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To the Editor: Dr Aligne and colleagues¹ reported that children who were exposed to passive smoking were more likely to have dental caries. They concluded that reduction of passive smoking would lead to better dental health among children. Although this argument assumes a causal relationship between passive smoking and dental caries, it is possible that this association is mediated or confounded by a number of factors.

It is possible, for instance, that parental smoking is associated with other dental preventive practices in the home. The authors admit that they cannot rule this out, as "NHANES III does not include a variable for tooth brushing or other oral hygiene practices." Similarly, other dietary practices may be related to parental smoking. However, Aligne et al presented no data on the use or duration of infant bottle feeding, or the content of infant bottles. Bottle-feeding practices differ by parental smoking status,² which is . . . [Full Text of this Article]

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