Environmental Tobacco Smoke (ETS) exposure; dental caries; children


Dental caries continue to plague young children worldwide with numerous adverse effects including pain, poor growth and development, decreased quality of life as well as the potential for the development of life threatening secondary infections. Factors associated with the development of childhood caries are complex as they relate to social, economic and/or cultural behaviors. Recent evidence has linked secondhand smoke to the development of childhood dental caries. The purpose of the study is to re-examine the association between the frequency and extent of exposure to secondhand smoke with the development of childhood caries in the United States. Cross-sectional data of 1,511 children age 4 to 11 years from the U.S. National Health and Nutrition Examination Survey (NHANES) (2011-2012) were analyzed. Results indicate that children living in a home where one or more cigarettes were smoked inside per day were 1.59 times more likely to have caries compared to those who were not exposed to smoke inside the home (95% CI=1.02-2.47, p=0.041). Those children without insurance were also at highest risk for dental caries. However those with Medicare/Medicaid, despite having government mandated dental coverage, were also significantly affected and 1.67 times more likely to have dental caries compared to those with private insurance (95% CI=1.08-2.58, p=0.021). Creative approaches to improving health outcomes of families should include education about the adverse effects of ETS exposure, providing families with low or no cost community smoking cessation programs and reducing barriers to accessing preventive dental services for both children and their families.