Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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.1- 3 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.
Aligne CA, Moss ME, Weitzman M. Passive Smoking and Dental Caries in Children. JAMA. 2003;289(22):2940-2941. doi:10.1001/jama.289.22.2940-a