Journal of Public Health Dentistry . ISSN 0022-4006
Association of environmental tobacco smoke and snacking habits with the risk of early childhood caries among 3-year-old Japanese children Yoshimi Nakayama, DDS, PhD1,2; Mitsuru Mori, MD, PhD2 1 Hokkaido Tomakomai Public Health Center, Tomakomai, Hokkaido, Japan 2 Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
Keywords environmental tobacco smoke; early childhood caries; snacking habits. Correspondence Dr. Yoshimi Nakayama, Hokkaido Tomakomai Public Health Center, 2-2-21 Wakakusa town, Tomakomai-shi, Hokkaido 053-0021, Japan. Tel.: 81-144-34-4168; Fax: 81-144-34-4177; e-mail: nakayama. [email protected]. Yoshimi Nakayama is with the Hokkaido Tomakomai Public Health Center. Yoshimi Nakayama and Mitsuru Mori are with the Department of Public Health, Sapporo Medical University School of Medicine. Received: 3/3/2014; accepted: 12/19/2014. doi: 10.1111/jphd.12085 Journal of Public Health Dentistry 75 (2015) 157–162
Abstract Objectives: The aim of this study was to investigate the association of environmental tobacco smoke (ETS) and other risk factors with early childhood caries (ECC) in 3-year-old Japanese children by a cross-sectional study. Methods: Study subjects were 1,801 children aged 3 years old. The self-administered questionnaire was completed by parents or guardians of the children. The survey contents included such things as if there was a smoker in the home, snack times, the kinds of snacks consumed more than or equal to four times a week, the kinds of drinks consumed more than or equal to four times a week, parents brushing their child’s teeth daily, and the use of fluoride toothpaste. We obtained the number of decayed, missing, or filled teeth per person (dmft) from the dental examinations. Logistic regression analysis was performed to estimate odds ratio of ECC. Results: The average number of decayed, missing and filled teeth (dmft index) was 1.00. The prevalence of dental caries was 22.4 percent. There was at least one smoker in the homes of 1,121 subjects (62.2 percent). After excluding items of multicollinearity, the results of multivariate analysis were as follows: drinking or eating sweets after dinner, irregular snack times, frequent intake of chocolate, frequent intake of sugar-sweetened gum, frequent intake of isotonic drink, and maternal smoking were significantly associated with the risk of ECC. Conclusions: This study suggests that there is a significant correlation between ETS from family members and snacking habits and ECC.
Introduction Early childhood caries (ECC) is one of the most prevalent chronic diseases among children. Heretofore, ECC has been shown to result from the transmission of bacteria from mother to child (1), daily habits such as oral hygiene practice, feeding habits, snacking habits, and socioeconomic status (2-5). Recently, it was suggested that children exposed to environmental tobacco smoke (ETS) also have an increased risk of dental caries in the deciduous dentition (6-14). Aligne et al. (7) reported that an elevated serum cotinine level was significantly associated with an increased risk of both decayed and filled teeth of US children from 4 to 11 years old. Shenkin et al. (8) reported that US children from 4 to 7 years old residing in homes with regular smoker had a higher prevalence of caries compared with © 2015 American Association of Public Health Dentistry
nonregular/nonsmoking homes. Tanaka et al. (13) reported that ETS exposure at home was associated with an increased prevalence of dental caries among 3-year-old Japanese children. In children, ETS exposure has been shown to be particularly associated with such issues as upper and lower respiratory tract infections, middle-ear disease, bronchitis, and sudden infant death syndrome (15). Furthermore, some previous studies (6-8) suggested that ETS was significantly associated with ECC even after socioeconomic status was controlled. However, because the association between ETS and ECC has been poorly studied, the process remains incompletely understood. The aim of this study was to investigate the association between ETS from family members and other risk factors and ECC in 3-year-old Japanese children by a cross-sectional study. 157
Tobacco smoke and childhood caries
Methods Subjects The study was conducted in one city and four towns in the east Iburi region, located in the center part of Hokkaido, the northernmost island of Japan. The population of the east Iburi region was 215,233 persons. The total number of subjects aged 3 years old in the east Iburi region was 1,879 people. Among them, 1,801 children (95.8 percent, male: 908, female: 893) received a dental examination from April 2012 to March 2013. The age in months of subjects was between 36 and 47 months. This study was approved by the Ethical Committee of Sapporo Medical University.
