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To the Editor: Dr Moss and colleagues¹ implicated high blood lead level (BLL) as a risk factor for dental caries. This conclusion may have resulted instead from the confounding of lead toxicity and tooth decay with socioeconomic status.

Children with high BLL (>10 µg/dL) are about 4 times as likely to be living in poverty and 4 times as likely to be black as children with lower levels of lead.² Being poor or being black is also strongly associated with tooth decay. For example, among children aged 2 to 5 years, those living in poverty are 7 times as likely to have decayed primary teeth as those from more affluent families.³ Blacks aged 6 to 18 years are twice as likely as whites to have decayed teeth.³

Certain limitations of the multivariate analyses used by Moss et al raise questions about whether these strong biases were controlled sufficiently. Adjustments were . . . [Full Text of this Article]

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