Does Secondhand Smoke Affect the Development of Dental Caries in Children? A Systematic Review

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• Published: 26 January 2019

Association between exposure to household smoking and dental caries in preschool children: a cross-sectional study

• Keiko Wada^one,
• Kie Konishiⁱⁱ,
• Takahiro Uji¹,
• Sachi Koda¹,
• Fumi Mizuta^ane,
• Michiyo Yamakawaⁱ,
• Kaori Watanabe^three,
• Kyoko Andoⁱⁱⁱ,
• Jun Ueyama^four,
• Takaaki Kondo⁴ &
• Chisato Nagata¹

Environmental Wellness and Preventive Medicine volume 24, Article number:9 (2019) Cite this article

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Abstract

Background

We aimed to examine the clan of exposure to ecology tobacco smoke with dental caries among preschool children. Exposure to ecology tobacco fume was assessed in terms of urinary cotinine concentrations and pack-years of exposure to smoking by parents and other family members at home.

Methods

This cross-sectional study included 405 preschool children anile 3–6 years from two preschools in Nihon in 2006. Information on the smoking habits of family unit members living with the kid was obtained from parent-administered questionnaires. Dental examination was conducted to assess dental caries, that is, decayed and/or filled teeth. Urinary cotinine levels were measured using first-void morn urine samples.

Results

Overall, 31.1% of the children had dental caries, and 29.v% had rust-covered teeth. Exposure to current maternal and paternal smoking was positively associated with the presence of dental caries after decision-making for covariates. More than than three pack-years of exposure to maternal smoking and more than five pack-years of exposure to smoking by all family unit members were significantly associated with the presence of dental caries equally compared with no exposure (odds ratio [OR] = 5.55, 95% conviction interval [CI] = 2.17–fourteen.22, P for trend < 0.001 and OR = 2.00, 95% CI = 1.12–3.58, P for trend = 0.004, respectively). These exposure variables were similarly associated with the presence of decayed teeth (OR = 2.92, 95% CI = 1.23–six.96, P for trend = 0.01 and OR = 1.75, 95% CI = 0.96–3.xx, P for trend = 0.03, respectively). Every bit compared with everyman tertile of the urinary cotinine level, the highest tertile of the urinary cotinine level was significantly associated with the presence of dental caries equally well as decayed teeth; the ORs for the highest vs. lowest tertile of urinary cotinine levels were 3.10 (95% CI = 1.71–5.63, P for trend = 0.012) and 2.02 (95% CI = 1.10–3.lxx, P for trend = 0.10), respectively.

Conclusions

These data suggest that exposure to tobacco fume may accept a dose-dependent influence on the development of caries.

Background

Information technology has been suggested that exposure of children to environmental tobacco fume is associated with an increased risk of dental caries. Many studies take evaluated this clan. A review of the literature by Hanioka et al. in 2011 identified eleven studies on parental or household smoking and dental caries in early babyhood [1]. Significant clan was reported in x of them [ii,3,four,5,6,seven,eight,9,x,11]. After this review, to our knowledge, six studies, including 4 cohort studies, have been published, and all of them showed a positive association between environmental tobacco fume and early babyhood caries [12,13,xiv,fifteen,16,17]. Although data on ecology tobacco smoke and early childhood caries have been accumulated, most of these studies concerned the presence or absence of current smoking past parents or family unit members, and data on a dose-dependent human relationship based on smoking dose have non been provided.

Cotinine is a straight metabolite of nicotine that has a high specificity for environmental tobacco fume exposure. Cotinine concentration in saliva, blood, or urine can be an effective measure out to assess a dose-dependent association of exposure to environmental tobacco smoke with dental caries [18]. To engagement, only one report included cotinine measurement to evaluate this association [10]. Since the cotinine level reflects brusk-term exposure to nicotine [xviii], information on long-term exposure to tobacco smoking is needed. The nowadays study assessed the association of environmental tobacco fume with dental caries amidst preschool children in terms of urinary cotinine concentrations and pack-years of exposure to smoking by parents and other family members at home.