Y. Nakayama and M. Mori
decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth” in children from birth through 71 months of age (1). Risk factors for the prevalence of ECC were evaluated using univariate and multivariate analysis by employing the logistic regression model as previous studies (6-11,14). The odds ratios (ORs) and their 95 percent confidence intervals (95 percent CIs) were estimated with regard to risk factors for ECC. Before the multivariate logistic regression analysis was conducted, we evaluated multicollinearity among the variables by the Spearman’s rank correlation test. Tests of statistical significance were based on a two-sided P-value, and the α-error was set at the 5 percent level. The SAS system (ver. 9.2; SAS Institute, Cary, NC, USA) was employed for the analysis.
Method of survey
Results
The self-administered questionnaire was completed by parents or guardians of the children before dental examination. After the questionnaire was completed, the data were checked by hygienists or public health nurses. The survey contents contained items such as whether a smoker resided in the home, the number of smokers in the home, snack times, kinds of snacks (fruits or vegetables, cheese or yogurt, snack foods, ice cream, candy, chocolate, sugar-sweetened gum, sugarless gum, pudding or jelly, Japanese cracker, bread, cake, and cookies) eaten more than or equal to four times a week, kinds of drinks (milk, Japanese tea or water, isotonic drink, juice, soda, and lactic acid drink) consumed more than or equal to four times a week, parents brushing their child’s teeth daily, and use of fluoride toothpaste. Our study did not investigate socioeconomic status.
The dmft index was 1.00 (standard deviation = 2.61). The prevalence of dental caries was 22.4 percent (404/1,801). Table 1 shows prevalence of dental caries in the study subjects according to ETS. There was at least one smoker in the homes of 1,121 subjects (62.2 percent). Table 2 shows a crude OR with 95 percent CI for ECC. Drinking or eating sweets after dinner sometimes (OR = 2.01, 95 percent CI: 1.52-2.67) or everyday (OR = 3.06, 95 percent CI: 2.31-4.05), parents brushing their child’s teeth less frequently (OR = 2.09, 95 percent CI: 1.492.93), irregular snack times (OR = 2.01, 95 percent CI: 1.592.53), frequent intake of ice cream (OR = 1.37, 95 percent CI: 1.08-1.72), frequent intake of chocolate (OR = 1.67, 95 percent CI: 1.33-2.09), frequent intake of sugar-sweetened gum (OR = 2.48, 95 percent CI: 1.63-3.78), frequent intake of sugarless gum (OR = 1.51, 95 percent CI: 1.02-2.23), less frequent intake of Japanese crackers (OR = 0.66, 95 percent CI: 0.52-0.84), less frequent intake of milk (OR = 0.61, 95 percent CI: 0.49-0.76), frequent intake of isotonic drinks (OR = 1.92, 95 percent CI: 1.36-2.70), frequent intake of juice (OR = 1.52, 95 percent CI: 1.22-1.91), frequent intake of soda (OR = 2.18, 95 percent CI: 1.48-3.21), frequent intake of
Examination The dental examinations were carried out at the municipal examination site by some dentists of a local dental clinic with a dental mirror under artificial light. They used the explorer when appropriate. The children’s teeth were not dried. We obtained dmft (number of decayed, missing, and filled teeth per person) from this dental examination. The dentists were given detailed criteria for performing the examination but were not specifically trained as to ensure standardization of their examinations. In Japan, when children reach 3 years old, the municipality in which the family currently resides sponsors a physical examination that includes a dental examination, measurement of height and weight, and an interview survey with parents or guardians regarding the child’s health by the Maternal and Child Health Act.
Analyses We defined ETS as at least one smoker residing in the home. ECC has been defined as “the presence of one or more 158
Table 1 Prevalence of Dental Caries in the Study Subjects According to ETS
ETS Yes No Total
Number of subjects
dmft index
Prevalence of ECC
1,121 642 1,763*
1.27 (SD = 2.98) 0.53 (SD = 1.69) 1.00 (SD = 2.61)
26.9% 14.6% 22.5%
* 38 subjects were lacking in ETS data. dmft index, the average number of decayed, missing, or filled teeth; ECC, early childhood caries; ETS, environmental tobacco smoke; SD, standard deviation.
