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June 11, 2003

Passive Smoking and Dental Caries in Children

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(22):2940-2941. doi:10.1001/jama.289.22.2940-a

In Reply: Dr Davies suggests that passive smoking may simply be a marker for poor oral hygiene or other dietary risk factors. However, formation of caries in the primary teeth is a poorly understood phenomenon, and it cannot be exclusively blamed on known risk factors, such as poor oral hygiene and diet control.13 Some previous studies have found an association with high sugar intake while others have not. Of those that found a link, none controlled for passive smoking. We did control for sucrose intake and found no significant association in the bivariate analysis, so there was no reason to include this factor in the multivariable analysis. For passive smoking to be simply a marker for poor tooth brushing or high sugar intake, one would have to imagine that after controlling for income, education, race, region of residence, and even frequency of visits to the dentist, that smokers of all backgrounds systematically fail to care for their children's teeth, while nonsmokers of all backgrounds keep their children's mouths well brushed and sugar-free. Given that we did adjust for all those variables, such a scenario seems unlikely.

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