Title	Exposure to Secondhand Smoke May Increase Caries Risk in Children
Clinical Question	Does a child that is regularly exposed to secondhand smoke have an increased risk of dental caries compared to a child who is not exposed to secondhand smoke?
Clinical Bottom Line	Many studies have shown a relationship between secondhand smoke and increased caries risk. Therefore, reducing secondhand smoke exposure in children may help to reduce dental caries. Still, more research needs to be done to show the exact relationship that secondhand smoke and childhood caries have.
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 21655133 Hanioka/ 2011 Children exposed to Second Hand Smoke Systematic Review of cohort study and case controls Key results 11 of the 15 studies showed a relationship between secondhand smoke exposure and childhood caries. Some of the studies contained weaknesses including populations with high caries prevalence or wide confidence intervals. More studies should be conducted to determine the dose necessary to cause increased risk of caries. Future studies should use a more varied population, use a cohort format, and research the underlying mechanism of how second hand smoke causes caries. This stronger evidence will help to show a true relationship between secondhand smoke and childhood caries. 12633187 Aligne/ 2003 3531 children aged 4 to 11 Case Control Study Key results Data was collected from 3,531 children aged 4 to 11 who had participated in the Third National Health and Nutrition Examination Survey. All of these children had both a dental examination to check for both filled and unfilled caries and a serum cotinine level measurement to check for exposure to secondhand smoke. Elevated cotinine level was significantly associated with decayed and filled tooth surfaces in deciduous teeth (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.5-2.9; OR 1.4, 95% CI, 1.1-1.8, respectively). There continued to be a relationship even after adjustment for age, sex, race, family income, geographic region, frequency of dental visits, and blood lead level. For decayed tooth surfaces, the adjusted OR was 1.8 (95% CI, 1.2-2.7) and 1.4 (95% CI, 1.1-2.0) for filled surfaces. The estimated population attributable risk from passive smoking is 27% for decayed and 14% for filled tooth surfaces. This data shows an association between passive smoke and risk of caries in children.
Evidence Search	(("Tobacco Smoke Pollution"[Mesh]) AND "Dental Caries"[Mesh]) AND "Child"[Mesh]
Comments on The Evidence	The systematic review used 15 high-quality studies, 14 case-control studies and one cohort study. Having the total number of patients and their ages from the studies would have improved this review. There was not a meta-analysis performed of the studies that were reviewed. This would have added extra strength and clarity. The case control study used the National Health and Nutrition Examination Survey to obtain cross-sectional data about the subjects. All subjects received both a dental examination and a serum cotinine level measurement. A relationship was then established between passive smoke and caries risk. There was a large and diverse subject pool and the results were adjusted to take out any outlying factors.
Applicability	Pediatric patients exposed to secondhand smoke
Specialty	(General Dentistry) (Pediatric Dentistry) (Dental Hygiene)
Keywords	Secondhand Smoke, Dental Caries, Child, Smoking, Tobacco Smoke Pollution
ID#	2242
Date of submission	04/25/2012
E-mail	oconnora@uthscsa.edu
Author	Amber O'Connor
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Kevin M. Gureckis, DMD
Faculty mentor e-mail	gureckis@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) None available