Sains Malaysiana 43(11)(2014): 1729–1735

Is Household Smoking a Risk Factor for Caries? A Case-Control Study

(Adakah Asap Rokok di Rumah Faktor Risiko untuk Karies? Suatu Kajian Kes)

A.M. ZURINA¹, M. ASMA'⁴*, R.J. RAJA LATIFAH² & Y. NORIAH³

¹Ministry of Health, Blok E1, E3, E6, E7 & E10, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62590 Putrajaya, Malaysia

²International Islamic University Malaysia, Jalan Sungai Pusu, 53100 Gombak, Selangor, Malaysia

³Faculty of Dentistry, Universiti Kebangsaan Malaysia (Kampus KL), Jalan Raja Muda Abd. Aziz

50300 Kuala Lumpur, Malaysia

⁴Department of Community Oral Health and Clinical Prevention, Faculty of Dentistry,

University of Malaya, 50603 Kuala Lumpur, Malaysia

Received: 20 September 2013/Accepted: 7 April 2014

ABSTRACT

Recent studies suggested that exposure to household smoking (HHS) could be a modifiable risk factor for caries development among children. Majority of the studies were cross sectional in nature. Therefore, a case-control study was designed to test the hypothesis that HHS is a risk factor to caries experience in permanent teeth. Calculation of sample size was based on the ratio of 1 case to 4 controls. Case was defined as a child aged 13-14 years old with caries in at least one second permanent molar and control was defined as a child from the same age and school with no caries second permanent molars. Matching was done for gender and ethnicity. School dental records provided information on oral health status and oral hygiene status. Information on HHS, socio-economic status, child’s smoking status and child’s oral health practices were obtained from a self- administered questionnaire, completed by the children and their parents. The result showed that 55.9% of the case group was exposed to HHS, as compared to 44.1% among the control group. In the final multiple logistic regression model after controlling for important risk factors for caries, children with caries were almost twice as likely to have been exposed to HHS for more than 10 years as compared to children with no caries, (Adjusted OR=1.90 and 95% CI=1.35, 2.60). In addition, children who only received dental care from the school dental service had reduced risk of having dental caries by more than one third (36%) as compared with those who received dental care from school dental service (SDS) as well as had additional dental problem solving visit outside SDS (Adjusted OR=0.64 and 95% CI=0.50, 0.90). It is concluded that exposure to HHS for a long duration (> than 10 years) increase the risk to have caries experience in permanent teeth of children.

Keywords: Children; dental caries; household smoking; risk factor

ABSTRAK

Kajian terkini menunjukkan bahawa pendedahan kepada asap rokok di rumah (HHS) boleh menjadi faktor risiko yang boleh diubah untuk pembentukan karies dalam kalangan kanak-kanak. Kebanyakan kajian adalah kajian keratan rentas. Oleh itu, satu kajian kes-kawalan telah dirancang untuk menguji hipotesis bahawa HHS adalah faktor risiko kepada karies pada gigi kekal. Pengiraan saiz sampel adalah berdasarkan kepada nisbah satu kes kepada empat kawalan. Kes ditakrifkan sebagai seorang kanak-kanak berumur 13-14 tahun dengan kerosakan gigi di sekurang-kurangnya satu gigi geraham kekal kedua dan kawalan pula ditakrifkan sebagai kanak-kanak yang sama umur (dan dari sekolah yang sama) tanpa karies gigi geraham kekal kedua. Padanan telah dilakukan untuk jantina dan keturunan. Maklumat mengenai status kesihatan mulut dan status kebersihan mulut diambil daripada rekod pergigian sekolah. Maklumat HHS, status sosio-ekonomi, status merokok kanak-kanak dan amalan kesihatan mulut kanak-kanak diperoleh menggunakan borang soal selidik yang diisi oleh anak-anak dan ibu bapa mereka. Hasilnya menunjukkan bahawa 55.9% daripada kes terdedah kepada HHS, berbanding dengan 44.1% dalam kalangan kumpulan kawalan. Dalam model regresi logistik berganda akhir selepas mengawal faktor-faktor risiko yang penting untuk karies, kanak-kanak dalam kumpulan kes hampir dua kali ganda berkemungkinan telah terdedah kepada HHS selama lebih daripada 10 tahun berbanding dengan kanak-kanak tanpa karies, (Adjusted OR=1.90 dan 95% CI=1.35, 2.60). Di samping itu, kanak-kanak yang hanya menerima rawatan pergigian daripada perkhidmatan pergigian sekolah mengurangkan risiko mempunyai karies gigi lebih daripada satu pertiga (36%) berbanding dengan mereka yang menerima rawatan pergigian daripada perkhidmatan pergigian sekolah (SDS) dan rawatan tambahan diluar SDS untuk menyelesaikan masalah pergigian (Adjusted OR=0.64 dan 95% CI=0.50, 0.90). Kesimpulannya, pendedahan kepada HHS untuk tempoh yang panjang (> 10 tahun) meningkatkan risiko untuk mendapat karies gigi kekal dalam kalangan kanak-kanak.

