animal data,1 showing an association between lead exposure and dental caries, provide a basis for investigating this association in humans. The NHANES-III data presented in our article support the need for further research.

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