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Moss ME, Lanphear BP, Auinger P. Association of Dental Caries and Blood Lead Levels. JAMA. 1999;281(24):2294–2298. doi:10.1001/jama.281.24.2294
Author Affiliations: Eastman Department of Dentistry (Dr Moss) and Departments of Pediatrics (Ms Auinger), The University of Rochester School of Medicine and Dentistry and Children's Hospital Medical Center, Rochester, NY; and the Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio (Dr Lanphear).
Context Experiments show that dental caries rates are higher
among lead-exposed animals, but this association has not been
established in humans.
Objective To examine the relationship between blood lead levels
and dental caries.
Design Cross-sectional survey conducted from 1988 to 1994 that
included a dental examination and venipuncture blood lead assay.
Setting and Participants A total of 24,901 persons aged 2
years and older who participated in the Third National Health and
Nutrition Examination Survey, which assessed the health and nutritional
status of children and adults in the United States.
Main Outcome Measures For children aged 2 to 11 years, the sum of
decayed and filled deciduous or primary surfaces; for persons aged 6
years and older, the sum of decayed and filled permanent surfaces; for
those 12 years and older, the sum of decayed, missing, and filled
Results The log of blood lead level was significantly
associated with the number of affected surfaces for both deciduous and
permanent teeth in all age groups, even after adjusting for
sociodemographic characteristics, diet, and dental care. Among children
aged 5 to 17 years, a 0.24-µmol/L (5-µg/dL) change in blood lead
level was associated with an elevated risk of dental caries (odds
ratio, 1.8; 95% confidence interval, 1.3-2.5). Differences in blood
lead level explained some of the differences in caries prevalence in
different income levels and regions of the United States. We estimated
the population attributable risk of lead exposure to be 13.5% and
9.6% of dental caries occurring in 5- to 17-year-olds exposed to the
high and moderate levels, respectively.
Conclusions Environmental lead exposure is associated with an
increased prevalence of dental caries in the US population. Findings
may help explain the distribution of caries by income and region of the
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