Kata kunci: Asap rokok di rumah; faktor risiko; kanak-kanak; karies gigi

REFERENCES

Aligne, C.A., Moss, M.E., Auniger, P. & Weitzman, M. 2003. Association of paediatric dental caries with passive smoking. JAMA 289:1258-1264.

Avsar, A., Darka, O., Topaloglu, B. & Bek, Y. 2008. Association of passive smoking with caries and related salivary biomarkers in young children. Archives of Oral Biology 53: 969-974.

Ayo-Yusuf, O.A., Reddy, P.S., Van Wyk, P.J. & Van den Borne, B.W. 2007. Household smoking as a risk indicator for caries in adolescents' permanent teeth. J. Adolescent Health 41: 309-311.

Burt, B.A. & Pai, S. 2001. Sugar consumption and caries risk: A systematic review. J. Dent. Educ. 65(10): 1017-1023.

Dupont, W.D. & Plummer, W.D. 2009. Power and sample size calculation software. Version 3.0. Department of Biostatistic, Vanderbilt University. http://biostat.mc.vanderbilt.edu.

Gustafsson, B.E., Quensel, C.E., Lanke, L.S., Lundquist, C., Grahnen, H., Bonow, B.E. & Krasse, B. 1954. The Vipeholm dental caries study: The effect of different levels of carbohydrate intake on caries activity in 436 individuals observed for five years. Acta Odontologica Scandinavica 11: 232-364.

Greene, J.C. & Vermillion, J.R. 2009. Simplified oral hygiene index (OHI-S) 1964; http://www.whocollab.od.mah.se.

Harris, R.M. 1963. Biology of the children of Hopewood House, Bowral, Australia: Observations on dental caries experience extending over five years (1957-1961). Journal Dental Research 42: 1387-1399.

Hausen, H., Milen, A., Heinonen, O.P. & Paunio, I. 1982. Caries in primary dentition and social class in high and low fluoride areas. Community Dent. Oral Epidemiol. 10: 33-36.

Heikkinen, T., Alvesalo, L., Osborne, R.H. & Tienari, J. 1994. Maternal smoking and tooth formation in the foetus. II. Tooth crown size in the permanent dentition. Early Hum. Dev. 40(1): 73-86.

Hussin, A.S., Mokhtar, N., Naing, L., Taylor, J.A. & Mahmood, Z. 2000. The timing and sequence of emergence of permanent teeth in Malay schoolchildren in Kota Bharu, Malaysia. Archives of Orofacial Sciences 2: 36-40.

Jaafar, N. & Razak, I.A. 2002. The prevalence and impact of oro-facial pain among 12-year-old schoolchildren in an epidemiological survey setting. Annal. Dent. Univ. Malaya 9: 11-16.

Kopec, J.A. & Esdaile, J.M. 1990. Bias in case control study: A review. Journal of Epidemiology and Community Health 44: 179-186.