© 2015 American Association of Public Health Dentistry
Y. Nakayama and M. Mori
Tobacco smoke and childhood caries
Table 2 Odd Ratios (ORs) and 95% Confidence Intervals (CIs) of ECC with Univariate Logistic Regression Analysis Variables
dmft ≧ 1
dmft = 0
OR (95%CI)
Application of 2% sodium fluoride solution: ≧3 times per 3 years ≦2 times per 3 years Use of fluoride toothpaste: Everyday or sometimes Never Drinking or eating sweets after dinner: Never Sometimes Everyday Frequency of parents brushing child’s teeth: Everyday Sometimes or never Complete mastication: Good Bad Snack times: Regular Irregular Consuming vegetable or fruits: No Yes Consuming cheese or yogurt: No Yes Consuming snack food: No Yes Consuming ice cream: No Yes Consuming candy: No Yes Consuming chocolate: No Yes Consuming cookies: No Yes Consuming cake: No Yes Consuming sugar-sweetened gum: No Yes Consuming sugarless gum: No Yes Consuming pudding or jelly: No Yes Consuming Japanese crackers: No Yes Consuming bread: No Yes Drinking milk: No Yes Drinking isotonic drinks: No Yes Drinking juice: No Yes Drinking soda: No Yes Drinking lactic acid drinks: No Yes Drinking water or Japanese tea: No Yes Smoker in family: Absence Presence Smoking father: Absence Presence Smoking mother: Absence Presence Smoking grandparent: Absence Presence Smoking parent: Absence Presence Number of smokers in family: No smoker One smoker Two smokers Three smokers
57 298 232 165 107 131 156 335 59 334 57 160 219 217 179 223 173 169 227 241 155 257 139 181 215 390 6 366 30 357 39 357 39 288 108 278 118 310 86 187 208 339 56 212 183 350 45 304 91 86 309 94 302 167 229 246 150 323 73 300 96 94 169 115 18
255 1,019 820 566 661 402 315 1,279 108 1,120 237 771 526 731 644 775 600 583 792 935 440 881 494 803 572 1,332 42 1,294 80 1,317 58 1,282 93 935 440 838 537 1,104 270 490 895 1,275 110 884 501 1,308 77 1,149 236 171 1,214 548 819 690 677 1,101 266 1,175 192 1,163 204 548 544 230 45
1.00 (reference) 1.31 (0.96-1.79) 1.00 (reference) 1.03 (0.82-1.29) 1.00 (reference) 2.01 (1.52-2.67) 3.06 (2.31-4.05) 1.00 (reference) 2.09 (1.49-2.93) 1.00 (reference) 0.81 (0.59-1.10) 1.00 (reference) 2.01 (1.59-2.53) 1.00 (reference) 0.94 (0.75-1.17) 1.00 (reference) 1.00 (0.80-1.26) 1.00 (reference) 0.99 (0.80-1.24) 1.00 (reference) 1.37 (1.08-1.72) 1.00 (reference) 0.97 (0.76-1.22) 1.00 (reference) 1.67 (1.33-2.09) 1.00 (reference) 0.49 (0.21-1.16) 1.00 (reference) 1.33 (0.86-2.05) 1.00 (reference) 2.48 (1.63-3.78) 1.00 (reference) 1.51 (1.02-2.23) 1.00 (reference) 0.80 (0.62-1.02) 1.00 (reference) 0.66 (0.52-0.84) 1.00 (reference) 1.13 (0.86-1.49) 1.00 (reference) 0.61 (0.49-0.76) 1.00 (reference) 1.92 (1.36-2.70) 1.00 (reference) 1.52 (1.22-1.91) 1.00 (reference) 2.18 (1.48-3.21) 1.00 (reference) 1.46 (1.11-1.92) 1.00 (reference) 0.51 (0.38-0.68) 1.00 (reference) 2.15 (1.67-2.78) 1.00 (reference) 1.40 (1.12-1.75) 1.00 (reference) 2.52 (1.98-3.22) 1.00 (reference) 1.38 (1.03-1.86) 1.00 (reference) 1.82 (1.39-2.40) 1.00 (reference) 1.81 (1.37-2.39) 2.92 (2.13-3.99) 2.33 (1.29-4.20)
dmft: total number of decayed, missing, or filled teeth.
