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The prevalence of dental caries in children in the United States has fallen greatly in the last 50 years probably because of the use of toothpastes and increased fluoride in drinking water. Nevertheless the treatment of paediatric dental caries is still estimated to cost US$4.5 billion in the USA each year. Children living in poverty are at particular risk. Now data from the Third National Health and Nutrition Examination Survey (NHANES III) of 1988–94 (
) have confirmed that passive smoking is a risk factor for dental caries in children.
A total of 3531 children aged 4–11 years had both dental examinations and measurement of serum cotinine concentrations (passive smoking defined as serum cotinine 0.2–10 ng/mL). Over half (53%) of the children had serum cotinine concentrations in this range. Almost half (47%) had caries in primary teeth and over a quarter (26%) had caries in permanent teeth. Dental caries in primary teeth, but not in permanent teeth, was significantly associated with passive smoking. After adjustment for confounding variables such as age, sex, parental income, and parental education, passive smoking was associated with significant increases of 80% in the number of children with decayed (unfilled) primary teeth and 40% in the number of children with fillings in primary teeth. The estimated population attributable risk from passive smoking was 27% for decayed primary teeth and 14% for fillings.
Passive smoking is an important risk factor for caries in primary teeth.