B Hasmun N N, Drummond B K, Milne T, Cullinan M P, Meldrum A M, Coates D
Faculty of Dentistry, Centre of Studies for Paediatric Dentistry and Orthodontics, Universiti Teknologi Mara, Sungai Buloh Campus, Jalan Hospital, 47000, Sungai Buloh, Selangor Darul Ehsan, Malaysia.
Department of Oral Sciences, Faculty of Dentistry, Sir John Walsh Research Institute, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
Eur Arch Paediatr Dent. 2017 Dec;18(6):393-398. doi: 10.1007/s40368-017-0308-6. Epub 2017 Oct 31.
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.
本研究调查了出生前和/或出生后暴露于环境烟草烟雾与未暴露于环境烟草烟雾的1至5岁儿童口腔健康问题（龋齿、牙龈炎、黏膜色素沉着和牙釉质缺陷）患病率之间的关联。儿童期暴露于环境烟草烟雾（ETS）可能会对健康产生重大影响。
使用结构化问卷收集有关儿童当前和既往疾病、口腔健康行为、饮食习惯、父母吸烟行为以及父母牙科病史的数据。口腔内检查记录龋齿（dmfs）、牙釉质缺陷、牙龈健康、黑色素沉着和软组织健康状况。收集刺激唾液。使用SalimetricsTM试剂盒通过间接竞争酶联免疫吸附测定法对总分泌型免疫球蛋白A（sIgA）水平进行定量。
招募的44名儿童（年龄在15至69个月之间）被分为两组：ETS组和非ETS组（对照组）。每组各有22名儿童：16名在孕期及产后暴露于ETS的儿童被确定为ETSB亚组。与非ETS组参与者相比，暴露于ETS的参与者在新生儿期更易患上下呼吸道感染和中耳感染，且平均龋失补牙数（dmft）、平均龋补牙面数（dmfs）、有界限性浑浊的表面平均百分比以及平均牙龈指数（GI）更高。出生前后暴露于ETS的儿童牙釉质浑浊发生率最高，即使该组中更多儿童使用了推荐的含氟牙膏（含氟量1000 ppm），其患龋齿的风险也更高。吸烟的母亲要么从未母乳喂养过孩子，要么母乳喂养孩子的时间少于推荐的6个月期限。结果显示，暴露于ETS的儿童的平均总sIgA（μg/ml）高于对照组儿童。
本研究表明，孕期前后暴露于ETS与口腔健康之间存在关联，包括幼儿唾液变化。牙科保健专业人员应在儿童牙科病史中纳入有关家庭吸烟情况的问题，这将为讨论吸烟对儿童口腔健康的影响提供机会。纵向口腔健康研究应包括孕期及产后母亲吸烟史。