© 2015 American Association of Public Health Dentistry
159
Tobacco smoke and childhood caries
Y. Nakayama and M. Mori
Table 3 Adjusted Odd Ratios (ORs) and 95% Confidence Intervals (CIs) of ECC with Multivariate Logistic Regression Analysis Variables
OR (95% CI)
Drinking or eating sweets after dinner: Never Sometimes Everyday Frequency of parent brushing child’s teeth: Everyday Sometimes or never Snack times: Regular Irregular Consuming ice cream: No Yes Consuming chocolate: No Yes Consuming sugar-sweetened gum: No Yes Consuming sugarless gum: No Yes Consuming Japanese crackers: No Yes Drinking milk: No Yes Drinking isotonic drinks: No Yes Drinking juice: No Yes Drinking soda: No Yes Drinking lactic acid drinks: No Yes Drinking water or Japanese tea: No Yes Smoking father: Absence Presence Smoking mother: Absence Presence Smoking grandparent: Absence Presence
1.00 (reference)
P-value
1.61 (1.18-2.20) 1.68 (1.19-2.37) 1.00 (reference)
0.0027 0.0035
1.23 (0.83-1.82) 1.00 (reference) 1.42 (1.10-1.84) 1.00 (reference) 0.92 (0.71-1.21) 1.00 (reference) 1.38 (1.07-1.78) 1.00 (reference) 2.01 (1.27-3.19) 1.00 (reference) 1.45 (0.93-2.28) 1.00 (reference) 0.78 (0.60-1.02) 1.00 (reference) 0.83 (0.64-1.07) 1.00 (reference) 1.47 (1.00-2.17) 1.00 (reference) 1.06 (0.81-1.38) 1.00 (reference) 1.28 (0.82-1.98) 1.00 (reference) 1.20 (0.88-1.64) 1.00 (reference) 0.73 (0.52-1.02) 1.00 (reference) 1.07 (0.83-1.38) 1.00 (reference) 1.91 (1.43-2.54) 1.00 (reference) 1.10 (0.78-1.53)
0.3121 0.0075 0.5615 0.0118 0.0031 0.1033
Discussion
0.0704
The present study found that ECC was significantly associated with the existence of smokers in the home. In particular, maternal smoking was significantly associated with a higher prevalence of dental caries, and the number of smokers in a family was significantly associated with the risk of ECC. The mother may influence her child more strongly than other family members, as the mother is likely to spend a longer time with the child. The percentage of children age less than or equal to 5 years old in daycare in Japan was 32.2 percent by data from the Ministry of Health, Labour and Welfare of Japan. Our results confirmed those of other studies showing an effect of ETS exposure at home on dental caries (6-14). Causes that influenced ETS exposure at home on pediatric dental caries are considered to be as follows: First, Preston et al. (16) reported that ETS can reduce concentrations of ascorbates in children, even when the amount of exposure to ETS is minimal. Väänänen (17) reported that decreased vitamin C levels have been associated with the growth of cariogenic bacteria. Lindemeyer et al. (18) reported that tobacco enhances the growth of cariogenic streptococci in vitro. ETS exposure may increase cariogenic streptococci in the oral cavity of infants. Second, Leory et al. (10) reported that children raised by parents who smoked, brushed their teeth less frequently, received less help with tooth brushing, and consumed more in between meals and nightly beverage may have had poor oral hygiene and were more likely to have dental caries. However, we found a relationship between ETS exposure at home and ECC even after controlling for oral hygiene and snacking habits in this study. Additionally, a transmission of streptococcus mutans from smoking mothers to their children may be considered an impact of maternal smoking on pediatric dental caries. Shinga et al. (19) reported that pregnant females who had
0.1475 0.0497 0.6672 0.2747 0.2389 0.0644 0.6145
Association of environmental tobacco smoke and snacking habits with the risk of early childhood caries among 3-year-old Japanese children Yoshimi Nakayama, DDS, PhD1,2; Mitsuru Mori, MD, PhD2 1 Hokkaido Tomakomai Public Health Center, Tomakomai, Hokkaido, Japan 2 Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
Keywords environmental tobacco smoke; early childhood caries; snacking habits. Correspondence Dr. Yoshimi Nakayama, Hokkaido Tomakomai Public Health Center, 2-2-21 Wakakusa town, Tomakomai-shi, Hokkaido 053-0021, Japan. Tel.: 81-144-34-4168; Fax: 81-144-34-4177; e-mail: nakayama. [email protected]. Yoshimi Nakayama is with the Hokkaido Tomakomai Public Health Center. Yoshimi Nakayama and Mitsuru Mori are with the Department of Public Health, Sapporo Medical University School of Medicine. Received: 3/3/2014; accepted: 12/19/2014. doi: 10.1111/jphd.12085 Journal of Public Health Dentistry 75 (2015) 157–162