Methods

Study population

This cross-sectional written report included children aged 3–6 years who attended ii preschools attached to Aichi Bunkyo Women's College in Aichi Prefecture, Japan. All children at the preschools (n = 533) were invited for the study between October and November in 2006. Of these, 74 children were excluded because their parents declined to participate. The remaining 459 children (86.1%, 243 boys and 216 girls) were enrolled in the study. Written informed consent was obtained from parents. They completed a questionnaire asking about lifestyle factors of the children and themselves. Since 11 parents did not answer the questions about smoking condition and 43 children did not nourish the dental examination, the nowadays analysis included 405 children. The questionnaire was filled in by mother (96.8%) or father (3.ii%). The written report protocol process was approved by the upstanding board of the Gifu University Graduate School of Medicine, Gifu, Nippon (No. 18-67 dated Sep. 6, 2006).

Assessment of exposure to environmental tobacco fume

We obtained information from respondents concerning the smoking habits of parents and other family unit members who live with the children. Respondents were asked whether a child's mother had ever smoked. If she ever smoked, we asked at what age she started and/or quit smoking. For the smoking habits of the begetter and other family unit members, the questionnaire asked whether they had smoked since the child was born. For those who had smoked, nosotros asked whether they had quit smoking during this time frame or were currently smoking. Likewise, considering this time frame, the smoking status of the female parent, father, and other family members was classified into three categories (never, former, and current smoker). Sometime smokers and current smokers were asked to report years they smoked and the number of cigarettes smoked per mean solar day. Children's pack-years of exposure to smoking at home was determined based on the smokers' years of smoking and the number of cigarettes smoked per day since the kid was born.

Dental measurements

The School Health and Safety Act in Nihon requires an execution of almanac dental health check-ups for children in preschool. In accordance with the Act, a school dentist commissioned past a preschool care for and checks the oral health of children. Dental examinations were performed in a standard manner past 2 school dentists (1 for each preschool). They detected caries lesions and tooth filling using a dental mirror under artificial light and recorded these data on dental formula. Teeth were dried and cleaned with cotton rolls or explorer if necessary. A molar with argent fluoride varnish and fissure sealant was regarded as a filled tooth. Visible dental plaque or calculus was besides recorded. Children were classified as having dental caries of deciduous teeth if they had one or more decayed or filled teeth.

Assessment of children's urinary cotinine

Showtime-void morning urine samples were obtained from children with the help of their parents at their homes, although we could not obtain urine samples for 6 children. All urine samples were stored at − 80 °C until analysis. The total cotinine concentration (complimentary cotinine plus its glucuronide) was measured via a solid-phase extraction (SPE) procedure and liquid chromatography–tandem mass spectrometry (LC-MS/MS) detection. The within-run precision of our method was examined through the assay of pooled urine spiked with cotinine at concentrations of 0.four, i.7, and 10 μg/L (n = 4–v), and the results were less than 14.iv% (relative standard deviation). The limit of detection (LOD) was 0.1 ng/ml. Urinary creatinine was measured using the conventional enzymatic method. The total urinary cotinine concentration was adapted for creatinine (μg/mg Cr).

Statistical analysis

Children were classified into two groups according to the presence or absence of dental caries. As preschool children (aged 3–6 years) by and large have deciduous teeth, we did not clarify data separately for deciduous and permanent teeth. Children were also categorized into three levels co-ordinate to pack-years of exposure to smoking by the mother, father, and other family members living with the child. The total urinary cotinine level was categorized into iii levels (low, middle, or high) according to the tertile of the concentration. 16 children whose cotinine concentrations were below the detectable levels were assigned levels of LOD/2 (i.e., 0.05 ng/ml).

To evaluate the associations between variables for environmental tobacco smoke and the presence of dental caries, a multivariable logistic regression model was used, and the odds ratio (OR) and 95% confidence interval (CI) were calculated. The child's sexual practice, age, indicator for preschools, female parent's historic period at commitment (24 years or younger, 25–thirty years, or 31 years or older), mother's educational activity level (12 years or less, xiii–15 years, or sixteen years or more), frequency of eating snacks (0, < 2, or ≥ two times/day), frequency of tooth brushing (0, < 2, or ≥ ii times/mean solar day), and feeding modes until 3 months of age (breast, mixed, or bottle) were included in the models as covariates. A liner trend was assessed using continuous values for pack-years of exposure. All P values were calculated using a two-sided examination, and a P value of less than 0.05 was considered statistically significant in all analyses. All statistical analyses were performed using the SAS programme (Version 9.4, SAS Institute Inc., Cary NC, USA).

