European Archives of Paediatric Dentistry

, Volume 18, Issue 6, pp 393–398 | Cite as

Effects of environmental tobacco smoke on the oral health of preschool children

  • N. N. b. Hasmun
  • B. K. DrummondEmail author
  • T. Milne
  • M. P. Cullinan
  • A. M. Meldrum
  • D. Coates
Original Scientific Article



This study investigated the association between the prevalence of oral health problems (caries, gingivitis, mucosal pigmentation and enamel defects in one to 5 year-old children exposed and not exposed to environmental tobacco smoke before and/or after birth. Exposure to environmental tobacco smoke (ETS) in childhood may have significant health effects.


A structured questionnaire was used to collect data on a child’s current and previous illnesses, oral health behaviours, dietary habits, parental smoking behaviours and parents’ dental history. The intraoral examination recorded dental caries (dmfs), enamel defects, gingival health, melanin pigmentation and soft tissue health. Stimulated saliva was collected. Total sIgA levels were quantified using indirect competitive ELISA with a SalimetricsTM kit.


The 44 children (aged 15–69 months) recruited were divided into two groups: ETS and non-ETS (control). There were 22 children in each: 16 who were exposed to ETS during and after gestation were identified as the ETSB subgroup. Participants exposed to ETS were more likely to have had upper respiratory tract and middle ear infections during the neonatal period and had higher mean dmft, mean dmfs, mean percent of surfaces with demarcated opacities and mean GI than the non-ETS participants. The children exposed to ETS before and after birth had the highest occurrence of enamel opacities showed a higher risk for dental caries even though more children in this group used the recommended fluoride toothpaste (1000 ppm fluoride). Mothers who smoked either never breastfed their children or breastfed their children for less than the recommended period of 6 months. Children exposed to ETS were shown to have higher mean total sIgA (μg/ml) than the children in the control group.


Associations between ETS exposure before and after gestation and oral health, including salivary changes in young children were shown in the present study. Dental health professionals should include a question about household smoking in children’s dental histories, which would allow opportunities to discuss the impact of smoking on child oral health. Longitudinal oral health studies should include a history of maternal smoking during pregnancy and afterwards.


Oral health Children Tobacco smoke 



The authors thank the Royal New Zealand Plunket Society for their support for the project and acknowledge the support of the Universiti Teknologi MARA and the Government of Malaysia IPTA academic training scheme scholarship for Dr Hasmun.

Compliance with ethical standards

Conflicts of interest

There are no potential conflicts of interest.


This study received no external funding.

Ethical approval

This study was performed in accordance with the ethical Standards of the Institutional Ethics Committee and the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Written informed consent was obtained from the mothers of the participants and assent was obtained from the participants in this study.


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Copyright information

© European Academy of Paediatric Dentistry 2017

Authors and Affiliations

  • N. N. b. Hasmun
    • 1
  • B. K. Drummond
    • 2
    Email author
  • T. Milne
    • 2
  • M. P. Cullinan
    • 2
  • A. M. Meldrum
    • 2
  • D. Coates
    • 2
  1. 1.Faculty of Dentistry, Centre of Studies for Paediatric Dentistry and OrthodonticsUniversiti Teknologi MaraSungai BulohMalaysia
  2. 2.Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research InstituteUniversity of OtagoDunedinNew Zealand

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