Abstract Objectives: The aim of this study was to investigate the association of environmental tobacco smoke (ETS) and other risk factors with early childhood caries (ECC) in 3-year-old Japanese children by a cross-sectional study. Methods: Study subjects were 1,801 children aged 3 years old. The self-administered questionnaire was completed by parents or guardians of the children. The survey contents included such things as if there was a smoker in the home, snack times, the kinds of snacks consumed more than or equal to four times a week, the kinds of drinks consumed more than or equal to four times a week, parents brushing their child’s teeth daily, and the use of fluoride toothpaste. We obtained the number of decayed, missing, or filled teeth per person (dmft) from the dental examinations. Logistic regression analysis was performed to estimate odds ratio of ECC. Results: The average number of decayed, missing and filled teeth (dmft index) was 1.00. The prevalence of dental caries was 22.4 percent. There was at least one smoker in the homes of 1,121 subjects (62.2 percent). After excluding items of multicollinearity, the results of multivariate analysis were as follows: drinking or eating sweets after dinner, irregular snack times, frequent intake of chocolate, frequent intake of sugar-sweetened gum, frequent intake of isotonic drink, and maternal smoking were significantly associated with the risk of ECC. Conclusions: This study suggests that there is a significant correlation between ETS from family members and snacking habits and ECC.
Introduction Early childhood caries (ECC) is one of the most prevalent chronic diseases among children. Heretofore, ECC has been shown to result from the transmission of bacteria from mother to child (1), daily habits such as oral hygiene practice, feeding habits, snacking habits, and socioeconomic status (2-5). Recently, it was suggested that children exposed to environmental tobacco smoke (ETS) also have an increased risk of dental caries in the deciduous dentition (6-14). Aligne et al. (7) reported that an elevated serum cotinine level was significantly associated with an increased risk of both decayed and filled teeth of US children from 4 to 11 years old. Shenkin et al. (8) reported that US children from 4 to 7 years old residing in homes with regular smoker had a higher prevalence of caries compared with © 2015 American Association of Public Health Dentistry
nonregular/nonsmoking homes. Tanaka et al. (13) reported that ETS exposure at home was associated with an increased prevalence of dental caries among 3-year-old Japanese children. In children, ETS exposure has been shown to be particularly associated with such issues as upper and lower respiratory tract infections, middle-ear disease, bronchitis, and sudden infant death syndrome (15). Furthermore, some previous studies (6-8) suggested that ETS was significantly associated with ECC even after socioeconomic status was controlled. However, because the association between ETS and ECC has been poorly studied, the process remains incompletely understood. The aim of this study was to investigate the association between ETS from family members and other risk factors and ECC in 3-year-old Japanese children by a cross-sectional study. 157
Tobacco smoke and childhood caries
Methods Subjects The study was conducted in one city and four towns in the east Iburi region, located in the center part of Hokkaido, the northernmost island of Japan. The population of the east Iburi region was 215,233 persons. The total number of subjects aged 3 years old in the east Iburi region was 1,879 people. Among them, 1,801 children (95.8 percent, male: 908, female: 893) received a dental examination from April 2012 to March 2013. The age in months of subjects was between 36 and 47 months. This study was approved by the Ethical Committee of Sapporo Medical University.