Results

Characteristics of the 405 children (218 boys and 187 girls) are presented in Table 1. The mean age was 5.i. Overall, 31.1% of the children had dental caries (decayed and/or filled teeth), and 25.9% had decayed teeth. About half of the children were reported to perform tooth brushing twice or more per twenty-four hour period. Most half of the children lived with current smokers at home (46.nine%). Urine samples were obtained from 399 children (215 boys and 184 girls). The mean of urinary cotinine levels was three.01 (SD four.5) μg/mg Cr. Urine cotinine ranged from 0.03 to 39.seven μg/mg Cr. The correlation coefficient betwixt the exposure to household smoking, i.e., the pack-years of exposure to all family smoking, and urinary cotinine level was 0.56.

Table one Bones characteristics of preschool children (n = 405)

Full size tabular array

Table ii shows the adapted OR and 95% CI for the presence of dental caries co-ordinate to ecology tobacco smoke exposure at domicile. Electric current exposure to maternal smoking was significantly associated with the presence of dental caries (OR = 3.xiv, 95% CI i.56–half dozen.31) after controlling for covariates. More than three pack-years of exposure to maternal smoking was associated with virtually a fivefold increased OR for dental caries as compared with no exposure. Electric current exposure to paternal smoking was significantly associated with the presence of dental caries, although this association was not and so great as that for maternal smoking (OR = one.64, 95% CI ane.02–2.64). More than five pack-years of exposure to smoking by all family members was significantly associated with the presence of dental caries, and the tendency was significant. The total urinary cotinine level was significantly associated with the presence of dental caries after controlling for covariates (P for trend = 0.012).

Table 2 OR and 95% CI for dental caries co-ordinate to environmental tobacco smoke exposure at abode

Full size table

Table iii shows the association of exposure to environmental tobacco smoke with the presence of decayed teeth. These associations were somewhat attenuated as compared to those with the presence of dental caries (decayed and/or filled teeth). However, the dose response relationships for pack-years of smoking by mother and all family members with presence of decayed teeth remained meaning.

Table 3 OR and 95% CI for the presence of decayed teeth according to environmental tobacco fume exposure at home

Total size tabular array

Stratified analyses according to children'due south age (3- to 4-year-old [n = 196] and five- to 6-year-old [due north = 209]) revealed a stronger clan of exposure to maternal smoking with the presence of decayed caries in the latter grouping; the ORs for pack-years of smoking to maternal smoking were ii.17 (95% CI = 0.48–9.77, P for tendency = 0.52) in three- to iv-year-old children and 4.05 (95% CI = 1.26–thirteen.01, P for tendency = 0.01) in 5- to vi-year-old children. However, ORs for pack-years of exposure to smoking by all family members did non differ profoundly; OR = ii.25, 95% CI = 0.73–6.98, P for tendency = 0.09 in 3- to iv-years-old children and OR = 1.79, 95% CI = 0.83–3.85, P for trend = 0.15 in 5- to half dozen-yr-old children. OR for the highest vs. lowest tertile of urinary cotinine level was greater in younger children grouping; OR = 4.67, 95% CI = 1.46–15.00, P for trend = 0.08 in three- to iv-year-old children and OR = 1.50, 95% CI = 0.68–3.32, P for trend = 0.46 in 5- to six-yr-erstwhile children.

Give-and-take

We found that exposure to maternal and paternal smoking was significantly associated with dental caries. Nosotros also observed significant dose relationships of the pack-years of exposure to smoking by the mother and all family members with the presence of dental caries. These data suggest that cumulative exposure to environmental tobacco smoke at domicile may affect the development of dental caries. Then far, only two studies [five, 15] take assessed the pack-months of smoking past family members with regard to dental caries, and they did not practise and then separately for the mother, father, and other family members. Both studies observed a significant dose-response relationship like to that in our study. Our results on maternal smoking condition are also consistent with the findings of previous studies for early childhood [7, eight, 13, 16].

