Abstract
To examine the available evidence on the association between exposure to tobacco use in the womb and in infancy and the presence of caries in primary and permanent dentition in children and adolescents.A systematic review was conducted through searches in 4 data bases (Pubmed, Scopus, Embase and Web of Science), complemented by hand-searching. Of the 559 articles identified, 400 were duplicates. Finally, 28 articles were included in the qualitative review and 21 in the meta-analysis. Their quality was assessed using the Newcastle-Ottawa scale. The quality was medium in 44% of the articles included and high in 56%.The overall meta-analysis gave a significant odds ratio (OR = 1.53, 95% confidence interval 1.39–1.68, Z test p-value = 0.000) and high heterogeneity (Q = 200.3, p = 0.000; I2 = 86.52%). Separate meta-analyses were also performed for three subgroups: exposure in the womb (prenatal) and caries in primary dentition, which resulted in a significant OR = 1.46 with a 95% CI of 1.41–1.52 (Z test p = 0.000), without heterogeneity (Q = 0.91, p = 0.824; I2 = 0%); exposure in infancy (postnatal) and caries in primary dentition, with OR = 1.72 (95% CI 1.45–2.05) and high heterogeneity (Q = 76.59, p = 0.00; I2 = 83.01%); and postnatal exposure and caries in permanent dentition, with OR = 1.30 (95% CI 1.25–1.34) and no heterogeneity (Q = 4.48, p = 0.880; I2 = 0%). In children and adolescents, a significant though moderate association was found between passive tobacco exposure and caries.
Highlights
Dental caries is still one of the main diseases of the oral cavity, affecting a third of the population in the world[1]
Longitudinal studies, case-control studies and cross-sectional studies were included provided they had a control group of subjects not exposed to tobacco use for comparison and that the primary outcome of caries was expressed as odds ratios, or as hazard ratios or indices (DMFT, DMFS, dft or dfs)
28 articles were included in the systematic review and 21 in the meta-analysis (Fig 1)
Summary
Dental caries is still one of the main diseases of the oral cavity, affecting a third of the population in the world[1]. Caries prevalence has fallen in industrialised countries in recent years, it has increased in developing countries. The current epidemiological pattern of dental caries in the child population of developed countries shows lower caries levels but an unbalanced distribution, concentrated in the most socially-disadvantaged sector of the population. The economic and social cost of caries is very high. Dental caries is considered a pandemic due to its global distribution and severe consequences[3]
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