Y. Nakayama and M. Mori
decayed (non-cavitated or cavitated lesions), missing (due to caries), or filled tooth surfaces in any primary tooth” in children from birth through 71 months of age (1). Risk factors for the prevalence of ECC were evaluated using univariate and multivariate analysis by employing the logistic regression model as previous studies (6-11,14). The odds ratios (ORs) and their 95 percent confidence intervals (95 percent CIs) were estimated with regard to risk factors for ECC. Before the multivariate logistic regression analysis was conducted, we evaluated multicollinearity among the variables by the Spearman’s rank correlation test. Tests of statistical significance were based on a two-sided P-value, and the α-error was set at the 5 percent level. The SAS system (ver. 9.2; SAS Institute, Cary, NC, USA) was employed for the analysis.
Method of survey
Results
The self-administered questionnaire was completed by parents or guardians of the children before dental examination. After the questionnaire was completed, the data were checked by hygienists or public health nurses. The survey contents contained items such as whether a smoker resided in the home, the number of smokers in the home, snack times, kinds of snacks (fruits or vegetables, cheese or yogurt, snack foods, ice cream, candy, chocolate, sugar-sweetened gum, sugarless gum, pudding or jelly, Japanese cracker, bread, cake, and cookies) eaten more than or equal to four times a week, kinds of drinks (milk, Japanese tea or water, isotonic drink, juice, soda, and lactic acid drink) consumed more than or equal to four times a week, parents brushing their child’s teeth daily, and use of fluoride toothpaste. Our study did not investigate socioeconomic status.
The dmft index was 1.00 (standard deviation = 2.61). The prevalence of dental caries was 22.4 percent (404/1,801). Table 1 shows prevalence of dental caries in the study subjects according to ETS. There was at least one smoker in the homes of 1,121 subjects (62.2 percent). Table 2 shows a crude OR with 95 percent CI for ECC. Drinking or eating sweets after dinner sometimes (OR = 2.01, 95 percent CI: 1.52-2.67) or everyday (OR = 3.06, 95 percent CI: 2.31-4.05), parents brushing their child’s teeth less frequently (OR = 2.09, 95 percent CI: 1.492.93), irregular snack times (OR = 2.01, 95 percent CI: 1.592.53), frequent intake of ice cream (OR = 1.37, 95 percent CI: 1.08-1.72), frequent intake of chocolate (OR = 1.67, 95 percent CI: 1.33-2.09), frequent intake of sugar-sweetened gum (OR = 2.48, 95 percent CI: 1.63-3.78), frequent intake of sugarless gum (OR = 1.51, 95 percent CI: 1.02-2.23), less frequent intake of Japanese crackers (OR = 0.66, 95 percent CI: 0.52-0.84), less frequent intake of milk (OR = 0.61, 95 percent CI: 0.49-0.76), frequent intake of isotonic drinks (OR = 1.92, 95 percent CI: 1.36-2.70), frequent intake of juice (OR = 1.52, 95 percent CI: 1.22-1.91), frequent intake of soda (OR = 2.18, 95 percent CI: 1.48-3.21), frequent intake of
Examination The dental examinations were carried out at the municipal examination site by some dentists of a local dental clinic with a dental mirror under artificial light. They used the explorer when appropriate. The children’s teeth were not dried. We obtained dmft (number of decayed, missing, and filled teeth per person) from this dental examination. The dentists were given detailed criteria for performing the examination but were not specifically trained as to ensure standardization of their examinations. In Japan, when children reach 3 years old, the municipality in which the family currently resides sponsors a physical examination that includes a dental examination, measurement of height and weight, and an interview survey with parents or guardians regarding the child’s health by the Maternal and Child Health Act.
Analyses We defined ETS as at least one smoker residing in the home. ECC has been defined as “the presence of one or more 158
Table 1 Prevalence of Dental Caries in the Study Subjects According to ETS
ETS Yes No Total
Number of subjects
dmft index
Prevalence of ECC
1,121 642 1,763*
1.27 (SD = 2.98) 0.53 (SD = 1.69) 1.00 (SD = 2.61)
26.9% 14.6% 22.5%
* 38 subjects were lacking in ETS data. dmft index, the average number of decayed, missing, or filled teeth; ECC, early childhood caries; ETS, environmental tobacco smoke; SD, standard deviation.