The clan of dental caries with smoking by the father or other family members appeared to exist weaker than that with maternal smoking, and the dose-relationship for pack-years of exposure to smoking by them was not statistically significant. In Japan, as younger children at preschool historic period generally spend a lot of time with their mothers at domicile, exposure to smoking by the mother assessed in terms of pack-years may have more consequence than exposure to smoking past the father or other family members [4, 13]. In our study, the association for total pack-years of exposure to smoking by all family unit members should mainly reverberate that for exposure to maternal smoking. Most previous studies assessed simply the status of maternal smoking or household smoking as a whole in relation to dental caries. Even for the status of paternal smoking, merely a few studies included this variable [4, 7, 13]. I report observed that paternal smoking status was significantly associated with the presence of dental caries [4], just the other two studies did not [7, 13].

We constitute that the urinary cotinine level was significantly associated with the presence of dental caries, and the dose-response human relationship was significantly positive. A previous study evaluated the association of serum cotinine levels with the existence of unfilled and filled caries, and a significant dose-response relationship was observed for unfilled caries [ten]. However, the OR did not monotonously increase with the higher cotinine level, and the authors suggested the possibility that there is a threshold of exposure in a higher place which children's run a risk for caries does non continue to increase. This may be partially attributed to the fact that the cotinine level indicates the corporeality of nicotine exposure over a brusque menses (almost iii days) [18]. Nevertheless, we cannot deny that current nicotine exposure reflects cumulative exposure to smoking, because the pack-years of exposure to all family smoking was well correlated with the urinary cotinine levels in our study.

Experimental evidence supports a positive association betwixt environmental tobacco smoking exposure and dental caries. Streptococcus mutans is one of the major cariogenic microorganism in the oral cavity [19]. Nicotine enhances Streptococcus mutans biofilm formation and biofilm metabolic activity [20]. Nicotine also increases extracellular polysaccharides, which can attract other microorganisms, such as Candida albicans, onto the dental plaque [21]. In fact, in vivo, the caries-affected area on the molars was more than expanded in cigarette fume-exposed rats than in control rats [22]. In humans, tobacco smoking was associated with elevated levels of Streptococcus mutans and Lactobacilli [23, 24]. It is also possible that the immunosuppressive backdrop of smoking may have furnishings on the evolution of caries, equally smokers had decreased levels of sIgA that was associated with the prevalence of dental caries [25].

Several limitations of the present study should be considered. Because of the cross-sectional study design, we cannot determine the cause–effect human relationship. Another limitation was that the sample size was not sufficient plenty to conduct meaningful analyses separately for decayed and filled teeth and for 3- to 4-year-onetime and 5- to 6-year-old children. Filled status could be determined not just by formation of dental caries only besides by the extent of dental intendance that children received. In add-on, although nosotros asked mothers' lifetime smoking history, we did not specifically ask whether they had smoked during pregnancy. Maternal smoking during pregnancy has been associated with dental caries among children in some studies [5, 6, 12, 26], but not all [27, 28]. Therefore, the observed positive association of maternal smoking with dental caries may be partially attributed to exposure to smoking during pregnancy. Because women who smoke during pregnancy are likely to continue smoking later on delivery, it has been difficult to study the independent effects of in utero exposure to maternal smoking and postnatal exposure. However, Tanaka et al. [5] observed that both maternal smoking during pregnancy and postnatal household smoking were independently associated with an increased prevalence of dental caries. Since nosotros observed a significant dose-response relationship for pack-years of smoking past the mother and past all family members, exposure to smoking after childbirth may have an effect on the evolution of dental caries regardless of in utero exposure. The misclassification of dental caries status is possible, considering the filled status may be caused by cracked or cleaved teeth rather than rust-covered teeth. Previous studies take pointed out the possibility that smoking or the cotinine level is simply a marker for certain unmeasured truthful causes of caries formation [x, eleven, 20]. Although we attempted to control for several potential confounders, we could not obtain data nigh the use of fluoride. Nevertheless, few local governments in Nihon fluoridate drinking water, which may have diluted a preventive effect of fluoride toothpaste. In addition, Tanaka et al. reported that the take a chance of dental caries with the utilise of fluoride amid Japanese 3 years aged children was significantly positive (OR = 1.32) [five]. Three other studies among 3-year-old Japanese children did non observe an inverse association between the use of fluoride and dental caries [iv, 13, 26]. Therefore, the observed associations between exposure to environmental tobacco smoke and caries experience are unlikely to be overestimates due to not-adjustment for fluoride utilise. Our study subjects were not representative of the preschool population in Japan, which may bear on the generalizability of our findings. According to the national school health statistics for 2006, the percentages of 5-year-old children having dental caries (decayed and/or filled teeth) and rust-covered teeth were 55.2% and 33.v%, respectively [29]. Lower percentages were observed in our study (the corresponding values in our report subjects were 37.0% and 29.4%, respectively). In the National Health and Diet Survey 2006 [30], the percentages of never smokers amid men and women aged 20–39 were 41.two% and 75.3%, respectively. Higher percentages of never smokers amidst parents in our study may partially explicate the relatively low prevalence of dental caries among their children, but the evidence is equivocal. A somewhat lower prevalence of dental caries (43.7%) and decayed teeth (25.vii%) was reported for 5-yr-old children in Aichi Prefecture [29].

