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Limited evidence shows a possible causal relationship between secondhand smoke and caries in children

David Leader DMD, MPH Associate Clinical Professor, Tufts University .


Systematic Review Conclusion

A possible causal relationship exists between caries in primary dentition and secondhand smoke (SHS), whereas a similar relationship for permanent dentition remains unclear.

Critical Summary Assessment

In this systematic review of 15 high-quality observational studies, the authors found that the results of 10 studies showed a weak to moderate relationship between caries in primary dentition and SHS, and the results of five studies showed a weak relationship for permanent dentition.

Evidence Quality Rating

Limited Evidence

This summary is published in the Journal of the American Dental Association and can be accessed at:

Critical Summary Publication Date:


These summaries are not intended to, and do not, express, imply, or summarize standards of care, but rather provide a concise reference for dentists to aid in understanding and applying evidence from the referenced systematic review in making clinically sound decisions as guided by their clinical judgment and by patient needs. American Dental Association © 2019