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Abstract
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.
To examine the relationship between dental caries and serum cotinine levels.
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.
Passive smoking defined as serum cotinine levels of 0.2 to 10 ng/mL and caries defined
as decayed (unfilled) or filled tooth surfaces.
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 tooth surfaces.
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.