Conclusion

In summary, we found that pack-years of exposure to smoking by the female parent and by all family members, equally well as urinary cotinine level, was associated with dental caries in preschool Japanese children. These data suggest that exposure to tobacco fume may accept dose-dependently influenced the development of dental caries. All the same, prospective studies that include the measurement of varying exposure levels over time are needed to delineate the event of cumulative exposure to environmental tobacco fume on the chance of dental caries.

Abbreviations

CI:

Conviction interval

LC-MS/MS:

Liquid chromatography–tandem mass spectrometry

LOD:

Limit of detection

OR:

Odds ratio

SPE:

Solid-phase extraction

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Acknowledgments

We thank all the study participants.

Funding

This study is supported in parts by a Grant-in-Aid for Scientific Enquiry from the Ministry of Education, Culture, Sports, Scientific discipline and Applied science of Japan.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available considering the written report involves man participants with a nondisclosure provision of individual information stated in the written informed consent in guild to prevent compromise of study participants' privacy, just are bachelor from the corresponding author upon reasonable request.

Author data

Affiliations

1. Section of Epidemiology and Preventive Medicine, Gifu University Graduate School of Medicine, 1-i Yanagido, Gifu, 501-1194, Nippon

   Yuko Goto, Keiko Wada, Takahiro Uji, Sachi Koda, Fumi Mizuta, Michiyo Yamakawa & Chisato Nagata

2. Department of Health and Welfare, Tokai Gakuin University, Gifu, Japan

   Kie Konishi

3. Section of Life and Civilisation, Aichi Bunkyo Women'southward Higher, Inazawa, Aichi, Japan

   Kaori Watanabe & Kyoko Ando

4. Department of Pathophysiological Laboratory Sciences, Field of Radiological and Medical Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

   Jun Ueyama & Takaaki Kondo

Contributions

YG analyzed the data and drafted the manuscript. KW supervised and interpreted the data. KK, TU, SK, FM, and MY conducted the data analysis and interpreted the data. KW and KA supervised the field activities and collected the information. JU and TK measured urinary cotinine levels and interpreted the data. CN contributed to conception and design of the study and helped writing the manuscript. All authors read and canonical the final manuscript.

Respective author

Correspondence to Yuko Goto.

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Ethics approval and consent to participate

Written informed consent was obtained from all participants. The study protocol process was approved by the upstanding board of the Gifu Academy Graduate School of Medicine, Gifu, Japan.

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Not applicable.

Competing interests

The authors declare that they have competing interests.

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Goto, Y., Wada, G., Konishi, K. et al. Association between exposure to household smoking and dental caries in preschool children: a cross-sectional written report. Environ Health Prev Med 24, 9 (2019). https://doi.org/10.1186/s12199-019-0764-1

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• Received: 29 October 2018

• Accustomed: 17 January 2019

• Published: 26 January 2019

• DOI : https://doi.org/x.1186/s12199-019-0764-1

Keywords

• Tobacco fume
• Dental caries
• Urinary cotinine
• Cross-sectional studies
• Preschool children

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