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Aligne CA, Moss ME, Auinger P, Weitzman M. Association of Pediatric Dental Caries With Passive Smoking. JAMA. 2003;289(10):1258–1264. doi:https://doi.org/10.1001/jama.289.10.1258
Author Affiliations: Pediathink, Rochester, NY (Dr Aligne); Eastman School of Dentistry, Rochester, NY (Dr Moss); and Center for Child Health Research of the American Academy of Pediatrics (Ms Auinger and Dr Weitzman) and Departments of Community and Preventive Medicine (Dr Moss) and Pediatrics (Ms Auinger and Dr Weitzman), University of Rochester School of Medicine, Rochester, NY.
Context Dental decay is the most common chronic disease of children and it disproportionately
affects those living in poverty, but the reasons for this are not clear. Passive
smoking may be a modifiable risk factor for dental caries.
Objective To examine the relationship between dental caries and serum cotinine
Design, Setting, and Participants Cross-sectional data from the Third National Health and Nutrition Examination
Survey (1988-1994) of 3531 children aged 4 to 11 years, who had had both dental
examinations and a serum cotinine level measurement.
Main Outcome Measures Passive smoking defined as serum cotinine levels of 0.2 to 10 ng/mL
and caries defined as decayed (unfilled) or filled tooth surfaces.
Results Twenty-five percent of the children had at least 1 unfilled decayed
tooth surface and 33% had at least 1 filled surface. Fifty-three percent had
cotinine levels consistent with passive smoking. Elevated cotinine level was
significantly associated with both decayed (odds ratio [OR], 2.1; 95% confidence
interval [CI], 1.5-2.9) and filled (OR, 1.4; 95% CI, 1.1-1.8) tooth surfaces
in deciduous but not in permanent teeth. This relationship persisted after
adjusting for age, sex, race, family income, geographic region, frequency
of dental visits, and blood lead level. For dental caries in deciduous teeth,
the adjusted OR was 1.8 (95% CI, 1.2-2.7) for the risk of decayed surfaces
and 1.4 (95% CI, 1.1-2.0) for filled surfaces. We estimated the population
attributable risk from passive smoking to be 27% for decayed and 14% for filled
Conclusions There is an association between environmental tobacco smoke and risk
of caries among children. Reduction of passive smoking is important not only
for the prevention of many medical problems, but also for the promotion of
children's dental health.
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