© 2015 American Association of Public Health Dentistry
Y. Nakayama and M. Mori
Tobacco smoke and childhood caries
Table 2 Odd Ratios (ORs) and 95% Confidence Intervals (CIs) of ECC with Univariate Logistic Regression Analysis Variables
dmft ≧ 1
dmft = 0
OR (95%CI)
Application of 2% sodium fluoride solution: ≧3 times per 3 years ≦2 times per 3 years Use of fluoride toothpaste: Everyday or sometimes Never Drinking or eating sweets after dinner: Never Sometimes Everyday Frequency of parents brushing child’s teeth: Everyday Sometimes or never Complete mastication: Good Bad Snack times: Regular Irregular Consuming vegetable or fruits: No Yes Consuming cheese or yogurt: No Yes Consuming snack food: No Yes Consuming ice cream: No Yes Consuming candy: No Yes Consuming chocolate: No Yes Consuming cookies: No Yes Consuming cake: No Yes Consuming sugar-sweetened gum: No Yes Consuming sugarless gum: No Yes Consuming pudding or jelly: No Yes Consuming Japanese crackers: No Yes Consuming bread: No Yes Drinking milk: No Yes Drinking isotonic drinks: No Yes Drinking juice: No Yes Drinking soda: No Yes Drinking lactic acid drinks: No Yes Drinking water or Japanese tea: No Yes Smoker in family: Absence Presence Smoking father: Absence Presence Smoking mother: Absence Presence Smoking grandparent: Absence Presence Smoking parent: Absence Presence Number of smokers in family: No smoker One smoker Two smokers Three smokers
57 298 232 165 107 131 156 335 59 334 57 160 219 217 179 223 173 169 227 241 155 257 139 181 215 390 6 366 30 357 39 357 39 288 108 278 118 310 86 187 208 339 56 212 183 350 45 304 91 86 309 94 302 167 229 246 150 323 73 300 96 94 169 115 18
255 1,019 820 566 661 402 315 1,279 108 1,120 237 771 526 731 644 775 600 583 792 935 440 881 494 803 572 1,332 42 1,294 80 1,317 58 1,282 93 935 440 838 537 1,104 270 490 895 1,275 110 884 501 1,308 77 1,149 236 171 1,214 548 819 690 677 1,101 266 1,175 192 1,163 204 548 544 230 45
1.00 (reference) 1.31 (0.96-1.79) 1.00 (reference) 1.03 (0.82-1.29) 1.00 (reference) 2.01 (1.52-2.67) 3.06 (2.31-4.05) 1.00 (reference) 2.09 (1.49-2.93) 1.00 (reference) 0.81 (0.59-1.10) 1.00 (reference) 2.01 (1.59-2.53) 1.00 (reference) 0.94 (0.75-1.17) 1.00 (reference) 1.00 (0.80-1.26) 1.00 (reference) 0.99 (0.80-1.24) 1.00 (reference) 1.37 (1.08-1.72) 1.00 (reference) 0.97 (0.76-1.22) 1.00 (reference) 1.67 (1.33-2.09) 1.00 (reference) 0.49 (0.21-1.16) 1.00 (reference) 1.33 (0.86-2.05) 1.00 (reference) 2.48 (1.63-3.78) 1.00 (reference) 1.51 (1.02-2.23) 1.00 (reference) 0.80 (0.62-1.02) 1.00 (reference) 0.66 (0.52-0.84) 1.00 (reference) 1.13 (0.86-1.49) 1.00 (reference) 0.61 (0.49-0.76) 1.00 (reference) 1.92 (1.36-2.70) 1.00 (reference) 1.52 (1.22-1.91) 1.00 (reference) 2.18 (1.48-3.21) 1.00 (reference) 1.46 (1.11-1.92) 1.00 (reference) 0.51 (0.38-0.68) 1.00 (reference) 2.15 (1.67-2.78) 1.00 (reference) 1.40 (1.12-1.75) 1.00 (reference) 2.52 (1.98-3.22) 1.00 (reference) 1.38 (1.03-1.86) 1.00 (reference) 1.82 (1.39-2.40) 1.00 (reference) 1.81 (1.37-2.39) 2.92 (2.13-3.99) 2.33 (1.29-4.20)
dmft: total number of decayed, missing, or filled teeth.