Leroy, R., Hoppenbrouwers, K., Jara, A. & Declerck, D. 2007. Parental smoking behaviour and caries experience in preschool children. Community Dent. Oral Epidemiol. 36: 249-257.

Lindermeyer, R.G. 1981. In vitro effect of tobacco on the growth of cariogenic streptococci. JADA 103: 719-722.

McNulty, J.A. & Fos, P.J. 1986. The study of caries prevalence in children in a developing country. J. Dent. Research 53: 76-82.

Ministry of Health Malaysia. 2003: Global Youth Tobacco Survey. Non Communicable Disease Control Section, Disease Control Division, Ministry of Health Malaysia.

Moynihan, P.J. 2005. The role of diet and nutrition in the aetiology and prevention of oral disease. Bull. World Health Organization 83: 694-699.

National Institute for Health and Care. 2004. Dental Recall: Recall Interval between Routine Dental Examinations. (GC19). London: National Institute for Health and Care Excellence.

Nomura, L.H., Bastos, J.L.D. & Peres, M.A. 2004. Dental pain prevalence and association with dental caries and socioeconomic status in schoolchildren, Southern Brazil. Braz. Oral Res. 18(2): 134-140.

Oral Health Division, Ministry of Health Malaysia. 2009. Annual Report: Oral Health Division. Ministry of Health Malaysia.

Oral Health Division, Ministry of Health Malaysia. 2004. National Oral Health Survey of Adults (NOHSA) Malaysia 2000. Ministry of Health Malaysia.

Reisine, S.T. & Psoter, W. 2001. Socioeconomic status and selected behavioural determinants as risk factors for dental caries. J. Dent. Edu. 65(10): 1009-1016.

Rugg-Gunn, A.J. 1993. Nutrition, diet, dental public health. Community Dental Health 10(2): 47-56.

Saad, A.Y. 1990. Postnatal effects of nicotine on incisor development of albino mouse. Journal Oral Pathological Medicine 19: 426-429.

Sharina, D., Zulkifli, A. & Nyi, N.N. 2007. Second hand smoke exposure at home and respiratory symptoms among primary school children in Kota Bharu, Kelantan. Malaysian Journal of Public Health Medicine 7(2): 59-63.

Sheiham, A. 2006. Dental caries affects body weight, growth & quality of life in preschool children. British Dental Journal 201: 625-626.

Shenkin, J.D., Broffitt, B., Levy, S.M. & Warren, J.J. 2004. The association between environmental tobacco smoke and primary tooth caries. J. Public Health Dentistry 64: 184-186.

Strauss, R.S. 2001. Environmental tobacco smoke and serum vitamin C levels in children. Paediatrics 107: 540-542.

Tanaka, K., Miyake, Y., Arakawa, M., Sasaki, S. & Ohya, Y. 2010. Household smoking and dental caries in schoolchildren: Ryukyus Child Health Study. BMC Public Health 10(1): 335.

Tanaka, K., Hanioka, T., Miyake, Y., Ojima, M. & Aoyama, H. 2006. Association of smoking in household and dental caries in Japan. J. Public Health Den. 66: 279-281.

Ten Cate, A.R., Sharpe, P.T., Roy, S. & Nanci, A. 2008. Chapter 5: Development of the tooth and its supporting tissues. In Ten Cate's: Oral Histology, Development, Structure and Function Edited by Antonio Nanci. Mosby: Elsevier. pp. 79-99.

William, S.A., Kwan, S.Y.L. & Parson, S. 2000. Parental smoking practices and caries experience in preschool children. Caries Research 34: 117-122.

World Health Organization (WHO). 1997: Oral Health Surveys, Basic Methods. 4th ed. Geneva: World Health Organization.

Yanagita, M., Kashiwagi, Y., Kobayashi, R., Tomedo, M., Shimabukuro, Y. & Murakami, S. 2008. Nicotine inhibits mineralization of human dental pulp cells. Journal of Endodontic 34(9): 1061-1065.

*Corresponding author; email: asmar@um.edu.my