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AHRQ Study Links Secondhand Smoke to Tooth Decay in Children

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Press Release Date: March 11, 2003

Young children who are exposed to secondhand smoke have a much higher rate of tooth decay than children who do not grow up around smokers, according to a study supported by the Agency for Healthcare Research and Quality. The study, "Environmental Tobacco Smoke and Risk of Caries," appears in the March 12 issue of the Journal of the American Medical Association (JAMA).

The study is the first in the United States to associate secondhand, or passive, smoking with tooth decay—a public health problem that costs an estimated $4.5 billion annually. Although the occurrence of dental cavities in children has declined dramatically in the United States, little headway has been made in reducing cavities in children living in poverty, who generally have less access to dental care and appear to be more vulnerable to dental decay.

Based on data from household interviews and health examinations of approximately 4,000 children ages 4 to 11 years, the study found that children had an increased risk of tooth decay if they had high levels of cotinine, a by-product of nicotine that is consistent with secondhand smoke exposure.

About 32 percent of the children with cotinine levels consistent with secondhand smoke exposure had decayed surfaces in their baby teeth, compared with 18 percent of children with lower levels of cotinine. The higher risk of cavities in tobacco-exposed children persisted after controlling for other factors such as poverty and frequency of dental visits. However, the study did not find a similar association between secondhand smoke exposure and cavities in permanent teeth.

Previous research has shown that nicotine promotes the growth of the bacteria that can cause tooth decay, so when mothers or others who smoke kiss children, they would tend to pass on these germs.

According to the study's lead author, C. Andrew Aligne, M.D., of Pediathink, a child health think tank in Rochester, New York, who worked in conjunction with researchers from the University of Rochester and the Center for Child Health Research of the American Academy of Pediatrics, the results provide further evidence that passive smoking is harmful and that all children should be allowed to grow up in a smoke-free environment.

Editor's Note: JAMA has produced a video news release about the article that will be available Tuesday, March 11, 2003. The VNR will be fed twice, first between 9:00-9:30 a.m. (EST), and second between 2:00-2:30 p.m. (EST).

For more information, please contact AHRQ Public Affairs, (301) 427-1364: Bob Isquith, (301) 427-1539 (; Farah Englert (301) 427-1865 (


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