© 2015 American Association of Public Health Dentistry
159
Tobacco smoke and childhood caries
Y. Nakayama and M. Mori
Table 3 Adjusted Odd Ratios (ORs) and 95% Confidence Intervals (CIs) of ECC with Multivariate Logistic Regression Analysis Variables
OR (95% CI)
Drinking or eating sweets after dinner: Never Sometimes Everyday Frequency of parent brushing child’s teeth: Everyday Sometimes or never Snack times: Regular Irregular Consuming ice cream: No Yes Consuming chocolate: No Yes Consuming sugar-sweetened gum: No Yes Consuming sugarless gum: No Yes Consuming Japanese crackers: No Yes Drinking milk: No Yes Drinking isotonic drinks: No Yes Drinking juice: No Yes Drinking soda: No Yes Drinking lactic acid drinks: No Yes Drinking water or Japanese tea: No Yes Smoking father: Absence Presence Smoking mother: Absence Presence Smoking grandparent: Absence Presence
1.00 (reference)
P-value
1.61 (1.18-2.20) 1.68 (1.19-2.37) 1.00 (reference)
0.0027 0.0035
1.23 (0.83-1.82) 1.00 (reference) 1.42 (1.10-1.84) 1.00 (reference) 0.92 (0.71-1.21) 1.00 (reference) 1.38 (1.07-1.78) 1.00 (reference) 2.01 (1.27-3.19) 1.00 (reference) 1.45 (0.93-2.28) 1.00 (reference) 0.78 (0.60-1.02) 1.00 (reference) 0.83 (0.64-1.07) 1.00 (reference) 1.47 (1.00-2.17) 1.00 (reference) 1.06 (0.81-1.38) 1.00 (reference) 1.28 (0.82-1.98) 1.00 (reference) 1.20 (0.88-1.64) 1.00 (reference) 0.73 (0.52-1.02) 1.00 (reference) 1.07 (0.83-1.38) 1.00 (reference) 1.91 (1.43-2.54) 1.00 (reference) 1.10 (0.78-1.53)
0.3121 0.0075 0.5615 0.0118 0.0031 0.1033
Discussion
0.0704
The present study found that ECC was significantly associated with the existence of smokers in the home. In particular, maternal smoking was significantly associated with a higher prevalence of dental caries, and the number of smokers in a family was significantly associated with the risk of ECC. The mother may influence her child more strongly than other family members, as the mother is likely to spend a longer time with the child. The percentage of children age less than or equal to 5 years old in daycare in Japan was 32.2 percent by data from the Ministry of Health, Labour and Welfare of Japan. Our results confirmed those of other studies showing an effect of ETS exposure at home on dental caries (6-14). Causes that influenced ETS exposure at home on pediatric dental caries are considered to be as follows: First, Preston et al. (16) reported that ETS can reduce concentrations of ascorbates in children, even when the amount of exposure to ETS is minimal. Väänänen (17) reported that decreased vitamin C levels have been associated with the growth of cariogenic bacteria. Lindemeyer et al. (18) reported that tobacco enhances the growth of cariogenic streptococci in vitro. ETS exposure may increase cariogenic streptococci in the oral cavity of infants. Second, Leory et al. (10) reported that children raised by parents who smoked, brushed their teeth less frequently, received less help with tooth brushing, and consumed more in between meals and nightly beverage may have had poor oral hygiene and were more likely to have dental caries. However, we found a relationship between ETS exposure at home and ECC even after controlling for oral hygiene and snacking habits in this study. Additionally, a transmission of streptococcus mutans from smoking mothers to their children may be considered an impact of maternal smoking on pediatric dental caries. Shinga et al. (19) reported that pregnant females who had
0.1475 0.0497 0.6672 0.2747 0.2389 0.0644 0.6145
